Although optometry has succeeded in differentiating itself via ocular disease management, contact lenses and spectacles, adding new areas of expertise can quickly invigorate your practice and create huge growth opportunities for the foreseeable future. This month, we’ll look at presbyopia, neuro-optometry and myopia management, and I’ll summarize where I believe you can best succeed and find the area that you are most passionate about—and own it.


Your success in this area will depend on how well you educate and communicate with your patients. First, recognize that most patients don’t understand presbyopia. I often hear this chief complaint: “My LASIK has worn off.” My assumption was that they regressed and are slightly myopic, only to find that the patient is 46 years old, plano in both eyes and can no longer read. Use an eye model, animations like Rendia or your best explanation to help patients recognize that the lens in the eye ages like our skin, nails and hair. Describe common symptoms they can relate to, such as night vision problems and having to make lights brighter, followed by difficulty reading and eventually full cataracts that require surgery.

Eye drops are a new development worth exploring, as well as determining the most appropriate candidates. Also, educate patients on the newest progressive spectacle lens option, Neurolens (eyeBrain Medical), for those who haven’t found success with progressive lenses and presbyopia-correcting contact lenses. For those with cataracts, discuss comanagement intraocular lens (IOL) options, including light-adjustable lenses (RxSight) and trifocal and extended depth-of-focus IOLs.

Neurological Conditions

Let’s face it, not everyone is accurate at performing the swinging flashlight test for neurological pupil assessment, and that’s frightening considering that a missed diagnosis could mean an impending aneurysm or brain tumor. I encourage you to look into new diagnostics like EyeKinetix (Konan Medical) that can objectively perform accurate pupil assessments in less than 40 seconds.

If you don’t think there are enough cases of these rare neurological conditions, consider that over 95% of all patients with early glaucoma have a subtle relative afferent pupillary defect that can be detected with this technology. Combine that with hysteresis (and the usual glaucoma tests like IOP, OCT, optic nerve assessment, visual field testing) and you’ll have a good idea of which patients should start medication or undergo SLT.

If you haven’t been an expert in binocular vision, Neurolens can help build your skills in this area. This device can accurately and objectively measure heterophorias, vergence conditioning, fixation disparity and accommodative convergence response in 90 seconds. More importantly, it provides information to prescribe the exact prism necessary (customized for near) to solve patients issues, whether it be headaches, dizziness, asthenopia or others. 

New visual field testing technology including virtual reality headsets (Hilco Vision, OllEyes) and objective field testing (Konan) are making things easier on patients as well.  


What better opportunity can exist than targeting a condition that affects 34% of the US population and is expected to surpass 50% within the next three decades? Get familiar with the various options, as some kids (or parents) won’t be able to insert contact lenses, bifocal spectacles may cause falls and low-dose atropine may not be tolerated by all children. Orthokeratology lenses may work better for some kids; in others, soft contact lenses are preferred. New diagnostic devices such as Myopia Master (Oculus) can help with optimizing treatment and monitoring progression. Lastly, educate parents and children on reducing near tasks like using iPads and have children spend at least 90 minutes per day outdoors.

One of the greatest things about optometry is the many choices available in how you want to practice. But to truly be successful in the coming decades, you’ll need to find additional areas of focus. This will allow you to practice longer, enjoy your time in clinic more, become more profitable, and most importantly, have a profound impact on your patients’ lives.

Dr. Karpecki is medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. He is the Chief Clinical Editor for Review of Optometry and chair of the New Technologies & Treatments conferences. A fixture in optometric clinical education, he consults for a wide array of ophthalmic clients, including ones discussed in this article. Dr. Karpecki's full list of disclosures can be found here.