12-12-12

It’s December 12, 2012 – aka ’12-12-12′, or ‘one-two-one-two-one-two’ day. It’s a fun day for many, especially dance instructors and wedding chapels. Optometrists, who have traditionally used the simple question ‘Which is better, one or two?’ for well over a hundred years to help patients refine their optical needs, are also quietly enjoying the day. Applying optical principles to help patients is a small part of modern optometric practice, but still a very important part of what we do.

The optics of the eye are surprisingly consistent among critters in any given species with a visual system. This means there is some variability between individuals, but by and large, the optical properties of eyes fall within a fairly narrow range of values. For the most part, lesser critters such as flies, salamanders, northern pike, and bears, good vision provides a bit of a boost; but these creatures have other means of getting around and finding what they need, so even if the vision is not quite perfect, they can survive. With more advanced critters like accountants, students, and carpenters, strong vision is required and not all eye types will do.

When optometrists ask that famous question, we are determining your preferences for what is called ‘sphere’ power and ‘cylindrical’ power. These determine your subjective preferences for nearsighted or farsighted correction, on the one hand, and astigmatism correction on the other. These values are combined to create what is called the ‘refraction’ or ‘refractive error’ of the eye, aka the ‘glasses prescription’. I prefer the term ‘refractive status’. These numbers can be used to correct blurred or strained vision through glasses, or as the starting point for correction using contact lenses, LASIK/PRK, or cataract surgery.

These days, refractive status values are calculated initially in advance using very sensitive digital equipment, but the refinement must be done through personal interaction with the patient with a good knowledge of other factors that might be playing into how the visual system is working at the time. This includes understanding of diseases, work requirements, eye alignment, focusing ability, and other factors.

The optics of the eyes is studied under the rather heady banners of ‘physiological optics’ and ‘physical/geometric optics’. Suffice it to say that it takes a few years to wrap your head around all the factors involved. In my own practice, the objective observation of visual behaviour leads to important insights into a patient’s health, including what might be troubling children when they don’t perform as we’d like in the classroom. In many cases this knowledge leads to relief of symptoms that have lingered for years and years, and that are not helped by drugs, surgeries, or medical imaging.

Correcting for an imbalance in refractive status is as critical to a child’s learning as good nutrition, sleep, and regular exercise.

Do you know what your ‘refractive status’ is? Not many people do. Still, it’s one of those things that all doctors, teachers and parents not only should know about children, they MUST know it in order to do their jobs effectively. It’s as important as knowing about diseases or developmental concerns; in fact, many children are diagnosed with developmental concerns where an early check of visual needs would have avoided the costs and trauma of testing and intervention. Correcting for an imbalance in refractive status is as critical to a child’s learning as good nutrition, sleep, and regular exercise. Uncorrected refractive needs in adults leads to medical concerns from headache and dizziness, to shoulder, neck and back pain.

Knowing a patient’s refractive status is as important to understanding their behaviour and health as is blood pressure and blood glucose levels.

Knowing a patient’s refractive status is as important to understanding their behaviour and health as are blood pressure and blood sugar levels. Why is refractive status ignored? Mainly because of a lack of coverage in schools of medicine, education, and psychology – it’s just not even on the radar. During my own teacher training, nothing was mentioned regarding the physical requirements of learning. With the years of professional training and experience I had in neural science and education, I had no idea what a ‘refraction’ even was, beyond a knowledge of basic optics. Ignorance does not change the fact that the refractive status is critical in understanding children’s behaviour and school performance. Sadly, our state of healthcare is such that a child is more likely to receive drugs for poor classroom behaviour than to be referred to vision assessment.

Sadly, our state of healthcare is such that a child is more likely to receive drugs for poor classroom behaviour than to be referred for vision assessment.

Ignorance is not an excuse, and uncorrected visual needs of children means that many, up to 1 of every 3 kids on reserves, struggle needlessly and are subjected to unnecessary and costly testing and intervention – if it’s available. For those that are not checked, it can even mean they never have a chance to finish school.

In Alberta, child and senior vision exams are covered under Provincial health benefits, but locally, doctors and schools are not doing enough to ensure something so basic is ever even checked.

In Alberta, child and senior vision exams are covered under Provincial health benefits, but locally, doctors and schools are not doing enough to ensure something so basic is ever even checked. Checking means saving millions in health and education spending each year. It’s simple math, like one and two.

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