My recent trawl around instrument suppliers at Optrafair emphasised the dynamic nature of clinical assessments.
Techniques for screening for diseases, monitoring eyes under suspicion and assessing the impact of treatments continue to evolve.
It seems that some areas have developed over the last few decades, way beyond anything that might have been predicted 20 years ago. Imaging is a good example here. It is not too long ago that retinal photography was a specialist test.
Dilation was the norm and the image taken on a mounted analogue camera needed to be developed like any photographic film once the reel was finished. We now have high resolution digital imaging, trans-tissue visualisation and analysis with OCT technology, and ultra-wide field scanning laser ophthalmoscopy capable of near full retinal assessment and monitoring.
Other areas, however, are notable for their lack of development. It seems to me that this is to some extent linked with those dreaded words ‘the gold standard’. Goldmann tonometry, a subjective interpretation of two blurred and moving boundaries, shows inter-user variability.
The fact that it may deviate from non-contact techniques for pressures in the 20s and higher, along with the fact that treatment protocols and assessment at secondary referral centres use the technique makes it essential for optometrists to also use if referral is being considered.
Standard automated visual fields assessment is still dependent on patient responses and reliability and repeatability is a major concern. Alternatives should be constantly sought if addressing existing limitations.
So it is disappointing that, when new technologies arise (ultra-wide SLO screening of diabetic retinas, corneal compensation of adapted non-contact tonometry, OCT/perimetric mapping and alternative SAP program options, pre-diabetic testing before bloods are needed to confirm diabetes), voices are raised to point out their difference from the ‘gold standard’.
Nothing should remain a standard without being questioned on a regular basis. Evolution is good.