Faced with an ageing population and increasing eye disease, Australia’s eye health resources are being stretched to capacity. Fortunately, we have technology on our side, as well as ambition to innovate and a willingness to collaborate in the provision of world-leading care.
As we propel headfirst into 2025, mivision invited some of our leaders in eye health to do some crystal gazing, and report back on how they see the near future unfolding.
Collaborating in Care
Dr Jacqueline Beltz, Ophthalmic Surgeon
A
s demands on healthcare continue to rise, collaboration among eye health professionals is crucial to meet the growing needs of our communities. Early detection is key to preventing and treating many eye conditions, and working together as ophthalmologists, orthoptists, and optometrists is essential to providing the highest quality care, especially in remote or regional Australia. Whether through shared premises or improved communication across practices, the future of eye care depends on teamwork and streamlined processes.
One major benefit of collaboration is improving access to eye screenings. By pooling resources and expertise, we can reach more people, offering screenings in convenient locations. This helps detect issues like glaucoma, cataracts, and diabetic retinopathy early – when they are most treatable – and prevents unnecessary vision loss.
A shining example of successful collaboration is the Lions Outback Vision Van. This initiative integrates care across health, corporate, and community sectors, providing services to areas where existing hospital facilities and Aboriginal Medical Services in Western Australia fall short. The Vision Van’s team delivers comprehensive care, avoids duplication of services, and focusses on building local capacity by upskilling and training local health workers. This model exemplifies how partnerships between community, corporate bodies, and government can address increasing demands.
Effective communication between eye health professionals is another critical factor. Clear communication reduces unnecessary or duplicate investigations, ensuring patients receive accurate diagnoses and timely treatment.
Ongoing education for all professional groups is vital to fostering excellence and innovation. Platforms like GenEye (an annual conference) bring ophthalmologists, orthoptists, optometrists, medical students, and junior doctors together for immersive training in eye health, patient communication, and professional wellbeing. Ophthalmology and optometry societies must continue working to make such educational opportunities more accessible and impactful.
Co-management is another evolving area of collaborative care. Educational bodies like RANZCO (Royal Australian and New Zealand College of Ophthalmology) devote significant resources to developing evidence-based, patient-focussed guidelines that clearly define the roles of different providers. These guidelines ensure timely access to the appropriate healthcare professional while avoiding over- or under-servicing.
By embracing these methods of collaboration – shared screenings, communication, education, and co-management – eye health professionals can shape the future of eye care, delivering more efficient, effective, and equitable care for all.
Ongoing education for all professional groups is vital to fostering excellence and innovation
Intervention Analysis in the Real World
Professor Mark Gillies, Retinal Ophthalmologist
Implementing systems that use treatment outcomes to drive improvements in health care on a large scale is becoming increasingly feasible with advances in information technology and data science. Medicine has traditionally relied on quality assurance measures, such as certifying health workers’ training, and testing (some) treatments in the scientific environment of randomised clinical trials.
Medicine has not rigorously evaluated the outcomes of treatment in ‘real world’ practice, largely because this has been difficult to do; paper-based medical records are difficult to analyse and electronic health records (EHR) have not systematically stored data in an accessible way.
The Fight Retinal Blindness! (FRB!) Project, flagship of the Save Sight Registries, is an Australian-based initiative that has helped doctors in 22 countries track the outcomes of their own patients. This activity vastly simplifies self-audit activities that are required for continuing profession development, and in turn, for their registration as medical practitioners.
The project has used the accumulated data for national and international analyses that have produced dozens of high impact publications, including the first to establish that the treat and extend regimen was the best way to treat patients with neovascular age-related macular degeneration in ‘real world’ practice. One of the barriers to FRB! becoming more widespread is that doctors still mostly have to enter data into the registry and their EHR separately.
We are on the cusp of an era in which treatment outcomes data will be seamlessly transmitted, at the discretion of the treating practitioner, for continuous analysis of whether patients are actually benefiting from treatment. This will require increased interoperability of electronic medical records (EMRs), which are generally not designed to download patient data. This can now be achieved through systems such as HL7’s Fast Healthcare Interoperability Research, which can transmit data directly from EMRs to outcome registries.
Such interoperability has largely been achieved in the United States, however the data that is available is of poor quality because important information noted by the doctor at the consultation may not be written down in the EHR. One current solution to improve the quality of real world outcomes data is to make a minimum number of fields mandatory. Future developments will include the ability for large language models, such as ChatGPT, to analyse doctors’ letters, and AI algorithms to independently analyse clinical imaging.
It is only a matter of time before we arrive at a healthcare system that continuously tracks the outcomes of the interventions it provides as well as the effect of any corrections it applies. This is likely to significantly enhance patient outcomes much more cost-effectively than developing new drugs.
It is only a matter of time before we arrive at a healthcare system that continuously tracks the outcomes of the interventions it provides…
Future Innovations
Professor Gerard Sutton, Ophthalmic Surgeon
I think there will be two important and potentially disruptive developments in ophthalmology over the next five years.
There will also be continued rationalisation of health care delivery with currently available technology.
Artificial Intelligence
This will not come as a shock to anyone practising medicine. Artificial intelligence (AI) will continue to improve capacity in diagnostic interpretation in retinal, corneal, and glaucoma disease. It will lead to efficiencies in treatments and healthcare budgets. One example that one of my PhD students, Nicole Hallett, is working on, is using AI to diagnose keratoconus in the earliest stages. More importantly however, will be the capacity to diagnose keratoconus progression very early and without ophthalmologist or optometrist input. This will lead to early and sight-saving intervention with collagen cross-linking.
AI, in conjunction with telemedicine, will also help us overcome barriers that cause significant variation in health care delivery in many areas, including eye care. Waiting times for cataract surgery, for example, can vary enormously between urban and rural and remote areas. Indigenous patients can face barriers that are financial and cultural in addition to the tyranny of distance for health care. The sophistication of telemedicine, together with AI diagnostic capacity, will help address this issue. One recent example is the Sydney Eye Hospital Foundation establishment of the Gadigal Eye Clinic at Sydney Eye Hospital, acting as a hub with remote spokes connected by telemedicine: a ‘Tele-Vision’ initiative.
Bioengineering, Cell-Based Therapy, and International Leadership
This focus may represent my bias after receiving an AU$35M grant to develop a bioengineered cornea from the Medical Research Future Fund. Nevertheless, the investment in this area internationally is enormous, with literally billions of dollars seeding this expanding area of research.
As a wealthy country, Australia has enormous capacity to contribute to global eye health research and to reap the benefits. Our world class hospitals and health care, together with our high-class universities, are the foundation for an innovative ‘cocktail’ that has been enhanced by government’s realisation that investment in these areas can provide not just improved healthcare but a financial return for Australia.
Currently Israel has the world’s highest number of innovation patents per head of population. Why can’t Australia, with all our advantages, be an innovation world leader, developing new treatments and exporting them to the world?
Why can’t Australia, with all our advantages, be an innovation world leader, developing new treatments and exporting them to the world?
Future Gazing in Myopia Management
Dr Kate Gifford, Optometrist and Founder of Myopia Profile
Future gazing in the field of myopia management is a fascinating task, especially with the recent biennial International Myopia Conference (IMC) still fresh in my mind. Taking place on Hainan Island, China, in late September, this IMC was epic in scale, setting, heat and humidity(!) and scope. In the seven years that I’ve been attending IMC conferences, they have tripled in size due to a convergence of scientific, clinical, and industry interest. In a world where myopia is on the rise and rise, including in Australia, it is my hope and belief that this widespread awareness and engagement with the importance of myopia management will continue to grow.
Over 400 new pieces of research were presented at IMC, around the key themes of myopia prevention, treatment, and developing technologies.
I hope to see myopia prevention become an increasingly key part of clinical care, with recent knowledge indicating that a one-year delay in myopia onset is as potentially valuable as two to three years of a myopia control treatment in reducing a person’s final level of myopia.
With optometry playing such a strong role in preventative eye care already, especially in chronic ocular or systemic disease, it makes sense to turn attentions more to myopia. A smorgasbord of treatment options is being shown in research: from greener school landscapes to low-dose atropine, red-light therapy, and the first data presented on myopia control spectacles (highly aspherical lenslets). Perhaps most gasp-worthy was the ‘outside scene classroom’ – imagine a nature scene of a blue sky with clouds and birds on the ceiling, and a forest of lush trees wrapped around all four walls as a realistic painted scene. In China, research has shown this special classroom can protect against myopia development as effectively as increased outdoor time or some concentrations of low-dose atropine. It does bring pause that the world of today’s child necessitates trees painted on walls more so than actual trees.
Once the myopia horse has bolted, changing the visual environment doesn’t seem to have the same universal impact on slowing progression, but we have a plethora of powerful optical, pharmacological, and light treatments for this important task. Now, and in years to come, we’ll continue to see more supportive evidence for our currently available treatments, as randomised controlled trials are followed by larger volumes of real world data. New treatments aim to provide more options for accessibility and optimum outcomes, which we’ll learn more about in the time ahead.
It is ophthalmology that will increasingly care for the ocular diseases of myopia, and interprofessional collaboration is key to early diagnosis and successful care in preserving vision. The future of myopia management will bring us big data and AI-driven analysis of retinal imaging to identify those most at risk; plus novel treatments if animal models on gene therapy and scleral cross-linking translate to humans. Together, we’re all in the business of protecting sight and eye health, whether this be starting the conversation at age five or setting the co-management plan at age 56.
… in years to come, we’ll continue to see more supportive evidence for our currently available treatments
Multi-disciplinary Models of Care
Skye Cappuccio, CEO Optometry Australia
As we approach the end of 2024, the national cost-of-living crisis and growing signs of workforce oversupply continue to challenge the optometry profession, with impacts expected to carry into next year.
Amid the challenges, we also observe encouraging trends, with movements towards collaborative and multidisciplinary care continuing apace. We are also actively working to foster increased integration of optometrists with public health settings.
In the short term, we also anticipate we will see more optometrists working more consistently to their full scope of practice in response to community needs. Over the medium to longer term, this is likely to lead to more optometrists choosing to focus and extend their clinical experience and expertise in particular areas, complementing our strong and well-established generalist workforce.
The focus on myopia and dry eye management strategies is also expected to continue as the prevalence of these conditions continues to increase. Optometrists will increasingly utilise and expand options to support their patients and communities in managing these conditions.
These are trends already underway. It’s crucial that we work collectively to shape them in ways that benefit both communities and the profession. The parallel pursuit of key enablers, including new funding models that support full-scope eye care and digital health tools that promote collaboration and information sharing among healthcare providers, is critical.
We also expect advancements in AI-enabled clinical and practice supports and digital health tools to continue apace. These offer new opportunities but come with a responsibility to ensure they are adopted and integrated in ways that facilitate timely patient access to quality care.
In 2025, as optometry’s professional association, Optometry Australia will actively pursue meaningful Medicare billing changes to enable Australians under 65 years old to access rebates for eye care more frequently and in line with best practice; building community awareness to ensure more children and their families access regular eye care; and embedding our Advance Practice Recognition program.
It’s crucial that we work collectively to shape them in ways that benefit both communities and the profession.
Smart Technology
Paul Johansson, Xocchiali
As we look ahead to 2025 and beyond, the eyewear industry is poised for a transformation, driven by advancements in technology and shifting consumer behaviours. One of the most prominent macro trends is the growing integration of technology into our everyday lives, often in ways we barely notice. Our increasing reliance on digital devices is having a significant impact, not only on our mental and physical health but also on our eyes. The average person now checks their phone more than 150 times per day, contributing to issues like digital eye strain, disrupted sleep, and poor posture.
Over the next five to 10 years, eyewear will evolve from a simple tool to correct vision or protect from the sun into a fully integrated, intelligent wearable. Smart eyewear won’t just enhance how we see, but how we live. Technologies such as augmented reality (AR), AI, and biometric monitoring are expected to be part of this evolution, enabling wearers to access important information seamlessly while staying engaged in the real world.
The future is an opportunity to redefine the role of eyewear in the digital age – but we need to balance the trends of the digital world with the needs of the real one. Successful solutions will support vision correction and protect the ocular system, while also helping people live healthier, more connected lives through thoughtful, integrated technology.
The future is an opportunity to redefine the role of eyewear in the digital age…
