Perimetry — the formal mapping of the visual field — has been a foundational tool in ophthalmology for over a century. Goldmann perimetry, the manual technique developed in the 1940s, set the standard for how we evaluate the visual field for decades. The transition to standard automated perimetry in the 1980s made testing more reproducible and easier to perform. The next set of advances is changing the rate at which we can detect disease progression — and that has clinical…
Domiciliary optometry — eye care delivered in a patient's home rather than a clinic — is a long-established model in the United Kingdom. It is comparatively rare in the United States, but the underlying need is the same in both countries: a meaningful population of older adults, disabled patients, and people with limited mobility cannot reasonably travel for routine eye care. This article describes how the UK model works, what evidence supports it, what limitations apply, and what the analogous…
Eye health is a lifelong project. The conditions that cause vision loss in adulthood — cataracts, age-related macular degeneration, glaucoma, diabetic eye disease — develop over years or decades, often silently. The behaviors that protect or harm long-term eye health are accumulated, also over years. There is no single dramatic action that determines outcomes; there is a steady pattern of attention that shapes what your vision will be like at 70, 80, and beyond. This article distills the most useful…
This is the personal essay among the more clinical articles on this site. I've thought about putting it down for some time, and the request to mark twenty years in practice was the right occasion. The lessons that matter most to me as a surgeon — the ones that shape how I work today — are not the technical ones. The technical knowledge is the floor. What matters more, decades in, is the framework that surrounds the technique. The right…