Take a seat
First the patient needs somewhere to sit.
First the patient needs somewhere to sit.
Are you sitting comfortably?
Then the optometrist can begin...
Today one of the most important pieces of an optometrist's equipment is a comfortable chair for the patient. By putting the patient at his or her ease in a less threatening environment the practitioner can reassure them and often gain a clearer description of symptoms, thus ensuring a more accurate diagnosis.
Even in earlier times eye practitioners paid some attention to the needs of their patients, although the technologies available to them for this purpose were somewhat limited. The 'victim' (for that can only be the word) of this early cataract operation at least has plump cushions to sit upon. The ophthalmic surgeon straddles his patient and there is an assistant to help keep him in position!
This plate was intended to be instructional. It formed part of Georg Bartisch's Ophthalmodouleia (1583). Bartisch wrote complaining that certain quacks were taking on the care of people and couching cataracts 'at the market out in the wind and air and in front of everyone...men and women, good and evil'. He compared the public damage done to people's eyes this way to the deliberate damage inflicted as judicial punishment by the civic executioner. Thus Bartisch can be regarded as an early advocate of privacy.
Bartisch wrote further:
Seat yourself on a bench in the light. Position yourself with your back to the window. Have the patient sit on a stool, foot rest or box and move right up to you. The patient should be seated lower than you are. Put the patient's legs and thighs between your thighs and have him lay his hands on your thighs. Position an assistant behind the patient to hold the patient's head.
(Translation by Donald L Blanchard, 1995)
We see here the need for ensuring that the patient remained still. One method was to cover the seeing eye so that the needle couldn't be seen coming. From this we may infer that the patient in the picture had cataracts in both eyes. It seems likely that assistants would have to be strong to prevent some patients from struggling. In the eighteenth century the cataract surgeon 'Chevalier' John Taylor wrote of restraining the patient 'in the usual manner'.
Bartisch also recommended the use of a bed or flat table, for example when administering medicines to the eyes. The patient was to lie on his back towards the light whilst the physician dripped the medicine into his eyes with a sponge. The patient was not to raise his head for at least a quarter of an hour so that the medicines would not pour out.
Things had moved on by the eighteenth century. We see in this period the earliest beginnings of the eye examination for purposes other than surgical intervention or the administration of drugs.
Look at our picture to the left from a print originally in the BOA Museum but since transferred to the Royal Collection. This French lady's voluminous dress almost conceals her chair but enough is visible to show that it features some kind of mechanical adjustment, possibly for assisting the accurate measurement of visual acuity using the contraption in front of her.
For another century or so most sight-testing was performed using ordinary chairs, or even with the patient standing at a counter.
Two considerations affected the design of chairs from the very late nineteenth century onwards. One was the matter of adjustment to place the patient in a suitable position to be tested. The other, perhaps more important, was how to attach various accessories to the chair so that the optician could reach for the appropriate instrument without having to get up.
Some opticians purchased dental chairs, but a possible problem was that these might invoke fear in the patient.
Purpose-designed ophthalmic chairs
In 1927 Leonard Crawford FBOA, an ophthalmic optician and lecturer from Bradford, proposed his own design for an improved optician's chair. His hobby was, after all, mechanical engineering. As was commonly the case an instrument maker, in this instance J & R Fleming Ltd of Clerkenwell, worked with an inventive practitioner to produce a viable commercial product. The illustration shows that it had fitments to the arms to attach a case of trial lenses. It does not look especially comfortable, the head rest was only an optional extra, but its fine oak construction won many admirers and it was considered superior to the market leaders, the De Zeng and Wellsworth models of chair, both imported from the USA. Notably the supplier claimed that, as the chair was manufactured in its own workshop, 'individual refinements that may be desired by purchasers can be incorporated'. (The Optician and Scientific Instrument Maker, 28.10.1927).
Another upright chair was the Gray's Refraction Chair, obtainable from Newbolds. This had a choice of two adjustable head rests which slid vertically and also a single centrally-placed leg to the rear so that the optician would not stub his toe whilst working around it.
You may click on the image of the advert for the Gray's chair to enlarge it.
It's really quite instructive to observe the item on the left supplied by Levers. It is called a 'Patient's chair' but is designed entirely for the convenience of the practitioner, with a refracting unit suspended from an anglepoise bracket and a swivelling trial case fixed to to the right arm. Note how these two items of equipment would effectively trap the patient in the chair until the optician chose to move them. This would not have helped in the event of a nervous patient.
More comfortable, but equally imprisoning would be the Calthorpe chair, named after a road in the Islington area of London (within the optical manufacturing district).
This adjustable chair represents a state-of-the art piece of practice furniture from the 1930s, though it appears to have been modified over a period of subsequent years. It has a hydraulic pump action, operated by a foot-pedal. With this and its heavy round base the chair is similar to that used by dentists or barbers. In fact it was used by an optician Mr Bernard Miles who obtained it from the supplier Ellis Optical Company and used it for several decades. The metal frame was covered in black vinyl with padded armrests although the twin round headrests, almost like a pair of earphones, appear less luxurious than the rest of the chair. A high stand is attached to the chair bearing a British Refracting Unit (B.R.U) in cream-coloured metal. In fact, inspection suggests that this object was originally all cream-coloured metal but the exposed metal parts of the chair have been coated in a silver paint. Did the practitioner prefer it like that or was it a conscious attempt to 'update'?
In the later twentieth century it became the common practice for dentists to recline their patients more fully. This led to a classic joke: Optometry remained upright whilst dentistry went backwards!
On the left is an advertisement from a Lever Brothers catalogue proving that these multi-purpose 'surgical' chairs were still targeted for sale to optical practices.
Chairs were now designed ergonomically to ensure maximum comfort for the patient, whether in the elevated or reclining position. In some cases the associated equipment might be designed so that the seat could be moved away, for example when a wheelchair user did not want to leave their chair during an examination. Washable materials were also favoured as such chairs could take a lot of daily punishment.
The standard patient chair can be adjusted in height by motor drive. Its seat and back are shaped to suit the body. The head support is integrated and the lumbar pad has been incorporated. The backrest can be tilted by approx. 20 degrees, its upper section locks automatically in place at 90 degrees.
(From a description of the 'Optiline' chair for examination, refraction and contact lens fitting by Herbert Schwind Optical Instruments of West Germany, 1980s).
By 1995 there were many types of chair on the market including rather plush executive styles or this Italian version, supplied in Great Britain by Carleton Optical, which appears more reminiscent of ordinary office furniture. That very ordinariness may be helpful in making the patient feel at home.
And where will the optician sit?
Having seated their patients comfortably, optometrists themselves have often favoured stools so as to have maximum freedom of movement about the patient. This typical example on the right is from 1957. We know that some practitioners even had colour-coded stools, e.g. green for the optometrist and white for the patient. When faced with an unfamiliar piece of testing equipment such as a Gullstrand slit-lamp it could be helpful for the patient to be directed to sit on the white stool.