Writing this as an optometrist who qualified when the ‘go to’ soft contact lens was hydroxy ethyl methacrylate with a 38% water content, refractive surgery meant a trip to see Professor Fyodorov on a ship in Cyprus for radial keratotomy, and the medical imaging breakthrough was a non-mydriatic camera that could produce a grainy polaroid of the central fundus, it is mind boggling to reflect on the transformation in the clinician’s armoury in all three of these areas today.
As an adviser to the Optical Consumer Complaints Service (OCCS), there is no doubt that the expectations of our patients are increasing, probably at the same exponential rate that technology is advancing.
In mediating situations when things may not have gone to plan, it is hard to avoid the feeling that a belief of many patients, that technology is infallible, is somewhere in the mix.
The paradox for me is that the solution lies in the most simple and enduring aspects of our role as optometrists – great communication and record keeping. The risk lies in the situation where by espousing the virtues of the new products or diagnostic tools, we inadvertently create a risk of over promising and under delivering. This is not a criticism, merely an observation that expectations are now very different.
In the contact lens arena, technology has transformed both the comfort and wearability of lenses to such a point that a significant risk now exists in the minds of wearers who no longer see their contact lens as a medical device. This can bring a greater level of risk and non-compliance, as outlined in the BMG research commissioned by the GOC in 2015. The solution highlights that it is not only about how we explain the benefits and the limitations of the product we are prescribing, but absolutely nail the understanding of the need for regular aftercare.
As a delighted LASIK patient of some 16 years, I am fascinated by the precision of new surgical techniques in bio metrics and ablation, and the ability to create simple and stunningly good outcomes. Yet the paradox is evident when the outcome is anything other than perfect. I often hear from patients who, for whatever reason, have had somewhat unreasonable expectations. For example, the 6/4 right and left with a residual -0.25DS who tells me that their surgery failed. However, from a clinical perspective, this is not a failure of surgery, but more of the need to ensure a pragmatic view of the outcome prior to surgery. This is not easy when the mind-boggling technology seems to come from a science fiction movie.
It is incredible to think how quickly the world of retinal imaging is changing. Not long ago a fundus camera was a luxury, now we can capture retinal images with an adaptor on a smartphone, and the era of optical coherence tomography (OCT) is upon us.
It is not uncommon, even for a consumer service such as the OCCS, to see the odd query about ‘why didn’t they see my dad’s wet age-related macular degeneration coming?’. An explanation and the supplying of a detailed booklet produced by the Macular Society often suffices, but I do wonder if this expectation will get even more challenging as OCT becomes more prevalent. Again, managing these situations effectively will always be underpinned by good communication, checking understanding and good record keeping.
"From a clinical perspective, this is not a failure of surgery, but more of the need to ensure a pragmatic view of the outcome prior to surgery. This is not easy when the mind-boggling technology seems to come a science fiction movie"
The only way is forward
Technology is driving a need to upskill. As a result, questions on how to make sure we don’t over refer for the slightest artefact and how do we manage with more precision the urgency, or not, of what we find are raised. Similarly to how the development of new multifocal lenses are raising the bar for dispensing opticians, OCT is bringing a whole new skillset into optometry.
Like the advent of the smartphone, I don’t think any of us would choose to be without our new products and equipment. However, it is worth reflecting on the insights from some of the OCCS cases, which highlight that the cornerstone of good communication and record keeping are perhaps going to be more important, not less important, as the public perception of technology being infallible continues.