Retinoscopy – What do you do with yours?

Over the past 18 months a friend of mine has been complaining of a deterioration her vision.  She is a soft CL and Spectacle wearer.  She originally complained that her new CL were not up to the job and even her glasses did not seem ‘strong enough’ (her words).

After three visits to her own optometrist she became exasperated and mentioned her symptoms to me. Her vision was now borderline for driving, thus putting her career at risk.

What made her all the more frustrated was that when she screwed her eyes together, she could see so much better! Alarm bells were ringing.  I persuaded her to back to her own practice to discuss referral into the Hospital Eye Service, which she duly did.   However, the hospital doctor who finally saw her could find nothing ‘wrong’ and after various electrodiagnostic tests returned her to her own optometrist for a recheck, as her VA could easily be improved with a pinhole.

I merely rolled my eyes in frustration. I finally persuaded her to seek a second opinion with a colleague in the GOS who was able to ‘diagnose’ her problem as Keratoconus, which also confirmed my suspicions too.

What makes me so angry is that a lot of frustration and angst could have been avoided if the previous (optometrist) practitioner/s had performed retinoscopy. A keratoconus ret reflex, even in its early stage is unmistakable.  Furthermore, her symptoms all pointed in this direction which would have alerted anyone to pick up a ret if this was not something that they did regularly.  Moreover ,as a CL wearer, what about K readings? Surely they would also have alerted even the most inexperienced practitioner? Alas, it would appear thay were not done.

She is now being fitted with rigid gas permeable contact lenses and is back behind the wheel. Meantime, I wonder in which direction our profession is going.  Cant we look at the symptoms and come to a plan of investigation any more?

I sincerely believe that standards are dropping.

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