All too often it is assumed that the States leads the way and the UK follows. This has certainly been the case in the last few decades regarding the introduction of retinal photography, firstly analogue then digital, and the use of OCT in optometric practice.
US optometrists were using OCT when many in the UK still considered the technique as ‘ophthalmology only.’ Indeed the very term ‘optometry’ was a US import to replace the description of ‘ophthalmic optician’ still used by some of our elderly patients. This pattern has not always been the model, however.
Firstly, we should never forget the fact that US optometry often cites the legal access to drugs such as mydriatics, topical anaesthetics and cycloplegics in the UK as an early source inspiration for US optometrists to establish their profession, often against strong resistance from US ophthalmology.
Which leads to the second point – that optometry and ophthalmology in the US are often antagonistic. As optometrists have gained increasing responsibility in diagnostics and therapeutics, ophthalmologists have all too often tried to block such moves. This has been all too evident in years gone by to any optometrists attempting to join the American Academy of Ophthalmology annual conference from which they have usually been barred. As the UK, albeit variably depending on where you are based, increases the clinical responsibility of the community-based optometrist, the support of ophthalmology in achieving this has been essential.
Finally, there are differences in the way the FDA approve instrumentation and medical appliances and devices to the way CE marking is achieved. This has led to some surprising trans-Atlantic disparities.
For instance, this year’s AAO conference saw the US launch of the Topcon Maestro – an instrument available to the UK for some years now. Similarly, we have had access to swept-source OCT, not yet a feature in the US.
Furthermore, the interest in OCT angiography seems somewhat stilted in US optometry judging by this year’s conference, and it will be interesting to see how the ophthalmology/optometry relationship influences its incorporation into primary care.