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HomemicontactCommunication is Key to Influencing Outcomes

Communication is Key to Influencing Outcomes

Have you ever considered inviting your local eye surgeon round for a game of pool? Alan Saks explains why you should and why you’re unlikely to win.

I recently saw a thread on a large social media optometric group. The poster had asked a relatively simple question, “What contact lenses have a concentric ring multifocal design?”. When asked to elaborate, they explained that they didn’t really know what they were asking!

Therapeutic training and upskilling have meant much greater interaction between the professions in both clinical and didactic environments, improving… understanding and mutual respect

An ophthalmologist had referred a patient awaiting cataract surgery for trials with a ‘concentric ring’ multifocal design contact lens. It was obvious to me that the surgeon wanted the patient to trial a diffractive (concentric ring) contact lens, as they were considering implanting one of the popular diffractive intraocular lenses (IOLs). Instead of communicating with the surgeon to clarify and understand the request, the optometrist went ahead with a centre near optical design multifocal contact lens (MFCL).

The surgeon sent the patient back saying that’s not what they’d wanted.

What a waste of time for all concerned, while not impressing anyone.

There were at least two diffractive MFCL designs in the last century. One was the Diffrax rigid gas permeable contact lens (for which I did clinical trials in the early 90s), the other, a low Dk HEMA soft lens called Echelon. Like most MFCLs, when they worked, they worked…

A retired contact lens guru who used to consult me wore an Echelon for ‘social vision’, which he liked. In between wears he stored them in pharmacy grade H2O2…

At any rate, to the best of my knowledge, there are no longer any such diffractive MFCLs on the market.

A simple call or email would have clarified this and sorted out the problem… although the value of a trial of this type – for a patient awaiting cataract surgery who already has reduced vision and poor contrast sensitivity – is debatable, but that’s for another discussion.


I was fortunate to build some great relationships with a handful of fantastic ophthalmologists during my practising years. We communicated very effectively and efficiently, via email or phone, and by post or fax in the past. We discussed every case we co-managed or referred, in-depth. As a result, our outcomes were superb. Collectively, the majority of our patients in both the private and public systems were extremely happy.

It was a pleasure to work like this and I still count a few of those surgeons as life-long personal friends. Two of them served on the New Zealand Cornea and Contact Lens Society Council with me, becoming presidents of the Society over time.

In contrast, in the United States we see some level of ‘antagonism’ between optometrists and ophthalmologists all too often. It seems to be about patch protection and distrust – when optometrists seek to expand their scope, there’s lobbying to stop them. The main losers are the patients. There was an element of this in the aforementioned social media discussion, and I’ve seen it many times over the years in various forums.

Fortunately, in New Zealand and Australia, relationships between the professions have greatly improved over the past decade or two. When optometry pushed for the introduction of therapeutics, there was great support from ophthalmology. Today, around three quarters of optometrists are therapeutically qualified and practice at a high level.

Therapeutic training and upskilling have meant much greater interaction between the professions in both clinical and didactic environments, improving communication, collaboration, understanding and mutual respect. Ultimately, patients have been the winners, with fast, efficient access to treatment, at a lower cost.

mivision is a great example of this kind of interaction. Go back a few years and you will see how much greater the ophthalmology content is these days. Full credit to all concerned.


Mutual respect and communication are the cornerstones of good relationships. If we could achieve this across all levels of society, the world would be a much better place.

I have the utmost respect for our ophthalmological colleagues, who are at the pinnacle of medicine. Very few people have what it takes to become a top gun surgeon – hence the limited numbers and why it’s so beneficial for optometrists to be able to do some of the non-surgical therapeutic work. By freeing ophthalmologists up for surgery, we can help reduce surgical wait lists.

Despite much gnashing of teeth, controversy, and lobbying, we are finally starting to see some optometrists in the United States being licenced to do minor laser surgery, like YAG PCOs and iridotomies. I think we’ll see the same evolution in Australia and New Zealand, in time…


If you have not done so already, do yourself a favour and invite some of your favourite surgeons out for dinner, or a game of pool. Most I know are top guns on the pool table too, with many great nights out into the wee hours, always scheduled on a night when they don’t have surgery the next day.

No doubt their prowess on the pool table is tied into their extremely fine motor control and refined eye-hand coordination, not to mention their understanding of optics, (angle of incidence equals angle of reflection), which is what pool angles off cushions are all about.

It’s a win-win-win situation, even if you lose at pool.