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HomemicontactOnwards and Upwards It’s All in the Balance

Onwards and Upwards It’s All in the Balance

It’s crucial that we stay at the leading edge of technology to evolve and expand our scope and abilities, but we must never lose the essential human touch.

The evolution of optometry continues its inexorable march, as we soak up advances in science and technology. Older practitioners will recall the 1980s, when the first electronic instruments were beginning to emerge. Rarely seen autorefractors were among those early Sci-Fi devices. They were not very accurate and subject to wild accommodation-related fluctuations. Optometrists outside of the United States had no rights to prescribe therapeutic drugs. Even diagnostic drugs were a rarity.

there’s no substitute for a decent chairside manner…

Today we are spoilt for choice. Amazing technology seems to pop up at every turn. Digital imaging and computerisation are now the norm across most areas of instrumentation and what we do.

In many areas of practice, however, we find there’s a need to balance high technology with old-school techniques and first principles. Contact lens practitioners around the world use topographers, imaging, optical coherence tomography (OCT), surface profilers, advanced lens design software and algorithms to help guide fitting and management. Yet, at the same time, many still use old-school techniques to fine tune and enhance results. There are many practitioners who don’t yet have access to fancy electronic tools.

Using legacy equipment – a retinoscope, fluorescein and maybe a decades-old keratometer – in conjunction with tried and tested techniques, a skilled practitioner can achieve outstanding results without any help from electronics and automated instruments.

On the other hand, a relatively unskilled practitioner can send electronic files to a contact lens laboratory and end up with a scleral or orthokeratology lens, custom designed and manufactured specifically for their individual patient. The results can be superb. Practitioners involved in the cutting edge of myopia control use the latest, sophisticated, integrated instruments to measure axial length, topography, and thickness of the cornea, lens and sclera. Integrating various other data and analyses helps guide treatment, management and determine success and efficacy, while monitoring progression and changes.


Artificial Intelligence (AI) is being touted, discussed and implemented at every turn. There’s much debate in this area, and as it’s a subject all on its own, I will not do a deep dive into it. Suffice to say, AI will support optometry and ophthalmology by improving diagnosis, management and outcomes, in much the same way as many other technological developments have improved what we do.

You can diagnose a maculopathy with a direct ophthalmoscope – technology from the 1800s, but with OCT, you can also see the potential cause, monitor subtle changes as the condition progresses, and see if a treatment protocol is working. Now, AI adds another layer to help you do all of this much faster, and with greater confidence.

One has to be in it to win it or potentially get left behind as an obsolete dinosaur. What changes over time is the speed of development, image and data acquisition, processing and interpretation.

I saw the benefits of computers, the Internet and electronic equipment early in my career. In the 1980s we pioneered the first desktop computers and practice management software in our practice in South Africa. Bear in mind this was before Windows! Subsequently, in the latter half of the 1990s, we were among the first in the world to integrate our practice in New Zealand with topography, fields, imaging, practice management software, email, Internet, websites and the like, and to great effect. We never looked back and many now emulate and use similar systems.


Despite the myriad benefits, the hightech electronic world can seem cold and inhuman. Patients can be overwhelmed by an impersonal technician speeding through data acquisition and testing, while having their head shoved into weird, uncomfortable positions to capture images… with a barrage of instructions to blink, not blink, open wide, look at the red light or click the button, adding to the stress and confusion, especially for older patients. Dilating drops sting and leave them photophobic, with watery eyes. We follow-up and assault them with bright flashes of light, burnt out retinal images (so they can barely see), along with psychedelic placido rings, flashing red and green lasers, dancing spots of tiny lights they are supposed to see, and many other challenging sensory assaults.

We should never lose sight of the fact that there’s no substitute for a decent chairside manner, compassion, communication, understanding and empathy.

Like most things in life, it’s all about balance.


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