The Pendulum in Eye and Vision Care

Dr. Art Epstein writes a weekly e-journal, Optometric Physician, always introduced by his “Off the Cuff” editorial comments.  This week’s piece, The Pendulum, was so powerful I decided to reproduce it in its entirety here.


“There was a time when optometry was simple. Back then, most ODs performed refractions and sold glasses. Some intrepid souls fitted contact lenses and a few focused on binocular vision or low vision. The few of us who embraced medical eye care were outliers who secretly applied topical anesthetics as a “lubricant” on the tip of a MacKay Marg tonometer and dreamt of being able to use topical therapeutics. One day, we’d say. One day.

Ancient history, you’re probably thinking, and you would be right about that. Optometry has moved on and today, most of our education reflects a strong medical emphasis. But what about traditional optometry? Don’t many, if not most, of our patients come to us because of visual issues? What about contact lenses, vision therapy and low vision? Is this still the core of optometry, or have they now become specialty areas?

I receive frequent e-mails from contemporaries concerned about the quality and training of new graduates. More than a few bemoan the massive shift that’s taken the profession so far from its roots. As a medical outlier myself, I dismissed most of these remarks as unfounded. However, I’ve begun to wonder if the pendulum has indeed swung too far. Has the profession lost its focus on core competencies that not only define us, but also meet our patients’ needs? And what does that mean for our future?”

Dr. Epstein’s concerns aren’t new.  Consider for example this editorial by Les Walls, O.D., M.D., in the journal Optometry and Vision Development from 2006.  They are however a breath of fresh air when discussed openly in a forum of this nature, and when inviting commentary from thought leaders.  So where will Dr. Epstein’s call for a closer inspection of our future take us?

Every pendulum operates within its own context of resistance and friction.  Take a look at this blog by physicist Matt Francis and you’ll note something interesting about the picture that emerges from the phase plot of pendular movement.


Rather than going around in circles with the types of discussions I’ve heard over the past 37 years of my career, I hope that Dr. Epstein’s comments are a clarion call for our profession to pay more than lip service to these crucial issues in eye and vision care.

6 thoughts on “The Pendulum in Eye and Vision Care

  1. Wanted to add something I posted on Facebook in regards to this… As one doc pointed out that technology-supported subjective refraction may be making the role of the traditional optometrist obsolete.

    The art that is lost is NOT the art of Refraction. It is the whole of the phorometry, and the art of prescribing for binocular vision, for nearpoint stress and emerging demands. This is the art of recognizing an emerging problem and prescribing with a long-term preventive/ supportive goal in mind. This requires the very human ability to recognize a constellation of findings as indications of a pattern, a style of engagement. This requires an understanding of how a prescription will alter the way the world appears to the wearer. Balancing the prescription entails a great deal more than refracting for the clearest visual acuity. There are clues to be recognized when a person DEVELOPS myopia, or astigmatism, or anisometropia. Compensating for the adaptation based on refraction/ auto-refraction/ automated subjective refraction does NOT require artistry.
    This art of prescribing for binocular vision rests in recognizing the conflict which brought about the adaptation, and treating the patient to help them resolve that conflict along with the presenting symptom.

    I am very grateful to Art Epstein for acknowledging the place for this art which is losing its place in Optometric education as well as professional practice.

  2. Dear Lenny,

    I also was pleased to SEE a medically oriented optometrist become more aware of our role in health care. For those, who want to practice, ophthalmology, there is an educational process, which needs to be followed. Optometry has a unique role in our health care system. We have an ability to improve our patient’s QUALITY OF LIFE through the use of lenses, prism and vision therapy. We also can detect and treat eye pathology but our gift to man/woman kind is far beyond the morbidity factor of eye disease. It is important to note that not every optometrist will become involved in binocular vision/vision therapy and/or low vision but it is another service, which is available within our tool box. We need to work together for the betterment of the optometric profession. With the advent of three D movies and the emerging development of three D televisions, the importance of depth perception/stereopsis is becoming a concern for patients of all ages. It is no longer about acuity (one eye at a time), refractive error and eye health. Although these components are important, there is more to vision than sight. Thank you for sharing this perspective. It is time to move beyond eight blind men/women and an elephant! Vision is more than 20/20 as 120/80 is more than perfect health!


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s