Volume 83, Issue 1 , Pages 1-2, January 2012
Thinking beyond ourselves
Article Outline
Paul B. Freeman, O.D.
For many of us, each New Year begins with at least 1 resolution that requires some action to better our lives: typically personal weight loss and exercise promises to oneself or the more-time-with-friends-and-family resolutions. I think it is safe to say most of these fall by the wayside in short order. There may also be resolutions having to do with patient care that can be made and that may actually be easier to maintain, in that these resolutions don’t require any more effort than just doing what we have been trained to do: keep our patients medically and functionally as sound as we can. Once the proper diagnosis has been made, the medical part of eye care (and one part of the resolution) seems, for the most part, to be pretty straightforward. However, the diagnosis and management of the functional aspects of eye care are less so. What makes this divergence of endpoints so frustrating is that there are numerous articles in well-respected journals encouraging us to do just that: improve function as well as structure. For example, a recent article stated “Every clinician recognizes that [visual acuity], although representing the gold standard of outcome, may not always accurately describe a patient’s level of visual function.”1 Certainly this is a very perceptive observation. Unfortunately, it is a long way from a manuscript to the practical application; although “every clinician recognizes” this (improved function), it is not always the case that it is addressed in practice. For example, consider the patient with wet macular degeneration who goes from 20/200 to 20/60 with the latest treatment and is returned to the primary eye care practitioner with a letter stating the patient has been successfully treated. Of course, this is certainly an improvement and, although it sounds (and indeed is!) significant, the patient may still be complaining about poor function. Or the patient who has been treated and attains 20/20 but has terrible contrast sensitivity yet the same letter of success is sent, despite the same functional complaints. Or the amblyopic child who, after treatment improves from 20/200 to 20/25, yet is still having problems in school. In these cases, the gold standard (improvement in visual acuity) has been met but the functional outcome may not be satisfactory.
A sports analogy might help. It is not unlike a pass in football; catching the ball is important and is the gold standard of the outcome of a pass. But if the player catches the ball and then stops because it was a job well done, he is missing the point of the game (assuming it is not caught in the end zone where both outcomes are accomplished). So, back to my patient care resolution, with a small shift in attitude it might go something like:
A second resolution could center more on the public health issue of the visual well-being of children. How is it possible that, in 2011, an article can start with the statistic “uncorrected refractive error is the leading cause of vision impairment in children”?2 My incredulity is not for those reporting the information but rather the notion that in this day and age a common, noninvasive procedure that is a part of routine eye care is not being made accessible to every child! Any responsible eye care practitioner should read this public health concern as a reason to get involved in some way, to aggressively look to encourage parents of children of all ages, starting at the preschool level, to have their children evaluated. The goal: to give all children equal footing, ensuring whatever their best visual acuity and functional vision can be. Additionally, we should strive to actively educate parents on preventable risk factors to further minimize the chance of developing or increasing refractive errors. One preventive measure that has been touted by optometrists, especially those who have a behavioral bent, is the need to balance near-point activities with getting outside and away from those activities. In a recent study at the University of Cambridge,3, 4 that recommendation was given “scientific” credibility. It was reported that “for each additional hour spent outside per week, the risk of myopia was reduced by 2%. Exposure to natural light and time spent looking at distance objects could be a key factor.”4 So along with preventive measures we can suggest, we might also support the American Optometric Association’s (AOA) efforts to ensure examinations for children are included in the essential health benefit being defined under health care reform.
In fact, the AOA is on record as an organization supporting the concept of early eye examinations for children as reported in Resolution 5 of 2011 approved at the House of Delegates at Optometry's Meeting®, the 114th Annual AOA Congress and 41st Annual AOSA Conference held this past June in Salt Lake City, Utah:
WHEREAS, undetected and untreated eye disorders, such as amblyopia and strabismus, can result in delayed reading and poorer outcomes in school; and
WHEREAS, studies show that while prevalence rates vary between demographic groups, there is an increasing need for eye care among children, indicating that 25% of children aged 5-17 have a vision problem, 79% have not visited an eye care provider in the past year, 35% have never seen an eye care professional; and
WHEREAS, the National Eye Institute’s VIP study of preschool children acknowledges a comprehensive examination performed by an eye doctor is the ‘‘standard’’; and
WHEREAS, the 2011 School Readiness Summit: Focus on Vision issued a joint statement by multiple organizations recommending the following: “We support comprehensive eye exams for school aged children as a foundation for a coordinated and improved approach to addressing children’s vision and eye health issues and as a key element of ensuring school readiness in American children”; now therefore be it
RESOLVED, that the American Optometric Association supports a comprehensive vision and eye health examination as the foundation for eye care services; and be it further
RESOLVED, that the American Optometric Association recommends that all children have a comprehensive vision and eye health examination between six months and twelve months of age, at 3 years of age, before entry into formal school, and as recommended thereafter by the eye doctor.5
However, while this is the message of our professional organization, we can each make our own resolution that might go something like:
Although we are past the zeal of the initial round of New Year’s resolutions, it is not too late to embrace 2 more. Most resolutions by definition are egocentric, something about how we want to change ourselves. Every once in a while it’s nice to look beyond that.
References
- . Economic considerations of macular edema therapies. Ophthalmol. 2011;118:1827–1833
- Risk factors for hyperopia and myopia in preschool children: The multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmol. 2011;118:1966–1973
- . Risk factors for astigmatism in preschool children: The multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmol. 2011;118:1974–1981
- BBC News. Lack of outdoor play linked to short-sighted children. Available at: http://www.bbc.co.uk/news/health-15427954. Accessed October 28, 2011.
- . 2011 House of Delegates. Optometry. 2011;82:576–581
PII: S1529-1839(11)00608-7
doi:10.1016/j.optm.2011.11.011
© 2012 American Optometric Association. Published by Elsevier Inc. All rights reserved.
Volume 83, Issue 1 , Pages 1-2, January 2012
