In Contact - March 2004
Full Circle
Optometrists, young and old support the advancement of the art and science of optometry.
Wholeheartedly.
What it seems they are less enthusiastic about is the fragmentation and multi-tiered registration the powers-that-be seem so keen on. Or so it appears from recent feedback and discussions with a number of optometrists. Unfortunately many did not make the rather short deadline for their HPCA discussion document submissions?
Pity.
Let?s hope enough did submit so that a balance is achieved.
We deal with people with multi-factorial problems.
Although the ?medical aspects? of our profession are ever greater, most clinical optometrists realise that the most common and important reason that people consult us relates to specific visual problems that need addressing on a multitude of levels. Issues such as vision, headaches, occupational and environmental issues are usually at the forefront. Health, medical, emotional, drug side effects and practical considerations also form part of our service. Of course cosmetic and economic issues are also paramount in the minds of our patients and clients.
Many have questions regarding floaters, cataracts, refractive surgery, AMD, diet, vitamins, fluorescent lights, computers, VDUs, myopia progression/control, ortho-K, behavioural aspects, vision therapy, genetic issues, low vision and sports vision - among an ever widening range of vision related topics. Sometimes we also have to explain what specialists did not adequately address. Keeping track of and up-to-date with all the contact lens and spectacle products - along with eye drops and developments in treatment, neuro-optometry, glaucoma, ocular surface disease, refractive corrections and care systems - also need much time.
Thus optometrists have, over the years, had to practice an ever widening role with much skill and far greater responsibilities.
We also need to be practice managers, retailers, marketers, IT managers and business people. Manage tax, ACC, OSH, staff relations, leases and so on.
Compliance costs in dollars and time are also becoming ridiculous.
Of course many recent [and past] graduates did not qualify with the requisite skill in areas of contact lenses, low vision, vision therapy, child vision care, behavioural optometry, nor other specialised areas of Police and Military screening, aviation medicine and so on.
Many optometrists thus prefer to work in practices that give them access to skilled mentors and over the years with time, effort and coal face experience, develop into multi-skilled practitioners.
Practitioners refer complex cases they are not equipped to deal with.
All the certification and CE in the world will not guarantee success, nor skill.
This is where the current trend for ?certification? falls flat.
We may well end up with licensed nincompoops while skilled, expert practitioners fall by the wayside.
I ask you then, who are the losers?
At the end of the day, patients vote with their feet.
I guess those of us booked-up well ahead, must be doing something right?
Papers
Enough of that.
The following papers are worth reading;
Change to Corneal Morphology after Refractive Surgery (Myopic Laser In Situ Keratomileusis) as Viewed with a Confocal Microscope by INMA PEREZ-GOMEZ, MSc, PhD and NATHAN EFRON, PhD, DSc
They showed that there was a decrease in anterior keratocyte density and microfolds in the anterior limiting membrane, with reflective particles observed at the flap interface. Corneal sensitivity was also reduced during the first six months after LASIK and that this improved as nerve regeneration occurred. Confocal microscopy is capable of providing interesting new insights into the effects of refractive surgery on corneal morphology. [Optom Vis Sci 2003;80:690?697]
Another interesting paper was;
Simulated Optical Performance of Custom Wavefront Soft Contact Lenses for Keratoconus by DE BRABANDER, JOHN PhD, FAAO. CHATEAU, NICOLAS PhD. MARIN, GILDAS PhD. LOPEZ-GIL, NORBERTO PhD. VAN DER WORP, EEF BSc, FAAO. BENITO, and ANTONIO BSc.
Their findings showed that dramatic visual improvements are potentially possible with ?three-dimensional aberration-customized soft contact lenses? as long as some very tricky practical issues are controlled, as follows;
Such lenses would need to be well positioned on the cornea. Translation errors would need to be limited to 0.5 mm. Angular errors seemed to be less critical. They questioned whether the visual system would be able to adapt to variations in optical performance of the correction in situ due to lens positioning and pupil size. [Optom Vis Sci 2003;80:637?643].
Personal communication with a US based aberration expert have also revealed that similar ?movement? limitations would also apply to potential, higher-order aberration-controlled spherical lenses and that toric forms would probably also have limits in rotational tolerance, but to a lesser degree.
So like many ?future? lens concepts these probably remain someway away from clinical practice.
How far away, is anyone?s guess?
The above papers are available online to American Academy of Optometry members and Optometry and Vision Science subscribers at www.optvissci.com.
Over a few months late last year and early in 2004, a number of Aussie and Kiwi based practitioners had difficult accessing the AAO website. Difficulty simply meant the site was ?not found?
Frustrating!
Emails to the AAO helpdesk got through and us ?downunder dufi?s? were simply told we had ?broken? browsers. Many well intentioned, albeit incorrect and misguided ?instructions? followed.
I could deduce, from my basic IT skills, that the problem was not on our end and trace routes and pings soon confirmed that we were getting blocked somewhere on a server in the US - after successfully hopping through a dozen or so, en route. I got our IT experts onto it and together with our local ISP and the host of the AAO site we finally determined that a major server in the US had experienced ?problems? with spammers and virus distributors within a range of IP numbers allocated to ISP?s, sites and users in NZ and AUS. Instead of blocking or tracking the culprits they simply blocked thousands of sites and IP numbers, inconveniencing untold users in a broad range of IP numbers.
As mentioned earlier, IT is becoming an ever widening issue and keeping things safe, secure and working properly is becoming a big task.
We couldn?t live without it though.
Quotes
People often ask me why I write this column, how long it takes and whether I ?enjoy? it. I recently came across this quote by Frank Zappa;
"I write because I am personally amused by what I do, and if other people are amused by it, then it's fine. If they're not, then that's also fine." -- Frank Zappa.
?Amused? may only apply to a small part of what I write but you get my drift? As to time, let me just say many, many hours. The writing and compiling may only be a few hours worth but research, reading and so on, takes up a lot more time. No doubt that will be ignored when it comes to having to prove my ?competence? ?regency? and CE efforts?
Zappa also made some interesting observations comparing LSD and MBAs. Additionally if you?re into classical music, composers, conductors, Bart Simpson, Matt Groening, life, the universe and more then check out the following interview;
?Here, then, is the condensed (!) version of the most amazing series of interviews I've ever been granted, by the most brilliant human I have ever faced, in the most open household I have ever entered.? So said the interviewer, Don Menn. Check it out.
Last Word
Rugby has kicked off and Formula 1 starts soon ? something to keep us occupied during the long winter months. Not that we had much of summer. In fact in my ten years in NZ I can?t recall a worse February.
Nice one Irene van Dyk. Maybe she should become Prime Minister? At least we have Don Brash giving Helen a go. Maybe that will stop the rot. Recently I have been amazed at how many patients are wanting referrals and a copy of their Rx. Seems many Kiwi?s, as well as a raft of Asian, South African and other migrants have had enough and are heading to ?greener pastures? in Oz, the UK, Europe and Asia.
The ink has barely dried on some of their passports.
For more information or any comments email Alan at incontact@optom.co.nz.