If you think the Canadian sight-testers are non-professional, why are you shilling for the NAIT program in Texas and who knows where else. Get off your high-horse.:hammer:Originally Posted by wmcdonald
If you think the Canadian sight-testers are non-professional, why are you shilling for the NAIT program in Texas and who knows where else. Get off your high-horse.:hammer:
Depends on several factors such as the age of patient and the age of practitioner. Younger patients can yield better data with a retinoscope, and older practitioners are often better at using retinoscopy to determine an objective refraction than a younger doctor.
Anyone can learn to refract. Anyone can learn to take blood pressure. It's how the data you collect 'fits in' to the whole management plan that matters most.
I use my retinoscope every day. I find it more accurate than the autorefractor. I am also able to glean other valuable information from retinoscopy such as clarity of the media, latent hyperopia, corneal ectatic disorders, etc, etc. I think those who are proficient in retinoscopy would agree that it is a very useful tool.
JP
NAIT's program teaches the materials I described, and in fact is a well-developed program of study. I do not, in any way, feel that Canadian Opticians trained in sight-testing are not professional; far from it! I feel they are ahead of us here in the US. I do consulting in the US for NAIT, and think they have a program that may be valuable to states in the US without an academic program, if that is any of your concern.
Technicians are those who do things in rote fashion, and often do not have an understanding why. Professionals are well-versed in their field of study, and have a broad and deep understanding, the why, instead of just the "what" related to their work. I have often complimented Canada's Opticians on this forum, and in my many lectures in Alberta, so I do not in any way mean to say they are not professional.
Hi Ted,
I agree with Warren, that basic prinicples in retinoscopy are essential. Once opticians learn the basics of with/against motion/sissor motion/ect., getting an objective starting point is quick and efficient. We can spend a couple of weeks on the principles, show streak/spot (does anyone do spot anymore?) retinoscopic reflexes, and add appropriate lenses (in the phoropter) to neutralize motion. Many optical professionals can get to neutrality as fast as it takes to set up the auto-refractor and click. Either method can yield a decent objective finding.
As you know, the patient (brain) cannot tolerate lenses based on objective findings...we need subjective refinement. (thank goodness, or we could be replaced by vending machines).
The Brain needs to be asked:
Which is better, one or two.
Automation cannot replace the human discernment of the brains' comfort in vision.
This is why additional time to practice this skill is essential... This is an art and a science.
All the best to you,
Laurie Pierce (Hillsborough Community College)...
...funny chatting with you here...look forward to seeing you at a future NFOS meeting...
: )
Hi Laurie: Nice to hear from you, too.
I don’t teach sight-testing here at BCCO but I am familiar with the workings of the EYELOGIC system, which is used by most sight-testers here in British Columbia (and no, I don’t own any shares). After the objective starting point is found with an auto-refractor, the sight-tester does a subjective refraction with the EYELOGIC system, using the same procedure you use with a manual phoropter, ‘Which is better, #1 or #2' , duochrome, binocular balancing, etc. This EYELOGIC instrument was developed by a Calgary Ophthalmologist. I’ve even seen the Topcon V1000? ‘self-tester’ in use, and it proved to be a very accurate sight-testing instrument, too.
The very young, the bed-ridden, the profoundly mentally challenged and those that cannot communicate... sure, use of a retinoscope is essential. But sight-testers do not and never will deal with such patients. And sure, the older, very experienced Optometrist may still use Copeland’s 1887 technology but as you indicated, an auto-refractor can give you a good objective starting point for your refinement, too. And as you know, some phoropters even have the capacity to automatically load the auto-refractor reading(s) to begin refinement.
I still remember the NFOS meeting when adding ‘refraction’ to the 2-year AAS program was discussed. Some instructors were in a quandary... "What do I take out... to fit in refraction?"
So I must assume some ‘nice to know’ topics were sacrificed to make room for 100+ hours of ‘refraction’, leaving the ‘must know’ and ‘should know’ opticianry topics alone.
So I respectfully submit that, speaking from an sight-testing point of view, the day of retinoscopy has passed. As has mandating the number of hours to be taught in any topic.:cheers:
Hi Ted,
The great thing about life is we can agree to disagree, and still be friends.
Prior to teaching refractometry, I spent a great amount of time shadowing refractionists and doctors ...the retinoscope is not dead. I believe it is important to include retinoscopy in a course, as the basics of retinoscopy mirror the basics of hand neutralization, which engages the opticians understanding.
No, dear, we did not eliminate any of our curriculum to add refractometry. We increased our credit hours. Our AS is 72 credits, and I will tell you, that, in my opinion, it is all 'must know', none of it is 'nice to know'. I wouldn't waste my students, or my time teaching objectives that are not necessary for a well rounded optician.
Yes, technology has made great strides, I strongly believe, however, that we need the human discernment factor for quality results.
: )
Laurie
Retinoscopy is NOT dead...not by a long shot. I am a 2003 grad, and I use mine every day. Once a practitioner gets proficient with retinoscopy, he/she will reach for it often.
I use it on many, but not all patients. However, if I'm having a difficult time refracting a patient, I always grab my retinoscope to see what is going on.
More accurate??? How much more?
And so what, you're still going to refine the RX subjectively, aren't you, using your Phoropter?
Lets put it this way...I would prescribe my retinoscopy findings with good confidence if necessary...I would never prescribe off the autorefractor findings.
We will disagree on some things, and that's OK too. Personally I think including hand neutralization in your program does add 'nice to know' material to your course of instruction. We mention it here, but don't train students in its use.
With respect to refraction, we have a couple of excellent 1 hr videos, in fact the same ones used in our OAA Refractometry course, so that our students know how the RX is determined, and one of these videos includes use and theory of the retinoscopy. We feel this exposure is adequate for a non-refracting Optician.
So I agree, let us disagree but still remain friends.:cheers:
Just so you realize that sight-testers here in BC have BOTH autorerafractors and EYELOGIC as a package. So they too do not 'prescribe off the autorefractor findings'.
And I doubt you would ever perform a refraction on a new patient without looking into their eye.
Anyone can learn refraction. But separating a refraction from a comprehensive evaluation is inadequate and regressive care.
I think I said it best in an earlier post...OD's requiring a comprehensive eye exam every time an asymptomatic person presents for a simple Rx update (good for business, isn't it) is like a GP requiring a comprehensive physical (along with the rubber glove:() every time a patient presents with the sniffles.;)
Is a patient that presents for an "rx update" really asympomatic? Blurred vision sounds like a a very real symptom to me - a symptom with many pathological differentials.
Ya...ya...ya... Even government decided to no longer pay Optometry for most eye exams. They're not fooled by your 'blurry' rhetoric.:finger:
A headache could be a brain tumor... or it could be just a headache. If your headache continues after aspirin, then you go get a more extensive exam. Blurry vision, more often than not, is just going to be an Rx change... if the blurriness continues after the new glasses are received, then you get a more extensive exam.
What does government insurance coverage have to do with anything? :hammer: It seems to be a favorite argument of yours, but it proves nothing more than the fact that provinces are only obligated by the Canada Health Act to pay for "medically necessary" care, this does not include preventative care.
Most of those who lobby for independent refraction have little or any clinical knowledge or experience. Opticianry would be far more ahead if these people placed accredited and credible education first, and legal changes second -- much like optometry did over the last 50 years to expand into ocular therapeutics. If they really wanted to do good for the people they see, they would learn refraction, learn pathology and become optometrists or ophthalmologists. Pharmacists are not lobbying for independent blood pressure diagnostic care so that they can measure BP and start rxing anti-hypertensives, yet some opticians lobby for independent refraction with the interest of providing better care. Nonsense.
A century ago, having a refraction only and calling it an 'eye exam' was all that we had. In the 21st century separating this procedure from an ocular pathology assessment does not do the patient any good. And don't give me the argument that if you have sniffles, why do a complete physical? Nonsense. Looking through a dilated pupil is hardly more invasive then getting your prostate massaged during a physical -- or so they tell me.
The independent refraction lobby is far more interested in commercialism rather than solid patient care and improving standards of care. They want to generate a quick lens power result, get people on their way and damn the consequences and damn what really is right to ensure that person is not in harm's way. :finger:
I assume then "Excalibur" that your are not in it for the money. Why do you think we all do it. You make assumptions that opticians haven't taken any courses on anatomy and pathology. I have picked up on things here by talking to a patient about their symptoms, this after they spent a half hour in a chair with an optometrist who missed the boat because they were intent on selling glasses ahead of doing what was best for the patient. As well sometimes when an emergency arises (contact lens or otherwise) an appointment can't be had with an optometrist so they seek out opticians for their advice on how to proceed. In our store if the patient has not had an exam in a long time we do strongly suggest to get their eyes re-examined before purchasing new eyewear with the knowledge that the optometrist will probably sell them new glasses. We do provide an important service and many of us already have a lot of the underlying knowledge, we are only looking to exacting some control over our future while using this knowledge to it's full advantage. Of course this is assuming that all opticians would know to refer when something is out of their league just like all optometrists are eager to do the same.
That's what's happening. They are getting educated in refraction and yes from what I understand they do learn about pathology just not to the extent that optometrists do. You could say the same about therapuetics optometrists don't get the same education in it that ophthalmologists do but you can now prescribe them. I enjoy hearing an optometrists thoughts about opticianry but they are just that thoughts. As an optometrists you have no place in saying what is in our scope of practice and your are naive to think that your scope will continually expand while opticians and all other professions will remain stagnant.Most of those who lobby for independent refraction have little or any clinical knowledge or experience. Opticianry would be far more ahead if these people placed accredited and credible education first, and legal changes second -- much like optometry did over the last 50 years to expand into ocular therapeutics.
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The 'money' is not the carrot at the end of my motivational stick. Principle, professionalism and interest in eye care is what motivated me. During university I was fortunate to have been accepted into med and dental school, but choose optometry because my optometrist had a role in providing me with great care. True story.
Independent refraction is not in the best interests of PATIENTS, but may (in some cases) be in the best interest of CUSTOMERS. There is a fundamental difference between the two. For those of you who don't know the difference between a customer and a patient, think this one through.
Opticians need to have accredited, credible and standardized university-based education programs. If that isn't possible and you wish to refract, there are approximately 20 optometry programs that will allow you to provide excellent first-line primary eye care rather than be a sales person. This will allow you to refract, diagnose and treat patients rather than help customers choose lenses and frames. You will be able to provide high quality primary care safely and be thorough.
Suffice it to say, opticians do provide a valuable service to their customers, when it comes to assisting in designing a pair of spectacles. But let's not be disingenuous and say that you are performing an independent refraction to improve your client's quality of life, whilst furthering the advancement of eyecare provision in your community.
I have to say, I agree with many of your points. I can only hope, however, that you & other ODs share such passion when the subject of cessation of OTCs comes up...
Like I've said before, I see this issue from both sides
FWIW
Barry
Couldn't have said it better myself!!
Get off your altruistic pot(s), Optometrists. What percentage of your gross receipts are generated by the optical dispensary in your office,
40-60%? So unless you are employed by another, more-business savy Optometrist, this sight-testing dogfight is about the money. In most cases your patient becomes your CUSTOMER, you merchant!!!
I love the way you chgange from patient to customer here. I find it interesting that many OD's hire untrained staff and hand them a PD ruler and send them out on the dispensing floor with little knowledge. That my friend is not improving the quality of the clients life. I don;'t know if that happens in CA but it happens in the states. The reason it happens is purely motivated by money. I agree that to refract the education must be there, but again it is highbrow and plain ignorant to assume that only the optometry schools can teach refraction and since a full eye health examination can be performed without even spinning one lens in the phoropter it is a stretch to keep trying to group the two together like it can't or hasn't been done another way.Opticians need to have accredited, credible and standardized university-based education programs. If that isn't possible and you wish to refract, there are approximately 20 optometry programs that will allow you to provide excellent first-line primary eye care rather than be a sales person. This will allow you to refract, diagnose and treat patients rather than help customers choose lenses and frames. You will be able to provide high quality primary care safely and be thorough.
Suffice it to say, opticians do provide a valuable service to their customers, when it comes to assisting in designing a pair of spectacles. But let's not be disingenuous and say that you are performing an independent refraction to improve your client's quality of life, whilst furthering the advancement of eyecare provision in your community.
I am glad OD's got their TPA and I am sure OMD's are a bit upset about it, and the arguement can be made that you should have went to med school (BTW it is very snobish of you to bring up that you could have went to med school but choose not to) and since you didn't you shouldn't be able to prescibe therapeutics.
The same arguements that have gained optometry expansion in scope of practice are now the same tools opticians are using to gain expansion in opticians scope.
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