Change can be a double-edged sword, and nowhere is this more true than in today’s optometric practice, where many things are in flux and not all of them look to benefit us. The latest gadgets are certainly revolutionizing how we care for our patients. But, in the wrong hands, advanced technology is also posing significant risk to our patients and our practices. 

Fight the Online Threat 

The first thing we must understand about online refraction is that this trend is firmly in place. It is no fad or flash in the pan. Hundreds of companies provide online or remote optical sales ranging from frames and spectacles to refraction. You can’t knock one down without another popping up, so optometry needs a game plan. 

Ultimately, we must always put our patients first. And an online or remote refraction is not in the patient’s best interest. Many may perceive the availability of this service as a rationale for not pursuing an eye exam because they have a prescription in hand. But refraction is of course just a small part of a complete eye exam that has the potential to not only save a patient’s eyes, but their life. We have all seen cases of a malignant choroidal melanoma in patients with 20/20 vision that would be missed with a remote refraction. Substituting an online refraction for a comprehensive exam would be the same as going to a drug store, using the automated blood pressure device and assuming you completed your cardiac health examination. 

We must educate patients about the myriad systemic diseases detectable during an ocular exam, such as brain tumors, diabetes and hypercholesteremia, to name only a few. We cannot let the public put their vision, or even their lives, at risk assuming they can take an online or remote test that fails to assess ocular and systemic health. 

Finally, the online refraction industry is fraught with companies that say they are working with optometry, but are setting up remote refraction systems to compete with optometry. We must keep an eye out for these masqueraders to protect our patients and our practice. 

This trend may not be our friend, but we need to understand the patient needs and constraints it addresses, such as the lack of time and the desire for use of advanced technology. To acknowledge these needs in our own offices, we can invest in new technology that enhances the refraction experience and efficiency in office, including advanced automated refraction systems that outshine the rather simplistic methods used by online services. We truly can show the world that our care is demonstrably better.

Embrace Better Therapeutics

New technology isn’t all bad, as it is improving our ability to provide medical eye care for conditions such as dry eye and keratoconus, both of which are featured this month. Before the FDA approval of the Avedro system for corneal collagen crosslinking, the lack of availability left a number of patients in need of a corneal transplant due to unfettered disease progression. In desperation, I have sent patients to Canada and study sites in the United States for this treatment. There is no question that the large majority of patients with keratoconus are seen in optometry practices, and the new treatment option is a welcome addition to the management plans for these patients. 

Given the growing shortage of ophthalmologists (especially in rural areas), optometry is taking on more medical eye care to fill the void, and that includes minor procedures and lasers. Optometrists practicing in states that allow the use of UV light laser in optometric practice may one day have the opportunity to help slow or stop the progression of keratoconus, allowing patients to remain in their contact lenses if crosslinking is performed soon enough. More technologies are on the horizon involving contact lenses and crosslinking to help stabilize patients at the earliest diagnosis of keratoconus.

So, the trend is our friend—sometimes. When it isn’t, we must follow it closely so we can properly educate patients about risks it may pose to their eyes and lives, and then work to ensure they are protected. In cases where the trend is our friend, those who embrace it will often thrive and enjoy the ride along the way.