The Use of Flippers in Optometric Practice Harvey Mayers OD FAAO "Simple style is like white light. It is complex but its complexity is not obvious…" Anatole France Every year the use of new technology seems to be changing the way we practice. It is always interesting trying new products. Some have little effect on our clinical routines, yet others make a significant difference in the way we manage our patients I have been using Optego Flippers daily in practice for a few months. I thought initially that they would be useful in refining small prescription changes in my bifocal contact lens patients. They were well designed with a useful stand, are color coded with the powers clearly marked and fit easily next to my examination chair. After practicing optometry for many years it becomes obvious that we are all "creatures of habit." In the last few years we have concentrated our attention on new 'high tech' devices, computerization of routine office procedures, have focused on the use of therapeutic pharmaceuticals agents, studied pathologies, developed new task delegation methods for our staff, but rarely review the basics of clinical diagnostic and counseling routines. The flippers were used on average on every 2nd or 3rd patient for a variety of reasons. Some examples of recent patients are shown below: The flippers were used: · To make small Rx spherical adjustments over bifocal soft lenses. (the aspheric designs make them sensitive to +25 or +50 changes - the phoropter is often not helpful. The analysis is much better in free space with variable light conditions both monocularly and binocularly. I also used them monocularly to establish the dominant eye. At times they were useful monocularly to demonstrate monovision) · To demonstrate increased add powers on all presbyopic prescriptions in the form of over-refraction. · To demonstrate additional power additions at the multiple distances that are required for computer users. · To show changes in spherical spectacle, contact lens and single vision corrections; often there is no need for loose trial lenses. · To be able to check accommodation limitations in children - demonstration of monocular accommodative rock therapy was useful and effective. · To apply Small trial Rx in children and prepresbyopes who suffered from near asthenopia. · In the examination of seniors and challenged patients (on-site) for static retinoscopy and to take the place of loose trial lenses for assessment in free space. · In evaluating and demonstrating depth of field and depth of focus concepts. · In explaining refractive changes to patients. (Flippers are well known among optometrists who do specialize in visual training. The lenses most often used are: (+2.00/-2.00) to test the dynamics and sustaining ability over time of relative accommodation directly and relative vergence indirectly. Vergence facility flippers contain a total of 12 p.d base out and 8 p.d base in. Small prism flippers base in (1 or 2 p.d.) are helpful in assessing advanced presybopes who are developing asthenopia from loss of convergence.) Within a month I was using the flippers regularly and they have helped to improve examination efficiency. It has been many years since a relatively simple device has changed a clinical pattern so much. The flippers were found to be convenient, inexpensive, and practical and impact on the day-to-day routine in a very practical manner. All optometrists (and other prescribing eye care professionals) would find a use for these devices in daily practice at some time in a busy day. Everything old is new again… Harvey Mayers OD FAAO Toronto, Ontario