Bill Harvey: These are near, those are far away
Author: Bill Harvey
It’s a busy time for College Assessors at present, with many trainees undertaking their stage 2 assessments. This year, pre-reg trainees have been required to show evidence of having completed a minimum number of contact lens fits and aftercares during their stage 1 experience (20 and 40 respectively) and it seems, in my experience, to have contributed to a noticeable improvement in contact lens ability in this group.
One significant change over the last three years has been in the successful fitting of presbyopes with multifocal lenses. Though there may still be a place for monovision for those already having gone down that route, or for those resistant to all other binocular options, it is a relief to see our upcoming optometrists embracing modern, better options. Monovision is becoming a rarity in case records.
As a wearer of multifocal lenses, I would go mad if someone tried to put me into monovision. I can drive the M4 at night and read the smallest of fonts even when tired. Interestingly, the only time I can notice any visual compromise is when looking monocularly at high contrast letter charts. Suitable as these old charts may be for emmetropes with clear media, I think their limitations will lead to their eventually being superseded by a range of real world and variable contrast targets.
Computerised systems make this easy to implement and would have made changes such as the introduction of simultaneous lenses much easier. logMAR size changes, controlled contrast variation and randomisation of targets make it difficult to justify the use of a static Snellen chart these days.
It is still the case that the first significant contact lens experience is gained during the pre-reg year. It will be interesting to see if any of the new courses address the issue of clinical experience during the undergraduate years.