I was chatting to an optometrist the other day who was reminiscing about ‘the old days’. It made me realise just how far this profession has come clinically in the past 40 odd years. He reminded me that it was really only at the start of the 1980s that optometrists began routinely checking intraocular pressure.
The thought of carrying out Goldmann routinely was a bit extreme, so the use of ‘palpation’ was the norm. Look it up if you don’t know what it is. Visual field testing involved the patient looking at a white button in the middle of a black cloth and indicating when they saw another white dot coming in from the side. Retinal viewing was via a direct ophthalmoscope, coined ‘the guessing tube’.
The scope of practice was so much more limited and our ability to spot different forms of pathology in the earliest stages even more so. That being said, the ophthalmic optician, as they were known back then, still managed to do a very proficient job despite the limitations.
Over the intervening years, we as a profession have always embraced new innovations with great ease. Each step forward for us has meant a great leap forward in what we can do for our patients. The innovations have been too many to mention in this one article.
Possibly two of the biggest steps forward to date have been optical coherence tomography (OCT) and the introduction of ultra-widefield (UWF) retinal imaging. While the profession was quicker to embrace OCT imaging, UWF imaging has been around for over 30 years.
Now we see its introduction into mainstream optometry, with one of the major multiple groups now embracing the technology – something they are to be congratulated for, given the major diagnostic improvement this will bring for their patient cohort. These technologies are now tried and tested and have proved their worth through many published scientific papers, but is all new technology good?
Like many industries, we are currently learning the potential benefits artificial intelligence can bring to us to the eye care profession. Companies, such as Altris AI, are leading the way in the use of this exciting new technology and we will undoubtedly see more advances as time goes on.
However, much as we have been willing to embrace each new phase of advancement, is there a risk that sometimes we find ourselves in a position where we are guilty of being over-keen in a genuine desire to help patients?
Immediately springing to mind is the episode a few years back where it was popular to prescribe blue tinted lenses and, at the time, many claims were made for their benefits, which subsequently were shown not to be substantiated. So, it was with interest that I happened across two things that seemed to coincide.
The first was a post on LinkedIn by an optometrist rightly very proud of their new practice and one of the major new installations within his practice was an instrument for the treatment of dry macular degeneration using the new technology of photobiomodulation (PBM).
Such innovation and introduction of such technology into a practice is to be congratulated and welcomed. That is, if the claims made for it are truly achievable.
The next email I opened was from Medscape Ophthalmology Journal entitled ‘Was a novel eye treatment approved too soon?’ In this article, the venerable ophthalmologist Srinivas Sadda, a retinal specialist in the US, called for more data on this treatment before clinicians can ‘confidently’ recommend the device to their patients.
He expressed reservations about the results of the latest studies and concluded by saying: ‘Treating physicians should seek and receive answers to these questions to increase the possibility of providing the best possible advice to patients. More data must come to light for physicians to recommend PBM to patients confidently.’
On the surface, PBM appears to be a brilliant breakthrough in the treatment of dry age-related macular degeneration and it is noticeable from a quick internet search that some of our leading practices in this country have embraced the technology. That this is a good thing to do would seem to be borne out by much of the evidence published so far.
But we must always be more aware of what is being said around new technologies and not run the risk of making claims that may not be possible to fully substantiate.
It is vital that the information we give to patients to allow them to fully consent to any treatments is of the highest quality and accurate in its claims. It is also important that, in introducing these new technologies, we ensure we always comply with the GOC Standards of Practice for Optometrists and Dispensing Opticians.
There can be no doubt that we, as a profession, often lead the way in embracing new technology. That must always be to our credit, but we must always bear in mind that being on the cutting edge does have its responsibilities.
That being said, I would rather be here than where we were in the 1980s.
