I was saddened to hear of dispensing optician Ian Jordan’s erasure from the register in early March. I don’t really know Jordan but I’ve heard him speak and read some of his work including A parent’s guide to vision in autistic spectrum disorder (ASD) (ISBN 978-1-326-15706-7 published by Lulu.com).
Notwithstanding the fitness to practice committee’s assertion that opticians can’t make diagnoses with regard to ASD my first purely personal observation of Jordan is that he displays traits of the spectrum himself as it is characterised by problems in social interaction and communication, and may explain his considerable empathy for his patients.
My second observation is that he is passionate about his work and has helped thousands of patients with dyslexia, autism and other disorders by the use of prescription filters and other contentious dispensing solutions over the years. This was evidenced by a patient starting a petition to have him reinstated to the register that had 1,300 signatures within 24 hours. Search Ian Jordan on change.org read the patient testimonials and make up your own mind.
There are several lessons from this case to apply to everyday practice. As with most cases, if your record keeping is not comprehensive or legible you are in trouble. As practitioners we must give informed choice, explaining the risks, benefits and if success is not guaranteed. We must ensure correct instructions for use are given to patients or carers.
Related to informed choice is the notion of explicit consent when dispensing tints for autism, dyslexia, etc, where there is only a small amount of evidence for their use even though tens of thousands of patients have been helped by them over the years. Other findings are deeply worrying.
It appears dispensing opticians should check with an optometrist before prescribing tints. One can imagine a situation where Jordan might work with a locum optometrist with no experience of prescribing tints yet he would be expected to check with them? Clearly a nonsensical situation. This appears to say that a tint must be prescribed by an optometrist and a dispensing optician cannot make that decision in which case the profession presumably wants a few million other cases to be taken into consideration by the regulator. It also flies in the face of the fact that non-opticians prescribe the plano version of these tints every day.
The notion of prescribing tints for retinitis pigmentosa (RP) was challenged as inappropriate which will surely come as a surprise to low vision practitioners and Norville whose tints PLS450, PLS480, PLS500, PLS540, PLS550 and PLS600 have been used by RP patients for decades, and incidentally are prescribed in a similarly subjective way (ie try it and see if it helps) to the tints Jordan dispensed using colorimetry.
Much of the findings against Jordan and previously an optometrist colleague seem to be at odds with one of the standard texts on this ‘contentious’ and ‘experimental’ practice. Visual diagnosis and care of patients with special needs (ISBN 978-1-4511-1668-7, 2012) clearly cites research that tints, low plus powers, yoked prisms, vision therapy (and many other treatments likely frowned upon by the mainstream UK optometric community) can help autistic patients. It also makes clear that no one treatment, including the many drug treatments, works for every person with ASD, which makes Jordan’s claim of success with 5,500 out of 7,000 patients remarkable if true.
Psychologist Gary Klein, in his book Seeing what others don’t, the remarkable ways we gain insights (ISBN 978-1-857-88678-8, 2017) analyses many situations where science is advanced by not conforming with the status quo, by changing practice as a result of insight and the combination of experience and necessity. Yet many times practitioners are ignored or pilloried for challenging the mainstream.
Consider Australian doctor Barry Marshall who in 1982 discovered that gastrointestinal ulcers were caused by bacterial infection, and not as had been previously thought, stress. It wasn’t until 1994 that the medical profession started taking note, and stopped using extreme surgical methods (removing the lower third of the stomach and reattaching it to the small intestine) using instead a simple course of antibiotics effective against Helicobacter pylori.
The GOC may wish dispensing opticians to know their place with regard to other eye care professionals, firmly considering in its findings that they are the bottom of the heap, but did it ever stop to think what the established order stands to lose if colorimetry becomes mainstream? And since when did optometrists, orthoptists or ophthalmologists know more than dispensing opticians about ophthalmic dispensing anyway? There is certainly no evidence of that.
Jordan may not have shown insight into his failings, but the GOC seems incapable of gaining insight from his practice. Rather than erasing him from the register and forcing him to become an unregistered vision consultant better surely to supervise his practice and put measures in place to conduct research into his 7,000 patients. Then, and only then, might it get the evidence it needs.
