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Adapting to the changing ophthalmic climate is what has enabled our profession to successfully meet the optometric needs of our patients. Optometry is much like the peppered moth of Great Britain, which originally had light coloration that effectively camouflaged it against the light-colored lichens attached to the trees-only to witness the Industrial Revolution create widespread pollution and the demise of the lichens. The peppered moths rested on blackened soot and, through evolution, the population of dark-colored or melanic peppered moths thrived in place of the aforementioned light moth. This optometric melanism is evidenced in the co-management of our cataract patients, and as witnessed in the evolution of the moth, the strong-minded ODs will flourish.
Optometric melanism is related to the paradigm shift in surgical outcomes. One does not have to look further than cataract surgery to see that a patient is no longer satisfied with the ability to just perceive bright color and shape without spectacle assistance. Patients now expect remarkable uncorrected vision. Refractive surgery has also seen a shift from the satisfied patients being able to function without spectacles, as evidenced by the radial keratometry inconsistencies and seemingly satisfied patients, to the expectation of a 20/20 or better outcome from the first day visit.
As in the example of the peppered moth, the Industrial Revolution brought amazing change and advanced technology, but the industrial soot left a dark cloud. The cataract surgeries of today must be viewed from “refractive-colored glasses” to help co-manage these lightly colored, like the moth, cataract patients. There are strategies that can be employed in this optometric melanism, which will help you and your patients in the exam lane.
Try this the next time you go into a post-operative visit. Do not mention anything about the chief complaint and solely focus on the results of your evaluation. For example, a 1-month post-operative patient with 20/20 UCDVA OU and J2 UCNVA OU has the beginnings of a great result. Focus your attention on how well she is doing visually, what you want her to do with her medications, and when you will see her back. In this scenario, if the patient was truly bothered by the chief complaint, she will stop you and ask for a resolution, or at least a time frame on when the complain will be resolved. As reported by AMO1 and Alcon2 in their QOL FDA studies, more than 90% of patients were satisfied, so the likelihood of needing to address the chief complaint is minimal.
While the peppered moth has adapted to change using industrial melanism, our optometric melanism will enable us to adapt to new paradigm shifts. However, unlike the moth that is camouflaging for survival, we need to display our traits like a male peacock.ODT
Tecnis Multifocal Foldable Acrylic Intraocular Lens [package insert]. Santa Ana, CA: Abbott Medical Optics Inc.
AcrySof IQ ReSTOR IOL [package insert]. Alcon Laboratories, Fort Worth, TX.
Rotsos TG, Moschos MM. Cystoid macular edema. Clin Ophthalmol 2008; 2(4):919-930.