This article is more than 5 years old. Information may no longer be current.
Which is better, 1 or 2?
Click Here to Manage Email Alerts
We've all seen it: just how intimidating this simple question can be for even the most intelligent patient - and for good reason. Sometimes the difference is indiscernible. Oftentimes patients fear a wrong answer will condemn them to years of wearing imperfect eyeglasses. Indeed, from the patient's perspective, the stakes are high.
Ironically enough, today's optometrist faces an equally daunting decision. Which is better, to refract or to delegate the refraction? Either way, the arguments are compelling.
In a traditional sense, most of us view refraction as the heart of an optometric exam. It is the refraction - and visual analysis - that initially provided optometry with its niche within health care.
Furthermore, for many patients, an optometric exam has become synonymous with a careful, accurate refraction. It is the essence of what we do. Without it, the optometric examination is eviscerated. Easy enough, the best choice is 1!
What about the other side of this debate? Optometry continues to expand its role as primary eye care provider, providing an ever increasing number of diagnostic and therapeutic procedures and resulting in a more complex examination. As our scope of practice has expanded many of us have found delegating - visual acuities, topography, tonometry, visual fields - a very effective way to practice optometry. Finally, as managed care mandates increased patient volumes, do we have any choice but to delegate the refraction? OK, so maybe 2 is the better choice!
Which is the better way to practice optometry? As is often the case, the best strategy lies somewhere in between. First, we must come to grips with the fact that a refraction is not an incredibly complex procedure. Like many other ophthalmic procedures, refractions can be taught and learned. And yet, we must not be so cavalier as to delegate refractions entirely. We know refractions are as much art as science, and many patients take great comfort in knowing that their optometrist is performing the refraction. To be indifferent to these individuals' needs is reason enough for them to seek another provider next time.
Therefore, the best approach is to delegate in moderation. First, check with your optometry board regarding what is acceptable practice in your state. Next, delegate the easier refractions and check the results. Finally, review patient symptoms in light of the refractive data, use a trial frame if necessary and personalize your prescribing habits. Remember that it is always your name - and reputation - on the prescription pad.
So, which is better, 1 or 2? The answer may not be that easy. Consider that the next time your patients struggle with their response!