One of the things that I always remember from my training at university was being taught the methodology behind a full eye examination. From the outset students were taught to do every test feasible on every patient every time. By the time we came to doing a routine sight test in the PQEs we had honed this technique so that it had become second nature to do every test every time on every patient. It had been ingrained in us that this was necessary in order to prevent missing any possible asymptomatic pathology. Without knowing it at the time we had been indoctrinated into a weird type of paranoia that never seems to leave an optometrist through their whole career. To reinforce this paranoia came the knowledge that we could be hauled in front of our professional body at any time if we had missed something and would have to prove we had done everything in our power and would have to answer to our peers, all of whom had been trained the same way and possessed the same level of paranoia, and prove we had not been negligent. It would be imperative to produce records of an eye examination that had reams and reams of results that proved we had actually performed individual tests and not just comments that what we had observed was normal or otherwise. If this was not possible, we stood the very real chance of being suspended or struck off. Therefore, over the years, every optometrist develops an ability to carry out meaningless tests on patients pretty much for the sake of protecting themselves rather than serving the needs of their patient. Undoubtedly this would have continued ad infinitum had it not been for the Covid-19 outbreak.
Talking to patients now it is interesting to hear that those that have problems want them sorted out. However, to many this is still a very stressful time and they would rather spend as little time in close proximity to another human being as possible given the risk of virus transmission. The last thing they want to do is go through a mass of unnecessary tests in order to achieve a new prescription for a pair of glasses to replace the ones they had broken. Ask yourself this, why does an asymptomatic 40 something need oculomotor balance tests, motility tests, full slit lamp examination, IOP check, visual field check, OCT check? Why are we doing all these tests when they will all come out normal in 99% of cases? The patient does not want any of these tests, they just want to get in, get some spectacles, and get out. Has the time now come to throw off our paranoia and recognise that a truly skilled professional will do what is necessary for their patient and the rest is superfluous and not what the patient either wants or needs?
At the start of the pandemic it became necessary to make changes to the content of an examination in order to protect both the patient and the practitioner. Ironically, it was the pandemic that actually caused us to take a reality check. It is this reality check that is so long overdue. When we go to the doctor for a flu jab we are not subjected to fifty other tests to ensure the doctor doesn’t miss something that might be wrong with us on the off chance. Why then would we carry on the way we do? Some of you will remember a rather odd advertising campaign run by one of the optical retail chains a few years back when they made the claim that each of their eye tests consisted of 100 different elements! Why would anybody in their right minds want to be subjected to 100 different tests, especially if they were asymptomatic? Why would anybody in their right minds want to do 100 tests on an asymptomatic person?
Of course there will be those who say that by taking this blanket approach we will case find at an early stage and prevent pathology developing further. This would also be true if everybody had a blood pressure check every year, an MRI scan and CT scan every year, and routine full organ screening for cancer every year, but this is just not good medicine and a huge waste of resource. Furthermore, it is not what the patient wants, especially nowadays.
One of the good outcomes from this pandemic will hopefully be a review by all concerned in our profession of the way we approach an eye examination. This blanket testing approach is wrong and is out of date. We should be looking at good medicine procedures as we move forward. We should be teaching students not just how to carry out the various elements that make up an examination but also when is the appropriate time to use each of them. This would be mature best practice, not self-serving preservation tactics to prevent us from being hauled in front of our disciplinary body. The time has come when unnecessary testing should be seen as the offence, rather than good peer practice.