Constituting Vision

A study of social interaction and professional practice in optometry

Will Gibson - w.gibson@ioe.ac.uk

Optometry

• Study of the operations of the eye• Only interested in visual experience as far as it

aids the assessment of visual acuity/eye health

• ESRC study to look at communication in optometry and the roles of technology in the process of visual assessment

Conversation Analysis

• Social structures and practices are made and displayed through interaction

• Through their talk and actions people display their understandings/analysis of social context

• Aim of our study is to unpack the tacit understanding of optometric work as seen within the actions in consultations

The Distance Vision Test

• Usually a test that comes at the start of the sequence of tests (after history taking)

• Patient read out lines of letters from a sheet at a distance from them

Optometrists have three ways of starting a test. They choose which formulation on the basis of:

• The optometrist’s level of experience• The level of knowledge they have about the

patient, gleaned by the history taking or by prior knowledge

(1) The textbook way: “Please read the smallest line that you can see on the chart” (Elliott 1997: 32)

Pauses as indications of • The apparent reciprocity of gesture is similar to other medical contexts

• Centrally though, the feature of this formulation is that it means the patient has to self-select an appropriate line that they can read – This is the NORMAL/TEXTBOOK way to start the test

• Ambiguity of what ‘reading’ means

(2) Starting at the top of the chart

• Least common method of starting the test

• Used mostly by more experienced optometrists

(3) Selecting a line to start on

Identifying visual problems through reading and talk

• Reading lines as a proxy for visual experience• Monitoring the way reading occurs to spot

visual problems

• Each line of letters as a turn construction unit• Acknowledgement tokens after each turn

(yeah, good, ok)• Change of acknowledgement token attending

to repair• Changes in reading structure treated as

instances of visual problems

• Reading of earlier letters helps optometrists to establish the normal way of reading letters

• Optometric methodology involves spotting reading differences to identify visual difficulties

• From here optometrists start the ‘test closure sequence’

The test closure sequence

• Sequence begins because of apparent difficulty of reading previous lines

• Administrative activity stops• Close attendance to the patients bodily

postures • Sequences designed to imply possible failure

(saving face for both optometrist and client)

Often the sequence comes very early on in the test process

• Closure of sequence involves production of the test score

• Test does not specify the nature of how something is/is not seen – simply that it can’t be read

• For the score to be correct it is important:– To establish what counts as a normal report on vision– To push someone to try to read something

• Managing the ‘saving of face’ of both optometrist and patient

• The close analysis of conversational structures helps to demonstrate the tacit methodologies of optometry

• There are no manuals or instructions that specify these features of the distance vision test

• The results from the study will be used to inform the design of training courses on communication for optometrists

Concluding Remarks