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Monday / May 10.
HomemicontactGood? Different!

Good? Different!

I’m sure we’re all tired of hearing the ‘new normal’ cliché. But even so, it is possible, and very much worthwhile, to postulate on how our professions will evolve without inducing boredom.

The trends toward greater use of telemedicine, remote triaging, algorithms and Artificial Intelligence (AI) are very clear, and expected to evolve rapidly into the future. A number of existing instruments already employ advanced algorithms and, to some degree, AI. It’s likely that new instruments will start making more tentative diagnoses on our behalf. Over the next decade, quantum computers will be capable of crunching tons of parallel data streams to deliver true AI. We’ll look back at current systems and laugh at their relative simplicity.

One of the great things about optometry is how it has evolved. The rate of change is increasing. COVID-19 has accelerated the process

Another trend we see – especially with the tighter hygiene controls surrounding rigid gas permeable trial lenses and COVID-19 – is a swing to more software-based contact lens design and fitting, derived from data and imaging. This can markedly reduce chair time, the number of trial lenses we actually need to see on the eye, and consequently, stress.

In many ways the tightened COVIDrelated hygiene controls now in place were long overdue. People had become complacent after concerns about human immunodeficiency virus and Creutzfeldt- Jakob disease of past decades faded from memory. Better hygiene and disinfection practices will hopefully remain in force as people become habituated to more thorough, all round safety practices and controls. That has to be a good thing.

Wider use of optical coherence tomography (OCT) and superwidefield retinal imaging will continue to dramatically improve standards of practise, as we’ve already seen.

Every now and then, we hear of a case of an optometrist being found guilty of malpractice. This happens in Australia, New Zealand, the United Kingdom and elsewhere, where high standards are enforced. Such scenarios usually pertain to missing glaucoma, or trivialising or not fully investigating flashes/ floaters that go on to become full-blown retinal detachments (RD). Such missed pathology has severe impacts. Apart from needlessly leading to permanent vision loss for the patient, it also dramatically affects the practitioner. As I was writing this column I became aware of another such missed RD in New Zealand. The practitioner was devastated, and in trouble. Use of the aforementioned instruments, coupled with AI, will likely reduce these unfortunate occurrences.

NEW CPD

We’re transitioning into a new era of potentially more equitable and simplified CPD. The old system was too complex, onerous and time consuming. It was also out of sync with the requirements foisted on other health care professionals. It remains to be seen how the new system pans out.

I suggested to some that this would be a good time to get Australia and New Zealand on the same points system. Alas that suggestion seems to have fallen on deaf ears. It’s ridiculous to have two systems when there are often Trans- Tasman educational events that have delegates from both countries. It’s a waste of resources to have to comply with both systems, especially when it may only apply to a handful of people. Maybe, in time, the authorities can talk to each other and find a balanced, equal and equitable points system for our long-suffering practitioners and CPD providers in ANZ and beyond.

Wouldn’t that be nice.

WISH LIST?

I know it’s not always practical or affordable, but apart from our everyday hand-held instruments and fundus lenses, one could really go to town and spend a few hundred grand on nice new toys.

It’s ridiculous to have two systems when there are often Trans-Tasman educational events that have delegates from both countries

If money (and space) was no object, a dream setup might include;

  • Digital motorised phoropter,
  • Digital imaging slit-lamp,
  • LCD chart/variable fonts/programs,
  • Four in one autorefractor/keratometer/ tonometer/pachometer,
  • Next generation OCT with AI,
  • Topography/corneoscleral profiling/tear analysis/meibography/CL algorithm,
  • Lid/tear film treatment devices,
  • Superwidefield retinal imaging with AI,
  • Myopia monitor/axial length/ultrasound, and
  • Objective perimeter.

A major challenge we face is space. Dozens of instruments, along with tables and chairs, waste expensive real estate. A sturdy boomerang-shaped instrument table can carry three or four instruments, aiding patient flow. Fortunately there is a trend towards multifunction, combination instruments, that save space, time and money. Ever more capable and exciting machines are always in the works.

To think my grandfather’s first retinoscope – just a hundred years ago when he founded our practice – was a simple, mildly concave mirror, with a hole in the middle, mounted on a wooden stick. His illumination source was a candle placed behind the left or right ear of the patient. A far cry from our modern, bright, LED Li-ion retinoscopes.

One of the great things about optometry is how it has evolved. The rate of change is increasing. COVID-19 has accelerated the process.

Hold onto your hats.

As Geoffrey Chaucer said, “Time and tide wait for no man”.

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