None Shall Lack for Proper Care?
Sight Gags by Scott Lee, O.D.
“With full deliberation, I freely and solemnly pledge that: I will practice the art and science of optometry faithfully and conscientiously and to the fullest scope of my competence … I will place the treatment of those who seek my care above personal gain and strive to see that none shall lack for proper care.”
It’s been a long time since I’ve recited those words from the “The Optometric Oath,” as put forth by the American Optometric Association. All of us have pledged this oath or one similar to this at some time in our careers, usually as fledgling students or upon matriculation. How many of us remain true to our promise as we practice today?
Recently, I sat beside a young doctor for several hours of continuing education. Much of it concerned peripheral retinal disease. During a break, she told me that she practices with a company that offers free eye exams. Under the circumstances, I couldn’t help but ask, “Do you dilate?” Exasperated, she replied, “There’s no time for that!” I wondered if she saw the irony in sitting through a class looking at photos of conditions, such as lattice generation, that she would rarely detect in practice.
If you really want to clear a table at a continuing education luncheon, just start asking about dilation.
I remember years ago talking with a recent graduate about his work situation. He said that before he was hired, he asked his employer if he could dilate. He was told that he could do anything he wanted as long as he saw six patients an hour. That type of schedule, with no assistant, precluded dilation with any regularity.
When asked if they dilate, a number of my older colleagues simply say, “That’s not why I got into optometry,” or “My patients hate it.” Sound familiar?
Our patients really do hate it, don’t they? Years ago, I had an older gentleman who presented with symptoms of retinal detachment. He had small pupils, was petrified to drive dilated, but refused to be referred. After a lot of cajoling, he finally consented. Sure enough, a third of the temporal retina in his left eye was detached. He broke down in tears when I gave him the news. He thanked me for being persistent. We called his daughter to come and drive him immediately to a retinal surgeon. Later that afternoon, he was buckled. He hated dilation, but I think he would have hated to lose the vision in his left eye more.
I called several optometric offices today asking to schedule an eye exam. I also asked whether I would be dilated. The most common answers I received were “no” and only if I were diabetic, had glaucoma, or only if the doctor sees a problem.
“Only if the doctor sees a problem.” You’ve got to love that answer. Ignorance is bliss.
Before optometrists were allowed to use DPAs in my state, I had a 30-year-old white female in my chair. She was asymptomatic. Best-corrected visual acuity in her right eye was 20/25. Tangent screen was normal. I couldn’t see anything amiss with direct ophthalmoscopy or biomicroscopy. It would have been easy to dismiss the slightly reduced acuity. Fortunately, I referred her out. Turns out, she had a mid-peripheral choriodal melanoma that just happened to distort the macula a bit. Two years later, when I could finally use DPAs and dilate, I realized what I couldn’t see: My pupils dilated, too! After that, I offered dilation at every comprehensive eye exam.
Or take Bob. Bob had retired 10 years earlier and moved away. He just happened to be in the area visiting family and decided he would have his eyes examined. When I asked when he’d last had his eyes dilated, he said that it was the last time I saw him. He had been examined many times since, but the doctor he saw, “Just doesn’t do that.” It took a couple minutes, but I finally convinced Bob that it was a good idea to dilate after so many years. He had a mid-peripheral choroidal melanoma.
If you think that you can see just as much with a direct or monocular indirect ophthalmoscope without dilation as you can with a binocular indirect ophthalmoscope and dilation, you’re deluding yourself. You will miss disease. You just won’t know it.
So, I ask you, doctor: Have you practiced the art and science of optometry faithfully and conscientiously and to the fullest scope of your competence today? Have you placed the treatment of those who seek your care above personal gain and strove to see that none shall lack for proper care? In other words, have you kept the oath that you professed so many years ago? Or have you subjugated your patients’ best interests to those of your own and/or to those of an employer?
—David N. Moore, OD (retired)
Burton, Mich.
Editor’s note: More than one-third of optometrists haven’t had a complete eye examination, including dilation, in three years or more, according to Review’s recent
Diagnostic Technology Survey.
Medical Model Muddle Rebuttal
As a recent 2012 graduate from Pacific University College of Optometry, I was very discouraged by Dr. Moffett’s letter to the editor. (
“Medical Model Muddle,” September 2012.) By assuming that new graduates are “suspect regarding refraction” and have “no knowledge in fitting firm contact lenses,” I think Dr. Moffett sounds as if he is the type of aging optometrist who has failed to truly continue his education since graduating in 1977.
I myself am completely comfortable fitting rigid contact lenses (bifocal, toric or spherical) as well as hybrid contact lenses. Most of my classmates feel the same.
Dr. Moffett’s letter also scoffs at pharmacology. Is he unaware of how vitally important it is for an O.D. to know what medications the patient is on, what ocular side effects the patient may encounter, and what contraindications may be present? While Dr. Moffett takes issue with what new graduates are learning (or seemingly not learning) about in school, it appears to me that he doesn’t care about advances in the optometry field, and he certainly appears to care less about his own patients if he is not concerned about pharmacology. Maybe he skips the medical articles in Review of Optometry because in his mind that would be something a junior M.D. would read, not someone who is concerned with proper patient care.
Let me point out a key phrase in the first paragraph of Dr. Moffett’s letter: “We were very well qualified optometrists.” Yes, refraction skills and contact lens fitting made you a qualified optometrist in 1977. If that is still only all you can do today, are you qualified? No.
In addition, with the shortage of ophthalmologists already hitting communities, who is going to manage that patient with glaucoma? Or remove the metallic foreign body from the welder’s eye? Or help the amblyopic 6-year-old reach his full visual potential? Or let a patient know if he is a candidate for LASIK surgery? Or know when a dry macular degeneration patient has converted to wet and needs ophthalmologic care?
New graduates are stepping up to the plate. We are trained in all the basics, all the advances and everything in between. Maybe it’s high time those who don’t want to change with the times and serve their patients fully (both visually and medically) get off their high horses and retire. Vision and health go hand in hand in the eye, and you truly aren’t caring for your patients unless you do both.
Now is one of the most exciting times to be entering into the optometry profession. We have the opportunity to be fantastic family clinicians dealing with a wide array of patients, or we can focus and hone our expertise on one main clinical skill such as pediatrics or neuro-optometry. And the technology is also extremely exciting! From frequency doubling technology to optical coherence tomography to topography to automatic phoropters—we are in an era where we can provide better care for our patients than ever before.
Dr. Moffett sarcastically asks, “But then, who really cares about patients anyway?” New graduates, that’s who.
—Brittany G. Schauer, OD
Mandan, N.D.
To send a Letter to the Editor, e-mail Jack Persico, editor-in-chief, jpersico@jobson.com, with “Letter to the Editor” as the subject line.
