BLOG: The optical management of ocular disorders
In my early years in practice, I worked with a multispecialty ophthalmology practice in a hospital setting. I was recruited to provide the unique optometric skills of low vision, contact lens and refractive management to a host of ophthalmic problems where vision could not be improved with further medical or surgical intervention. My tools were specialty refractions, prisms, magnification, contact lenses, and therapy.

My Pennsylvania College of Optometry classmate and, as it turns out, a lifelong friend is Richard Edlow, OD who practiced in a similar clinical setting in Baltimore. Together, we authored a paper that highlighted our mutual experience and suggested that our experience could be the basis for a new mode of practice for optometry. We both used the tagline: “Optical management of ocular disorders” on our business card and letterhead.The actual tasks that we performed in this area of optometry changed as we moved forward in time. In the early 1980s, we spend much of our time fitting aphakic contact lenses. We had more Permalens in our fitting stock than CooperVision. The most common low vision referral was for disciform macular degeneration. We learned that as the disease progressed we could always add more plus power to the system and improve reading.

We developed a therapy program to teach eccentric reading at the very close focus of a high plus lens. We fit keratoconus and corneal transplants with K-readings and retinoscopy. We developed great relationships with our friends in ophthalmology because we were an important part of the team. One of my subspecialty friends used to call our service “the final common pathway.” Many patients with significant ocular problems needed to pass through the optometry service to get back to the functions of life.Although today much of the nuts and bolts of the care we provide has changed, we still provide the optical management of ocular disorders. The “optical” has broadened a bit to include a number of vision-based therapy programs and the “ocular” has broadened to include neurological-based vision problems, but the mission is the same. We provide unique optometric services to patients with medical problems in a multiple disciplinary setting. We communicate and collaborate to facilitate the best possible medical care.