End of alliteration. I promise. Just couldn’t resist playing with a topic expounded nicely in this month’s Optometric Management (OM), begging the question as to whether modern refraction faces a Fiddler on the Roof in terms of conducting refractions the way we always have because of tradition.
But wait a minute, you ask. What’s Dr. Lou Catania doing as the lead author on an OM article that opens by paraphrasing a scene from the mythical town of Anatevka? I don’t know. Actually, I think I do know. Lou adopted Dr. Irv Borish as his mentor for refraction, and Irv’s family was from a town just like Anatevka. Lou Catania teaming up with Irv Borish on refraction about 20 years ago was the optometric version of Christof Koch teaming up with Francis Crick on consciousness. For Lou to get into refraction seemed to be career suicide after making his mark in anterior segment disease. Yet he has done very well in bridging refraction with adaptive optics. I hold Lou in high regard.
The OM article elaborates on a shorter version that Dr. Catania authored for Primary Care Optometry News last year, one that was met with some controversy over the delegation of refraction in a response by Drs. Harris and Thal. Dr. Catania laid the groundwork for delegating the data gathering portion of refraction in a 1998 article he co-authored with Dr. Borish in the Journal of the American Optometric Association entitled Traditional versus computer-aided refraction: “which is better”? Dr. David Goss captured the flavor of some of this in a mini-review in the Indiana Journal of Optometry in 2005. He cites a chapter that I wrote on intelligent use of autorefraction, incorporating some of the interpretive use of retinoscopy. Since co-authoring my textbook on Clinical Pearls in Refractive Care, we now use an additional autorefractor that provides a direct open view binocular measurement of accommodation.
Now if you Google “Lou Catania and Irv Borish – Refraction”, you’ll come up with a very interesting insider newsletter that Lou writes to Marco Reps, whose job it is to sell automated refraction equipment with emphasis on delegation. In this issue he writes: “You observe the doctor spending an inordinate amount of time measuring phorias on a 60 year old. We all know that phorias on a 60 year old are meaningless. But that wasted time is also telling you something about that doc’s approach to refraction.” Wow! That’s quite a statement. After reading that I’m trying to figure out how someone who has such great insights about the role of the brain in vision, neuroplasticity, and neuroadaptation (see here) can be so dismissive of the significance of binocular vision in adulthood. I hope to convince him that his view on phorias is an aberration of the highest order, and that concerns for binocular vision at any age are not merely vestiges of tradition.