There are many dangers to working in a consulting room.
One of these has been partly addressed by the move towards interactive CET and, now, CPD. Peer discussion, attendance of interactive events and clinical audits have all helped put pay to the temptation of that post-exams hibernation all of us have been tempted by at some stage (be honest).
Another danger is all too prevalent, as can be seen when undertaking in-practice assessments and also by some new results published in this week’s issue (see page 26). It is all too easy to forget that the visual environment of a consulting room is never able to replicate everyday conditions exactly. Common errors resulting from this include prescribing near additions that are not those required for the actual working distances adopted out in the real world. Decompensated phorias might not be as easily detected if the conditions causing decompensation (such as poor lighting or time of day) are not easily replicated in practice. Trainees often dim the room lights to help a patient respond to duochrome or to see more letters on a poorly contrasting projector chart. A patient just able to achieve a binocular 6/12 with a well-lit and highly contrasting target might be told they are legal to drive when, in real life circumstances, they might all too easily fail the driving vision test.
The results of our recent interactive CET exercise suggest that all too many people view simultaneous vision multifocal contact lenses as problematic, as likely to cause significant reductions in acuity, and will not be tolerated as well as, say, good old-fashioned monovision. I disagree. Indeed, had someone prescribed me clear vision in just one eye I would have been offended. These lenses are an excellent opportunity for us all to reconsider what a successful visual outcome is in the real world, how we manage expectation, and to remind ourselves that high contrast monocular acuity is just one facet of how people view the real world satisfactorily.