Bill Harvey: Blind faith
Author: Bill Harvey
Were Aesop still alive, I am sure he would be thinking of writing a sequel to his fable of the lupine howler with another about ‘the eye care practitioner who cried dry eye’.
Over the last three months I have sat in on the routine eye examination of many an optometrist trainee as part of the College’s Scheme for Registration. I notice again two themes developing that seem to present each year but, if anything, are yet more common this year.
The first is with regard to dry eye disease. When taking a history and symptoms, trainees will always ask about headache, flashes and floaters and double vision. However, it is rare to hear someone ask about dryness or grittiness directly, despite this being way more common than, for example, diplopia. Also, without repeating (yet again) the full definition of DED established by TFOS in its DEWS II report, it is always worth remembering that, buried between the sexy ‘homeostasis’, ‘inflammation’ and ‘osmolarity,’ is the good old ‘accompanied by ocular symptoms’. Why do I mention this? Because I have seen so many patients being recommended ocular lubricants, despite them having no reported symptoms. As common as this is, it is just as rare to hear advice about environment management. This blanket drop-giving approach is unlikely to enhance our reputation as skilled DED clinicians.
The second theme seems to be the demise of visual fields. Trainees usually recommend tonometry automatically as a supplementary test for everyone, but rarely fields. When questioned, the answer most frequently heard is along the lines of ‘I recommend fields if there is a family history of glaucoma’ or ‘for headaches’. If we ignore for a moment the fact that someone has to be first in any family, since when has age stopped being a significant risk factor?