Whereas last year’s Optrafair Question Time saw feisty exchanges between representatives of the independent and multiple sectors, the 2016 edition saw cool consideration triumph over heat.
This year’s debate, entitled The Future of Technology in Practice, could not have been more timely just a month after the Foresight Project Report was released.
Online refraction, virtual reality, handheld OCT and smart contact lenses were just some of the issues thrown up by the 194-page Foresight report, providing food for thought at Question Time and across the whole exhibition hall.
However, as we’ll see, the comments of Joshua Silver, professor of physics at the University of Oxford, on the application of corrective eyewear sparked most reaction at the Main Theatre venue.
BBC disability affairs correspondent Peter White was again called upon to chair Question Time this year, perhaps hoping for a more straightforward afternoon after 12 months ago refereeing heated debate over the merits of free eye tests and advertising techniques.
Progress in optics
Introducing the debate, he said: ‘We are living at a time when real progress is being made in halting and in some cases reversing sight loss and technology is playing a big part in all this.’
The panel was then asked if they expected robots to replace the role of the practitioner.
Julia Manning, chief executive of the 2020 health think tank commissioned by optical bodies to produce the Foresight report, emphasised that technology was an opportunity.
‘But the community can’t stand still,’ she said. ‘You can’t carry on doing what you’ve done in the same way. There are lots of ways in which you can harness technology to improve the quality of what you do, but you do need a different model of working.
‘Across health professionals we are going to a see a shift in the boundaries between the professions as we currently know them. We don’t actually have the set-up that is required to deliver quality care in the future.’
Ophthalmologist Andrew Bastawrous, said each part of the world had its own technological requirements. He said he had been leading a major eye disease study in Kenya to develop and test the ability of smartphone-based tool Peek to detect eye diseases there: ‘Technology is undoubtedly an opportunity in those countries where people who are not accessing eye care are based. It only becomes a threat if people are standing still, so everyone is going to need to up their game,’ he said.
[CaptionComponent="2557"]Prof Silver, who has created several prototypes of self-adjustable eyeglasses since the mid-1980s, said that the vigour with which new technologies were rolled out should depend on the local needs.
He added: ‘We should welcome all technologies that actually work, but you should insist that any technology anyone wants to introduce is fully clinically tested. I created my technology for under-served populations and in some countries it is estimated that people would have to wait 200 years if they were to see an optometrist. If you want to give them clear vision you have got to find another way.’
Practising optometrist Gillian Bruce said patients find the use of technology within practice a reassuring sign.
She said: ‘We have to embrace technology as optometrists but we also have to tap into our personal skills so that we can communicate what we’re seeing – and that’s where technology is our friend.’
Befriending technology
Specsavers director of optometry advancement Paul Morris added: ‘In any research we’ve done on technology what it always comes down to is the skill of that clinician in the interpretation of the [eye test] results. With product in mind, we are in a very fluid situation in terms of the advent of 3D printing and the ability of the patient to take ownership of their own purchase. It’s possible today to order glasses online, as we all know. However, it may soon be possible to print out your own lens and assemble a frame.’ He said there would always be people looking for an individualised look, but urged caution.
‘Anything we do as a profession must be progressive but it must keep the patient in the centre, so the patient and the market can decide what they want from the product. What we must make sure is that we make ourselves indispensable to that patient in terms of quality eye care that’s accessible to all.’
A sound investment?
But what technology should practitioners invest in for the best return? One delegate at Optrafair said equipment with little life span can cost thousands of pounds.
Bruce, an independent prescriber based in Scotland, responded: ‘When you are using technology you have to make it pay. It has to be of value to the patient and add value to what you’re choosing to do.’
Morris said it was clear that OCT was going to be a major part of primary care, particularly for management of conditions such as glaucoma, age-related macular degeneration and diabetes in the community.
He said: ‘OCT is here to stay. There’s lots of “snake oil” out there and lots of things that perhaps might be useful on a small demographic of patients. But, of course, before you make that sort of capital investment you need to be assured that those community services are forthcoming, and at the moment I am yet to meet anyone who can tell me when that will be.’
Morris called for integrated patient records that can travel with patients to improve the link between ophthalmology and community optometry. Less than a dozen trailblazing areas were getting close to this model though, in part due to a lack of access to IT funding in optics.
‘At some point, if access to IT funding doesn’t arrive then we’ll have to make a decision as a profession to invest ourselves,’ he added. At the moment, it was suggested, ophthalmology was the gatekeeper to such technology.
[CaptionComponent="2558"]Bastawrous said: ‘I see this the world over, it is about territory because everyone wants their own thing. That applies to both optometrists and ophthalmologists.
The key is how do we find a way to work together to serve the demands of our patients. For me it is obvious that the closer this is to home the better it is for the patient and the more that relationship builds the more services are going to move out into primary care.’
In Scotland, Bruce noted there was a GOS contract inviting patients back for repeat visits – with 13% of optometrists in the country qualified in independent prescribing. ‘We already have a system that we’ve taken up north and it’s working brilliantly,’ she added.
Prof Silver then turned the focus on the 50 million people with preventable blindness throughout the world. He estimated that half the world cannot see properly because vision correction hasn’t been prioritised.
‘As a physicist I find it interesting to look in on the world. Some of the NGOs say they are really dealing with eye health, and others are dealing with refraction issues. But I look at it a different way and ask why don’t you ask how well people can see and deal with that.
‘I also see a deal of control in accessing the funds to deal with this, which goes to the medical side and what they want to see happen. This is towards eye health rather than helping people to see clearly and it puzzles me,’ Prof Silver said.
DIY vision care
While smartphone technology was now allowing certain eye tests to be done outside of practice, Bastawrous said it was not sufficient without a clinician’s input to reassure patients. He added: ‘My personal experience is not the best way forward because ultimately you need to be engaged with a professional.’
Prof Silver, who explained that as an atomic physicist he was not qualified within eye care, instead took the debate onto adaptive eyewear, even providing a demonstration in the theatre location.
‘You have to make a distinction between eye health and correcting refracting error,’ he said. ‘You don’t need a smartphone to correct your own refractive error. All you need to do is put a pair of [adaptive] glasses on like this and adjust them using a reading chart. At the end of that I have created glasses that have given me slightly better than 20/20 vision and cost a few dollars.’
Concern was expressed across the floor that allowing people to do their own eye tests would lead to conditions going undetected. ‘There’s more to it than putting a pair of glasses on and twiddling the dials,’ said one delegate.
‘I didn’t say you don’t need to screen people for eye health, of course you do. But you can achieve good acuity with eyewear you can make yourself very cheaply, but of course you still have to have provision of eye care – and that’s a challenge,’ responded Prof Silver.
Morris, also the ophthalmic director of Specsavers Opticians in Bridgend and Porthcawl, emphasised that the UK sight test was protected by law.
He added: ‘That sight test is not only there to assist people to see more clearly but also to protect the patient’s health by an examination of the internal and external features of the eye.’
Therefore, while DIY testing cannot be ignored, optometrists and dispensing opticians who embrace the full range of eye care technologies will continue to be known as the experts.