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Refractions are often the most valuable service you can provide
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 Michael D. DePaolis |
In a recent Primary Care Optometry News editorial, I commented “… despite optometry’s tremendous advances, we are very much – in the minds of our patients – synonymous with seeing clearly. In short, we are still refractionists.”
My editorial served as a humble reminder of our roots. It also served to underscore the importance of providing this routine – and oft times mundane – service for the masses with otherwise healthy eyes.
I understand that refractions are not exciting. As someone who sees patients daily, I appreciate the many distractions we face and the rigors of staying abreast of a dynamic and technology-leveraged profession. Nonetheless, while refractions are not necessarily the most gratifying thing we do, they are an essential service in providing primary optometric care.
Given this reality, one has to ask the inevitable: Is a refraction ever the “high point” of one’s day? Well, consider the following scenarios.
You have just diagnosed wet age-related macular degeneration in the second eye of an 80-year-old who is already essentially monocular. After a retinal consult and series of anti-VEGF injections, she is back for follow-up. While not the most invigorating part of the day, is there any service more important to this individual than a careful refraction?
As another example, consider the 35-year-old who underwent successful LASIK surgery 5 years prior, suffers from dry eye and spends most of her time in front of a computer every day. She has seen two other doctors, is extremely compliant with her dry eye therapy and still complains of eye discomfort and fatigue. Again, while not terribly exciting, a careful refraction and binocular vision assessment is critical in this case.
In both scenarios the “heavy lifting” has been done. Diagnosing and managing wet AMD and postrefractive surgery dry eye is challenging and rigorous. While we are up to the task of managing these conditions, the key is realizing that our efforts do not end with therapeutics. Our efforts often end with our patient behind the phoropter or in a trial frame.
In this month’s issue of PCON, Dr. Scott Edmonds provides an exceptional overview of the role low vision care plays in primary care optometric practice. Dr. Edmonds offers sage advice for refracting low vision patients and for implementing services that, historically, have only been offered within the confines of a vision rehabilitation clinic.
Additionally, Dr. Jeff Krall and colleagues discuss the not uncommon and oftentimes overlooked condition of proprioception disparity, an extremely frustrating condition for patient and optometrist alike. These sources offer clinical pearls for diagnosing and managing this elusive entity.
I encourage you to invest a little time in these articles and, if you have not already done so, incorporate the recommendations into your daily routine. I think you will agree with the results – a renewed appreciation for refractions and better vision for your patient. While a refraction will likely still not be the high point of your day, it may well be your patient’s.