Review of Optometry March 2000 Chairside

CHAIRSIDE

Which is Better: Number 1 or Hunan Beef?

Montgomery Vickers, O.D.

Have something to say to Dr. Monty Vickers? E-mail him at reviewofoptometry@jobson.com

What’s more fundamental to optometry than the refraction? What’s more fundamental to an optometric

columnist than an opening sentence like, “What’s more fundamental to optometry than the refraction?” Glad that’s over. Refraction is a way to know our patients. Think of what you can learn during refraction:

If a patient can’t choose between number one and number two, how in the world does he handle the buffet at China Chef?
Is there 20/100 vision and 20/15 intelligence, or is it vice versa?
What does THIS dial do? Cool.

In optometry school, we receive extensive training in the art and science of refraction. We get grilled in the clinics about refraction’s nuances. We refract one another, our families, our professors, our patients and stray animals. Then we get into the real world and discover that it only takes 10 more years to get the hang of it. I’d be retired if I got a nickel for every refraction I screwed up the first years in private practice. I discovered such things as ...

Most patients have no clue whether number one or number two is better.
It may make some sense to actually write down the result when you are done.
A “+” is a little different than a “-” when you are driving down the interstate.
There should be some relationship between the old Rx and the new Rx, other than that both are written in black ink.
If you have to ask “number one or number two?” 35 consecutive times before the patient actually speaks, you are either going too fast, and/or there is no difference between “number one and number two,” and/or the patient was/already is now brain dead and/or bored to tears, and/or maybe you should get around to cleaning the phoropter once a millennium.

What about YOU, doctor? Are YOU, doctor, in the room during the refraction? Some big-time O.D.s tell us that we shouldn’t be there. It’s inefficient. (Imagine, an optometrist inefficient!)

That’s why these big companies build these fancy-schmancy, computer-driven automated refractometry systems. Here’s the typical sales pitch:

“Doctor, your time is critically important. You need to be free to provide the kind of care that ONLY the doctor can provide. YOU need to take care of your patients at all times. It is YOU, the doctor, who must be a more active partner with your patients, who depend on YOU, the doctor, for their eyesight. So, you need to let your secretary do the examination. The best way you can BE THERE for your partners is for you to NOT BE THERE! Now, give us $35,000 and you can leave, which is, after all, the best thing you can do to BE THERE!”

It would be kind of nice to refract from Hilton Head, I guess. But there’s something so special that occurs when you are right there in the room, actively working side by side with this person, this wonder of nature, in the dance of optimizing the visual system so this guy can sell those used cars better, or whatever. (You probably should ask what he does, I guess.) Refraction is magical, mystical, heck, even a little boring, but ... doggone it, I LOVE IT SO! Besides, it’s my only talent, and when a patient is driving me crazy, with a simple twist of a dial, I can crank in enough prism to make the strongest grandma puke. Power, baby!

I am certain that, after 20 years, yesterday was the first time I actually figured out how to refract. I had one of those moments of inspiration, a feeling of calm and control, a moving, dynamic revelation. I finally got the hang of it. I understood. My eyes welled up when I moved into the third level of Refraction Nirvana as I quietly asked the patient, “Do you prefer Mandarin or Szechwan?” u

Let Dr. Vickers know how you achieve Refraction Nirvana by writing to him at Review of Optometry, 11 Campus Blvd., Suite 100, Newtown Square, PA 19073; or send him an e-mail to reviewofoptometry@jobson.com.

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