Our profession is dynamic, and much has changed for the clinical optometrist in the past 30 years. We have seen the adoption of diagnostics, the implementation of therapeutics, and, in the past 10 years, an increase in the use of more invasive procedures to treat ocular disease. It’s fair to say that our profession is not the same as it was 30 years ago or, in many cases, even 10 years ago.
It would stand to reason, then, that the practice of optometry will continue to evolve in the years to come. Taking into account the pressures of the health care environment and changing dynamics, let’s take a look at where the currents are taking us.
THE BIG PRESSURES
Health Care Policy
Health care policy will likely have the largest effect on optometry, because it is a legislated profession. We provide the bulk of comprehensive eye care, and leveraging that role to improve reimbursement, parity with ophthalmologists, and positioning as preferred providers in insurance plans is critical to maintaining our standing. Vision plans have begun to seriously undercut the bottom lines of many small private practices, which is a major concern. The efforts to minimize cost and overhead on the insurance and business side increase pressure on providers to see more patients in order to receive adequate compensation, which results in minimized services.
Commercial practice represents a larger percentage of our profession than it has previously. Cost sharing in today’s environment is critical, and it’s easier to achieve in larger groups. Integrative and collaborative care models with ophthalmology are another component of this transition. Ophthalmology residencies are decreasing in number, while surgical volume, particularly for cataracts in the baby boomer generation, is increasing and is expected to remain high for the next several years.
Although politics is involved, the transition from an employed OD doing refractions and comprehensive examinations to true collaboration with ophthalmology (ie, surgical counseling and consenting, procedure-based care, and advanced medical care) is happening now and is likely to continue to be adopted by forward-thinking MDs and ODs. Expect this transition to continue.
Internet-Based Eye Care Services
Telemedicine and other internet-based eye care services are causing anger and frustration in our profession at the moment, but how we deal with this situation will dictate how much control we have in providing these services ourselves and thus dictate their impact on our profession. Also, with improved regulation, we may have a tool that serves our patients and profession in a manner nearly unthinkable just a decade ago.
There are a number of advantages in allowing these types of services to succeed. They improve patient access to providers on a more immediate, urgent basis, especially those who live in rural areas. Moreover, internet-based eye care services are convenient for patients to use, and they may help improve compliance and allow more consistent home monitoring of ocular disease.
Growth of the Profession
In the past several years, there has been an increase in the number of optometry programs across the United States and, as a result, an increase in the number of optometrists entering the workplace. There must be an increasing demand for optometry on the clinical side in order to accommodate more practitioners. As ophthalmologists age and retire and fewer younger MDs are available to take their places, more and more optometrists will have opportunities to offer medical care to patients.
With half of the US population destined to wear spectacles for myopia correction, increasing efforts toward implementing early-phase myopia control seem likely. Clinicians will be better able to monitor progression and assess risk of retinal pathology, particularly myopic maculopathy, with the development of affordable and more patient-friendly devices for measuring axial length.
Assessing AMD Risk
Progress in the diagnosis and treatment of age-related macular degeneration (AMD) is coming, with dark adaptation proving to be a promising area of research for early detection. It seems feasible, as more information is gathered, to make this a standard diagnostic procedure, especially alongside genetic testing, to assess the risk of AMD and to catch it in the subclinical phase.
Monitoring IOP at Home
In glaucoma care, home monitoring of IOP outside of a practice setting will become more commonplace, and selective laser trabeculoplasty, micropulse technology, and other minimally invasive procedures will outpace pharmacologic treatment as first-line interventions.
CHANGES WITHIN THE PROFESSION
In addition to the changes occurring in the clinical and administrative health care space are those occurring at the teaching institutions where optometrists are trained. In the past 20 years we have seen an increased emphasis on bringing surgical awareness and training to the profession, and it won’t be long until laser and minor surgical procedures will be taught and practiced at all optometric schools. The battle for scope of practice expansion has been hard fought to include minor procedures, injectables, and laser therapy. Sharing of the turf with ophthalmology likely will not become easier. Also, as optometry’s presence in hospital-based settings increases, it may be prudent to incorporate a more eye-specific administrative degree to allow those areas to be run by optometrists.
STAND STRONG AND CARRY ON
Although we are well positioned to remain the primary providers of eye care for the foreseeable future, we must be able to face challenges that arise and ensure that any new developments and technologies are beneficial to patients and do not compromise care. The future of optometry will likely include increased management of medical and minor surgical care and more collaboration with ophthalmology.