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HomemicontactPlanning For Future Trends

Planning For Future Trends

In 1965, Alvin Toffler coined the phrase ‘future shock’. Now half a century later, I dare say we are firmly in the grip of it.

I discovered a first edition hardback copy of Toffler’s legendary 1970 book, Future Shock1 at my parent’s house while lecturing at the re-launched Contact Lens Society of South Africa, ‘Contact Connect’ conference. The meeting was a great success. The well travelled, respected, overseas speakers absolutely loved their time in South Africa. They rated the conference one of the best they’ve ever attended, anywhere, as they did their time on safari. Delegates too rated the speakers and conference very highly. Full credit to the conference committee. If any of you want a good excuse to see South Africa, keep an eye out for the 2019 meeting.

Future Shock was gifted to my Dad, in October 1972 by Thomas E Eichhorst, legal counsel for the American Optometric Association. He’d been visiting South Africa and providing guidance to the South African Optometric Association.

We are now half a century into Toffler’s future shock. I dare say we are firmly in the grip of it. In his introduction he stated; “I try to show that the rate of change has implications quite apart from, and sometimes more important than, the directions of change”.

Certainly technology, the internet, social media and big data have accelerated the rate of change – one could say at light speed – as our data is exchanged, accessed and processed via fibre optics.

Where are We?

When I qualified as an optometrist in 1981 we were only just seeing the first autorefractors and electro-optical instruments. Today, some of our laser driven instruments harness light-speed and access amounts of data and detail only dreamed of a few years ago. We have instruments that operate in the femtosecond domain and nanotechnology is quickly becoming part of our vernacular.

My grandfather, father and I, over three generations, moved with the evolving practice of optometry. For my grandfather, optometry was largely about refraction and being an expert in spectacle dispensing. My Dad added contact lenses as a new, speciality area to his practise in 1957. During my time I have experienced a broadened medical scope, thanks to diagnostics and new technologies like computers, fundus cameras and topographers. Today we are rapidly reaching the point where an optical coherence tomographer (OCT) with fundus autofluorescence (FAF) and laser-scanning ultrawidefield retinal imaging are fast becoming the standard of care, with much more to come.

Whereas the ‘traditional’ optometrist of the recent past took great pride in being an expert dispenser – performing individual frame selections, delivering and expertly fitting spectacles – today’s optometrist rarely does this or even has the skill or inclination to do so.

Commercial optometrists may churn out a spectacle Rx every 20 minutes. The ‘lucky’ ones might get 30 minutes per eye exam.

Those that prefer ‘longer’ 30-minute consultations tell me they are pressured to drop that patient contact time to 20 minutes, to improve turnover. Some tell me they hate their job.

These practitioners in general do no pretesting, which is performed by assistants or technicians. They also hand over the spectacle Rx to qualified or unqualified dispensers for action and take in the next refraction.
The same can be said for some independents. There are however, still those who enjoy the fashion and dispensing side of things. Some add value to their patient contact time by performing the pre-testing themselves.

The majority of optometrists are now therapeutically (TPA) qualified and increasingly and enthusiastically practise in this direction. OCT, wide-field imaging and topography form the basis of much discussion in online educational forums and at conferences.

Shifting Sands

So called ‘Optometric Physicians’, (US ODs) are even further down this path. Many are pushing for and embracing wider scopes to include laser surgery and ‘cutting’ with surgical instruments. I foresee the day when ODs become ‘needle jockeys’, administering anti-VEGF drugs, as retinal specialists tire of this ‘boring’ procedure.

I’m however of the opinion that if these optometrists want to be ophthalmologists they should have studied ophthalmology.

The art and science of optometry is continually evolving, with a strong shift toward science – but the art is still alive in things like contact lenses, dispensing and the psychology of dealing with and communicating with patients.

We covered some of these aspects at the aforementioned Contact-Connect conference.

Optometry is suffering from future shock… Interconnected telemedicine kiosks, that can refract and image the eyes and retinas, are also appearing. They can spit out an Rx and potentially, spectacles and contact lenses too

Optometry is suffering from future shock.

Practitioners increasingly suffer from burnout – success and compassion fatigue.

We keep handing over our core skills to others while taking on things that were (and still are) traditionally performed by ophthalmology and other branches of medicine. Traditional refraction could be replaced by hand-held aberrometers, which are already being used in the marketplace. Interconnected telemedicine kiosks, that can refract and image the eyes and retinas, are also appearing. They can spit out an Rx and potentially, spectacles and contact lenses too. The Internet does and will increasingly, offer such services.

I’m not exactly sure where optometry will be in the future.

Are you?

Current Trends

For now myopia control seems to be one of the biggest developments, of which optometry currently has ownership. We need to be on that bus. However once ophthalmology wakes up to the fact that laser refractive surgery can sculpt the cornea – to provide customised aberration controlled corneal profiles, to tailor retinal focus and eliminate hyperopic defocus – it is likely that this could become the main stream of myopia control; along with drug, diet, environmental, and genetic methods of control.

How often do you see LASIK patients’ progress in myopia? Their oblate corneas are not too different to those created by myopia-controlling OrthoK.

Emerging Trends

In the next years it is likely that optometry will become more involved in screening for, detecting, diagnosing and monitoring things like Alzheimer’s disease (AD), Parkinson’s and other neurological conditions. A recent paper Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease by Koronyo et al, compared histological evaluation, scanning laser ophthalmoscopy, detection of curcumin fluorescence and hallmark amyloid β-protein (Aβ) deposits. They concluded, “The feasibility to non-invasively detect discrete retinal amyloid deposits in living patients, may lead to a practical approach for large-scale AD diagnosis and monitoring”.2

Coming soon to a practice near you; via a high resolution AD-enabled FAF, OCT?


Optometry can and does provide many services for significantly lower fees than ophthalmology, thus making it more accessible to patients. The downside of this is that it is harder for optometrists to afford and finance the expensive technology required. This is especially so when after just a few years that fancy equipment becomes an expensive boat anchor.

We are all too familiar with such obsolescence, with for example, computers and smartphones. This is another cornerstone of Toffler’s future shock. He said, “Rapid obsolescence is an integral part of the entire accelerative process – a process involving not merely the life span of sparkplugs, but of whole societies”.
One could also say that the move by so many optometrists to upskill into therapeutic practise was their way of avoiding obsolescence… it won’t be long before non-TPA practitioners become unemployable.
No matter what the future holds, passionate, proactive practitioners will always be looking forward and implementing the latest state-of-the-art future technologies, in order to stay ahead of the game.

Enjoy the ride on the ever-accelerating, rollercoaster treadmill of modern life.

1. cdn.preterhuman.net/texts/literature/general/Alvin%20Toffler%20-%20Future%20Shock.pdf

2. www.ncbi.nlm.nih.gov/pubmed/28814675