Welcome to question of the day #233

Eyetools question of the day #233

I’m just starting out as an optometrist in my first job since leaving college. Do you have any tips as to how I can be the best I can be for my patients?

People visit optometry practices to have their eyes checked and also to get glasses if they need them.

There are lots of subspecialties now in optometry but the most important aspect of our work remains the provision of the optimum glasses. To me, the most important part of the traditional eye examination is refraction.

Refraction is an art and a science. Retinoscopy is a combination of physics, biology, and the experience of the practitioner. It is often called an objective test because no response is required from the patient. However, there is a large subjective element in that the practitioner needs to make judgments as to when the movement of the retinoscopy reflex has been neutralised. The more practice the better these judgments become. Tip number 1 is, get good at retinoscopy.

Avoid needless detail or jargon when describing what you are doing or giving the results of your tests. Patients will agree that they understand but really they haven’t. Don’t use words such as cross cyl, spherical, cylindrical, refraction and presbyopia. I remember a patient who fainted in my practice when I told him he had some astigmatism. He thought it was a disease. Do explain things but use very simple short words and ask the patient to confirm that they have understood. Remember that you have studied eye care and have a qualification; most patients have not. My tip number 2 is, keep your language simple.

Go slowly when needed and try to make the choices the patient faces as easy as possible. Many people dread having an eye examination because of all the choices. They fear making the wrong choice and getting the wrong glasses. You examine many eyes on most days. People have their eyes examined every two years and forget the detail of what is involved from one eye examination to the next. My tip number 3 is, maintain your patience.

Some patients, through no fault of their own, are hard to refract. Each time you make progress tell them they have done a good job, especially when examining children. My tip number 4 is, provide encouragement

Do not offer more choices than are necessary to establish your endpoint. Boredom and particularly fatigue can result in poor subjective responses. If you go on for too long, some patients may start to think about other things, like shopping or what’s on TV or why is this taking so long? Don’t do tests that won’t help you determine the optimum prescription and decide on whether the eyes are healthy. My tip number 5 is, be efficient with everything you say and do.

I know that optometry has made enormous strides in expanding its scope of practice such as contact lenses, binocular vision, myopia management, and dry eye treatment refraction remains at the core. Remember that it is, in the main, a subjective experience, which usually will not be as precise as we would like. Applying my tips will help remove some of the variables that lead to suboptimal results.

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