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Tuesday / August 9.
HomemicontactTime Marches On

Time Marches On

If there’s one thing for certain, it’s that nothing stays the same. In optometry, it pays to keep looking forward.

In the general optometric world we continue to see major changes in the eye care industry as the evolution of the professions continue. In the US opticians are gaining the right to refract and prescribe spectacles while the online threat, globalisation, massive mergers and the march of the chains continue unabated. App based refractive devices and those promoting them as ‘optometrist replacements’, seem to be gaining traction. The threat this poses is of concern to many. Technicians armed with smartphone-linked, handheld, aberrometer based ‘autorefractors’ are touted as a fast, mobile way to spit out a prescription that can then be filled online or potentially to drive traffic to bricks and mortar providers.

Such things seem to be giving many in the professions the ‘heebie jeebies’.


Already in Sydney we are seeing kiosk based ‘eye examinations’ that are linked to ‘specialists’ who review OCT, imaging and other data provided by the kiosk. Direct referrals for further investigations for any suspect findings are then executed. I am aware of at least one case where such a kiosk-based evaluation resulted in a referral to a retina specialist who confirmed active, potentially sight threatening pathology. In my view, that’s a positive thing; it increases the potential for prompt diagnosis in people who shun the traditional channels. In saying that, there are those who consider this the thin edge of the wedge, before such kiosks generate spectacle and contact lens prescriptions. This is currently illegal in Australia, however, as we are seeing in the US and elsewhere, such ‘protective’ legislation can be changed by lobbyists with big money behind them.

Already in Sydney we are seeing kiosk based ‘eye examinations’ that are linked to ‘specialists’

Niche PractiCe

This is all the more reason for optometrists to find specialist niches in their practice and charge proper fees for service – a mode of practice differentiation I’ve espoused for decades.

Recently, Margaret Lam stated (mivision June 2017) that in general, we don’t refer enough cases to low vision specialists. The question you should ask yourself is whether or not this is a good subspecialty niche to develop? Instead of referring, develop your skills and take it on yourself. Along with myopia control and dry eye, low vision is an excellent mode of practice that can be very rewarding. Providing much needed services, in an under-resourced arena, is a no brainer: there are way too few low vision specialists.

Mark Koszek also explained in his article (mivision June 2017), how Ortho-K had rekindled his passion after it was doused by the monotony of twiddling phoropter knobs.

Some see therapeutics as a niche practice area, but these days the majority of practitioners do a good job in this field, so it’s really part of the broad base of modern optometry. Specialising in glaucoma management, however, can become a niche, free from too much competition.

Rural optometrists must be able to provide a wide range of optometric services and we see that they too are becoming more exposed to the threats of commercialism: the chains increasingly seem to be opening up ‘stores’ in rural towns, where patients traditionally only had access to one or two independent practitioners.

Some of these independents are now hurting.

What Goes Around…

Even the chains are worried about the threat of online spectacle and contact lens providers. Some chains are attempting to counter this with moves into audiology and the provision of hearing aids and other revenue streams.

Whether you choose contact lenses, low vision, Ortho-K, myopia control, glaucoma or dry eye, there’s a lot of specialised skill that needs to be developed. Specialist equipment, the space to set it up, networking, marketing and the necessary support staff can be quite costly. It therefore pays to have a well thought out strategy before simply jumping in boots and all. Skills can be obtained from CPD events, tutorials, workshops and from passionate mentors.

In the long term, speciality practice can shield you from the competition and the threats we face.

They say that history is written by the victors. Think it through and choose your niche in order to not only survive but thrive. Be one of the passionate, successful practitioners of your generation: write your own chapter of the history of our great profession.

Searching for Game Changers

Over the past few years we’ve seen some ground-breaking contact lenses launched, although it’s been a bit anticlimactic since. Range extensions and reworking of existing lens portfolios have dominated the market this year.

CooperVision’s MiSight lens and the evolution of myopia control has been the most interesting development. Considering that MiSight has already been in limited trials for around seven years, it is hardly ‘new’. That said, the promising myopia control statistics associated with MiSight – presented at the recent British Contact Lens Association (BCLA) meeting in June – will likely mean that this method of myopia control will become more mainstream. Such things will be focussed on at the forthcoming ICCLC meeting in Sydney, in September.

We remain all eyes and ears to see which manufacturer can bring us another game changer.

Speaking of game changers, another highlight of the BCLA conference was the awarding of the inaugural ‘President’s Award for Contact Lens Excellence’ to our very own myopia queen, Kate Gifford.

Congratulations Kate.

Efron: Contact Lens Practice

I was pleased to get my hands on a copy of the third edition of Contact Lens Practice, edited by Nathan Efron AC, DSc, PhD, BScOptom, FACO, FAAO, FIACLE, FCCLSA, Professor Emeritus, School of Optometry, Queensland University of Technology.

Nathan is one of the legends of our time and one of the most widely published, cited and respected optometrists. Although he has spent his career in academia, he has lectured widely to optometrists around the world. To his credit, his publications and lectures are largely practical and clinically focussed and he’s been one of my gurus for almost forty years. Not to be confused with his third edition Contact Lens Complications, this latest tome is an up to date text that should be part of any contact lens practitioner’s library. Purchase of the print edition includes a link to the online version via ExpertConsult. This provides an easily accessible, searchable electronic version.

Consisting of six well thought out parts, containing 43 chapters and twelve useful appendices, it covers most aspects of practice. It is likely the most current and up to date text you could find. This is confirmed by the new chapter on myopia control, partly written by the late Professor Brien Holden. There are re-written chapters on keratoconus, orthokeratology, aspects of soft and hard lenses and on obtaining a decent case history. The section on ocular surface management is also nicely up to date and includes many of the latest diagnostic and treatment regimens, equipment and the like, including meibography, MGD management and so on. Although a
book summary claims the text includes the ‘newly described’ condition of lid wiper epitheliopathy, in my view this is hardly ‘new’, as we’ve been covering it for well over a decade.

Many ‘newer’ instruments, such as eye surface profilers, are also covered.

Well written chapters cover, among other things, history, anatomy, physiology, optics, soft and hard lenses, manufacture, care systems as well as sclerals, compliance, modalities and speciality lenses. Nathan has solicited contributions from a wide range of world leaders who have excelled in sharing their love, passion and expertise in the fantastic area of contact lenses.

Nicely done, one and all.

Add it to your library.

Visit www.elsevier.com and search for Contact Lens Practice, Third Edition.


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