Recent Posts
Connect with:
Thursday / May 30.
HomemicontactProgress Comes With Debate

Progress Comes With Debate

Leaders are often viewed with scepticism and criticised for their work… but how would we advance without them?

In monitoring optometry related social media posts and those on the AUSOPTOM list, I note there’s often quite a bit of debate surrounding hot topics that relate to modern eye care. Some pretty emotional posts and discussions arise. Some of the hot topics are things that barely existed a few years ago, while others are long lasting battles that have gone on for decades.

Behavioural optometry seems to get its unfair share of criticism, and has done for the past century – it eems the attacks will never go away. Some slam it for being unscientific and lacking in evidence, while many armchair critics do acknowledge they will be happy if or when the evidence base ‘proves’ such interventions ‘work’. However, we are dealing with complex visual, neurophysiological, psychological and behavioural issues that are difficult to test or ‘prove’ through randomised, controlled, double blind studies. In many cases, comparing an intervention in one group versus a control group, would not meet with ethics approval, nor the rigours of scientific evaluation due to too many variables being present.

For those involved in behavioural optometry, seeing the dramatic, positive changes in a struggling patient is enough to convince them of its merits. Providing vision therapy and/or spectacle corrections – that are life changing to some battlers – is extremely rewarding and satisfying. As is working in a multidisciplinary team that’s often necessary to help these patients. Health professionals who have seen the results of behavioural optometrists have the utmost respect for this aspect of our practice. I fail to see why other optometric colleagues are so negative.


I’ve seen many criticisms of contact lens practice too. Well over a decade ago I was a moderator on one of the first online forums for optometrists: ODWIRE. Created by respected New York optometrist Paul Farkas and his son Adam, it covered many aspects of optometry. With US ODs regarding themselves as optometric physicians, there were some heated exchanges. Egotistical ODs regarded spectacle prescribing and contact lenses as passé and below their dignity. They seemed to forget that prescribing corrective eyewear is a cornerstone of optometry and the main reason patients seek care.

Someone has to make discoveries, develop treatments and pave the way


The so called ‘myopia epidemic’ is also being criticised. Some say it does not qualify as an epidemic while others feel it does. Critics also question the sample sizes of studies that show myopia control benefits of, for example, certain dual focus contact lenses, as well as other interventions such as atropine eye drops and spectacle lenses.

From all I’ve observed over my practising career, and more recently in the relatively new field of myopia control, there appears to be little doubt the prevalence and incidence of myopia is increasing to alarming, if not epidemic, proportions. While some critics merely play devil’s advocate – stir the pot – others perhaps, try to justify why they are not involved in these important areas of eye care.

Someone has to make discoveries, develop treatments and pave the way, so that studies can ultimately make the fence sitters happy by providing the ‘evidence’, they need to hop on board.


I’ve also noted disgruntled owners of older diagnostic instruments venting on AUSOPTOM about a supplier that palms them off when they have technical issues by stating such instruments are no longer supported. With current fee structures, it’s not possible to replace fancy equipment willy-nilly. We expect high tech instruments purchased from leading companies, to be supported for the life of the product.

As one disgruntled commentator put it, “Makes the decision easier when buying ophthalmic equipment in the future at least…”

Manufacturers need to take note. Practitioners vote with their feet and it’s hard to win back clients once lost.

There’s plenty of competition.