How Disruptive is New Refractive Technology?

There’s an old line in our profession about an Optometrist who visited a long-standing patient on his deathbed.  The aged and infirm gentleman opened his eyes and in a barely audible voice whispered: “So tell me Doc, before I go – which one was better, number one or number two?”

One of the best neuro-ophthalmologic writers beyond conventional textbooks and articles is Christian Wertenbaker, who writes essays for Parabola Magazine – and while he doesn’t explore the great philosophical question of which is better one or two, he does tackle the challenge of merging the objective and the subjective.



Dr. Wertenbaker’s essays in Parabola have been packaged into a paperback titled: “Man in the Cosmos: G.I. Gurdjieff and Modern Science“.  From the introduction:  “Because science deliberately tries to be objective and to remove the subjectivity of the observer from its deliberations, its findings may only apply to the external world, leaving the inner world of conscious beings to another realm of inquiry.”  

Wertenbaker Book

The difference between the objective and subjective visual states is taught to every Optometry student during “Methods Labs” either in the first or second year of their graduate program.  It is no secret that clinical refraction is a relative strength of Optometry in the eye care field, and my co-lecturer at Dr. D. Leonard Werner and I spent a semester each year instilling the art of balancing the objective with the subjective to our SUNY students.  This culminated in a textbook that he and I co-authored on the subject.


Around the same time as the publication of our book, disruptive innovations were taking place in Ophthalmology in the early 2000s.  How might this impact impact refractive care?  Here is an interesting quote about disruptive refractive technology in a recent issue of Optometry Times from Vitor Pamplona, PhD, CTO and co CEO of EyeNetra, a Smart Phone based refractive system:

“Dr. Pamplona makes the analogy that optometry will not go the way of typists, disappearing completely as technology evolved. Instead, he sees it going the way of photographers.

Photographers used to be chemists who knew how to mix the chemicals needed to develop a photo. Then, the profession moved to those who had the most expensive equipment. Now, everyone has devices with cameras, and yet photography is a bigger industry than ever.

‘People pay for the artist—they’re not paying for the device or the mechanism,’ he says. ‘This is exactly what optometrists are—they are artists. Even with refraction, they will always be better than any machine out there.'”

The art of the science …

3 thoughts on “How Disruptive is New Refractive Technology?

  1. Well, I think the subjective is a bit of Psychology as my Clinical Psychologist daughter understands. I don’t want the exam room cluttered with cell phone noise and a bunch of siblings talking as the subjective is vision not sight.
    The patient needs to be calmed down. Reminds me of an associate who told the 8 year boy to read the letters on the chart after the associate reprimanded the kid. Well the kid could not see any letters on the chart and after the associate screamed at the young man that the letters are clear and the kid needs to read them, the kid shut down so he could read nothing.
    AND, young woman about age 13 to 16 who are emotional can’t read the letters either.
    Note: I still have my cheat sheets on ICD 10 however I discovered a free app ICD10 Consult. Wonderful.

  2. So. The objective we recall as the #4 is great for those who can’t subject. But that which is better than auto refraction still lacks in the subjective which is a negotiated brain to objective resulting in better visual comfort especially with digital lenses.

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