Optometry is no stranger to change. The profession itself is practically an embodiment of it, as the twin engines of education and legislation continually redefine what it means to practice optometry. But aside from optometry’s unique growing pains, the science of eye care seems to be at an inflection point, poised to trigger change on a number of fronts.
Probably the one that will make the biggest impact in optometry is presbyopia medications. Before the year is out, you’ll likely have access to the first of many products in this category, all of which aim to improve near vision pharmacologically, usually by pupil constriction, though one does so by softening the crystalline lens to restore some flexibility and thus accommodative amplitude as well.
An early test for presbyopia drops will be the need to keep adverse effects tolerable enough to not kill enthusiasm for the idea before it even has a chance. Headache/brow ache, impaired distance vision, ocular surface disruption and questionable durability of effect are all obstacles to success—not to mention the small matter of paying for it. Everyone expects a pilocarpine drop from Allergan to be first out of the gate; others will follow not long after. Before you know it, we’ll be off to the races with an entirely new product category to put through its paces.
What will these drops do to traditional presbyopia correction methods? The meds will be targeted at younger presbyopes, so they won’t supplant premium IOLs, but they will steal some of the limelight those are currently receiving thanks to the strides made by newer implants. No matter what, all corrective lens modalities will have an upstart competitor turning up the heat.
Contact lens practice—though currently being battered on the commercial side as the FTC prescription release rule gives online sellers newfound chutzpah to run roughshod over clinical expertise—seems destined to evolve beyond refractive correction and begin providing other eye health benefits, most notably drug delivery.
In this issue, Melissa Barnett, OD, provides an eloquent summary of the state of the science and its implications for practice. A contact lens to treat ocular allergy is already available internationally from Johnson & Johnson and should reach the US before long. Others to follow will target glaucoma, inflammation, pain and postoperative antibiotic prophylaxis. Expect to start thinking about a contact lens’s drug content as well as its water content.
A new drug delivery method of another sort is also just around the corner, as Genentech hopes to make monthly or bimonthly intravitreal injections of anti-VEGF a thing of the past. Instead, the company’s Port Delivery System—now making its way through FDA trials—uses an implantable reservoir that time-releases ranibizumab over six months, and can be refilled in an office procedure. If they pull it off, the entire infrastructure of anti-VEGF dosing and delivery could be re-engineered.
Lastly, if you’ll allow a bit of wishful thinking, I’d like to believe the progress being made in epi-on crosslinking might open the floodgates to optometric adoption of the procedure. Regardless, we’re on the precipice of a new wave of disruptive change, with plenty of upside for ODs and your patients.