It’s always reassuring, if a little surprising, to find out that someone other than a certain Mrs Trellis reads this column. It’s even better when some of you get in touch over a clinical matter.
It would seem, therefore, that I am not alone in observing a general decline in retinoscopy among some of our younger colleagues. Are we just autorefractor-denying Luddites?
No; retinoscopy is an essential and flexible way of objective refraction that offers an accurate view of variability of accommodation, media clarity and refractive error, the latter helping us to modify the typically less than accurate subjective responses of the patient to lens presentations.
So, some further patterns of concern. Too many people are treating OCT disc analysis as an alternative to fields rather than complementary. I know I have just slagged off subjective testing, but fields assessment is function testing and not structural measurement. Both are useful, though fields only when done accurately and with some considerable operator patience.
Another; it would seem that hours of wear, and so oxygen availability, is slipping down the list of reasons for choosing a specific contact lens material. ‘Dryness’ and ‘comfort’ are being prioritised. Those practising in the BS era (Before Silicon) can remember the regular neovascular roadmaps on too many corneas, while those qualifying AD (Anno Dk/t) may not have had the luxury of this warning against the evils of hypoxia.
And finally; is an alignment fit of a rigid corneal lens the ideal endpoint? I tended to go for these lenses, if not for saving those neovascular disasters above, when cylinders needed masking in a stable way that allowed rotation. Hence, full alignment was rare. Was I alone in this one?
Joke of the year, overheard at Glastonbury. I saw a man smashing up a wardrobe. When I asked what he was doing, he replied: ‘Narnia business.’ Soz.