I am re-reading a great book. Its Clinical Pearls in Refractive Care (Butterworth-Heinemann, 2001) by Drs. D. Leonard Werner and Leonard J. Press. You know what happens when you get two Leonards together to talk about refraction: fireworks!

NO! WAIT! DONT TURN THE PAGE! I PROMISE REFRACTION CAN BE FUN!!!

The two Leonards offer great information. They give a whole list of pearls to follow when prescribing spectacles for our patients.

Now, the two Leonards couldnt cover EVERY contingency we see in routine practice. So, Ive come up with some pearls that I think they should include in the next edition of this great book. In reverse order, here are my top 10 Clinical Pearls in Refractive Care.

10. Take a VA. Oh, I know, youre a doctor. VAs are for mere staff members. Well, something very special occurs when YOU take a VAyoull notice not only what letters the patient can see, youll notice how they see em. Are their answers quick and crisp, or are they struggling? It matters.

9. Touch the patients glasses. Hold them. Feel the power, the heft, the weight that their little bitty nose is carrying. Try them on ... Hmm, I can see great. Whatll you take for these, Mrs. Jones?

8. If, as soon as you stroll into the room, the patient says, Im not getting new glasses! you should say, No, you are not! Then, check their eyes. If they would see better with new glasses, just say, Well, be careful out there. I hate how blurry you see, but no new glasses for you! Theyll go, Why not, you jerk?

7. Remember this important mathematical formula:

(M + C) / T = L (1/ W) *

* Number of miles the patient has to drive to pick up his glasses plus the cost of the glasses divided by the number of times the patient has been to your office equals the likelihood that the right lens is in the left eyewire and the left lens is in the right eyewire.

If the patient looks freaked out when dispensing, try a lensometer, doctor. If you have to switch lenses, never admit it!

6. Your optician will always sell the most expensive, drill-mounted, AR-coated, titanium-framed, progressive, photochromic-lensed product to the patient who has to have a remake every single time. Get over it.

5. The doctors IQ in prescribing is inversely related to the patients age up to age 70, at which time the patient respects you again as a peer, not a doctor. Thats gone at age 42.

4. The worst patient in the world is a one-eyed emmetropic/early presbyopic male engineer, age 43, who has a wife whos 35 and a -4.50D myope, and whose 18-year-old son, who has never had an eye examination, has just been rejected by the Air Force Academy because he is color deficient you know, speaking in general, I mean.

3. During refraction, never use the line, Okay, now look at the white square No, not me. The one across the room! In 28 years of practice, no patient has ever gotten that joke.

2. Give HUGE senior citizen discounts. In short, accept Medicare.

And, my NUMBER 1 CLINICAL PEARL NOT FOUND IN DRS. PRESS AND WERNERS FINE BOOK ... When in doubt, just make em see better. (Thanks to the late Dr. George Bodie for passing this pearl to me in 1979.)

Now, put down that National Enquirer and go get Clinical Pearls in Refractive Care by the two Leonards. Sure beats reading about Britneys bald head.

Vol. No: 144:04Issue: 4/15/2007