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It all comes back to the refraction

Issue: March 2004

ByMichael D. DePaolis, OD, FAAO

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What’s the most commonly performed procedure by optometrists on a daily basis? If asked that question 20 years ago my answer would have been “the refraction.” If asked the same question today, my answer is — “the refraction.” Still. And for good reason.

Yes, it’s true that our expanded scope of practice has resulted in a much more diagnostically diverse group of patients than we’ve seen in the past. It’s also true that we now have our technical staff perform many of the procedures that were traditionally performed by the doctor in years past. However, despite these trends, the refraction remains a very critical part of what we do — and who we are. For example, consider the following scenarios.

All patients need refractions

A 28-year-old female is referred to your practice for contact lens consultation, having been previously unsuccessful with lenses due to astigmatism. Among the first things we do? A refraction. A 35-year-old is very interested in laser vision correction. Certainly, a refraction is necessary to determine eligibility. A 65-year-old glaucoma patient is performing a visual field. A current refraction is necessary for proper diagnostic lens selection. Finally, a 78-year-old has atrophic AMD. No one can argue the value of a refraction in this patient’s ongoing care.

Need to see well a commonality

While these patients are actually quite representative of the diversity seen in today’s optometric practice, they all share a commonality: the desire to see as well as possible. We all know that providing patients with optimal vision involves more than a simple refraction, but it is the refraction that is the cornerstone of virtually every patient’s care. An important consideration. Particularly given how complex practice has become and, as a result, how insignificant the refractive status can seem.

Unfortunately, this dilemma will not go away anytime soon. As our profession evolves, expands and provides an even more diverse array of services, it will become an even bigger challenge to achieve a proper balance. A balance in which we strive for the best possible vision. When you think about it, isn’t this precisely why our patients come to see us?