As David Bowie sang:
“I watch the ripples change their size
But never leave the stream
Of warm impermanence
And so the days float through my eyes
But still the days seem the same”

Bowie was a keen, if not prescient, observer of the world. We are only just beginning to see what he saw. In our small universe, at this moment, things seem unchanged; yet, the world is impermanent, and changes are coming that will wash over us in unrelenting waves.

Yesterday, you were worried about Opternative. As I write this, a few surviving independent opticians up and down the East and West Coasts—notably areas with the highest concentration of eye care providers—are finally seeing their dreams come true. No more need for an OD or the rare moonlighting ophthalmology resident to do refractions, and no matter that the opticians were never able to win that right for themselves, they have replaced trained and licensed eye care professional with the SVOne—a portable Hartmann-Shack wavefront aberrometer that attaches to a smartphone.

While the opticians never had the political clout, financial resources or public health justification to gain refraction privileges, Smart Vision Labs, the creator and distributor of the SVOne, has achieved most of the first two and is hard at work trying to convince the public and legislators of the third. For what it’s worth, the device works as well as a modern autorefractor, which was astonishingly validated in an article authored by two noted SUNY researchers and published in our very own Academy journal. I wonder if SUNY encloses the article in their applicant information package?

While you would think that this clearly would be practicing optometry without a license and that optometry boards in NY and CA would be up in arms, so far these opticians have been able to skirt existing laws by using ophthalmologists with time on their hands to sign off on prescriptions for patients they’ve never actually seen. While this might be gratifying to the few remaining antediluvian MDs who hate optometry, technology is, indeed, a harsh mistress, and the technology shoe will soon be on the other foot. Automated and autonomous cataract surgery isn’t that far down the stream, and what goes around, indeed, comes around. 

Our own inter-professional war must come to an end. Somehow optometry and ophthalmology must find a path to cohesion. Working together is the only way to ensure our patients’ safety and channel technology for good rather than greed and profit.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com