New technologies shaping optometry’s future

Excerpted from page 22 of the Summer 2024 edition of AOA Focus 

Smart contact lenses that deliver medication to the eye. Cloud-based software that autonomously diagnoses diabetes. Voice recognition technology that transcribes conversations in the exam room directly into the electronic health record—not only generating notes but also an order or prescription.  

What does it all mean for optometry? 

Members of the AOA Board of Trustees, informed by tech-knowledgeable experts and their professional experiences, seek to help doctors of optometry navigate the future and even shape the delivery of care ahead. 

Coordinating new practice tools  

Progress is profoundly changing how practice tools are delivering eye care, says AOA President Steven T. Reed, O.D. The tools themselves are changing, but so are the ways they work together. For example, take telemedicine and optical coherence tomography (OCT).  

“In the rapidly evolving landscape of health care, telemedicine has expanded, reshaping how some medical services are delivered and accessed,” observes Dr. Reed. “Among the services we provide is OCT imaging. OCT in optometry serves as a valuable tool for the diagnosis and treatment of a multitude of ocular conditions. In many offices, it is a ‘must-have’ technology in care delivery. But telemedicine is now changing how we have traditionally used OCT,” says Dr. Reed. “Tasks now done by doctors of optometry in the office might be performed in the future by non-eye-care professionals or even by patients at home.”  

Nevertheless, Dr. Reed says, doctors of optometry are in a prime position to offer patients and other health care providers the benefit of optometrists’ education, expertise and experience. As experts, optometrists also coordinate care, and the use of new technology may require doctors to reimagine the delivery of care.  

“In the future, instead of sending a patient home with an Amsler grid, a patient may use a modified form of an OCT to help track changes,” Dr. Reed says. “This higher level of monitoring may strengthen the relationship between a patient and their optometrist.  

Keeping an open mind and looking for ways to improve access to quality eye care should be our guiding light as we shape the future of patient care. It is critical that optometrists continue to use human intelligence, with the aid of AI, to make treatment plans.”  

These new practice tools become all the more important as the optometry demands of the public are increasing, says AOA Trustee Tad R. Kosanovich, O.D.  

“The demand for health care is skyrocketing and optometric physician services are as sought after as any other discipline in the healing arts,” Dr. Kosanovich says. “With more than 11,000 Americans turning 65 every day, the need to manage eye disease is a primary responsibility in optometric practice. The invention of OCT has completely revolutionized eye health care. In one piece of equipment, we can manage macular disease, optic nerve disease and corneal disease—leading causes of vision loss in the retirement age population. An investment in technology allows optometrists to build a thriving, successful practice.” 

Making space for telemedicine  

In the right hands, telemedicine can improve patient access to care, offer convenience to patients and enable practices to efficiently manage their resources, as well as support doctors in their clinical care, says AOA Trustee Terri A. Gossard, O.D., M.S. However, it’s essential that teleoptometry practices adhere to regulatory guidelines, maintain patient privacy and data security, and uphold the standards of professional practice, she adds.  

William T. Reynolds, O.D., AOA past president, agrees. “As with any new technology, doctors of optometry must weigh the benefits of the technology versus the potential drawbacks,” Dr. Reynolds says. “Telehealth can allow us to expand our reach to patients unable to come to our offices while increasing patient convenience.  

“Conversely, we must ensure that our patients continue to receive quality optometric care, and that the standard of care for telehealth is the same as it is for in-person patient visits,” he says.  

“Since 2017, the AOA has been working to lead policy discussions related to the appropriate role for telemedicine in optometry,” Dr. Gossard says. “The AOA Telemedicine in Optometry Policy Statement reflects the perspectives of practicing doctors, industry partners, experts in the AI space, contact lens and device manufacturers, optometry school faculty and optometry students.”  

The policy statement, revised in 2022, details the appropriate use of telemedicine in optometry. Dr. Reynolds notes that the policy is updated on a continual basis and is a “tremendous guideline” for doctors and industry, as a future shaped by tremendous technological change unfurls.  

“Optometry has never been a profession afraid of technology,” Dr. Gossard says. “The AOA Board of Trustees is committed to ensuring doctors of optometry have access to the best technologies to provide care to patients.” 

Finding efficiencies with AI 

In 2018, the Food and Drug Administration cleared LumineticsCore™ (formerly IDx-DR) for marketing in the U.S.—the first medical device to use AI to detect early, mild cases of diabetic retinopathy. According to Digital Diagnostics, which manufactures LumineticsCore, the device is now in more than 60 health systems.  

Today, AI’s advance continues apace.  

“AI-driven systems can be used to optimize appointment scheduling,” says Belinda R. Starkey, O.D., AOA Trustee. “They may also enhance the functionality of EHR systems by enabling more accurate and faster data entry, analysis and retrieval. Natural language processing will likely help make record-keeping more efficient and reduce errors, all while allowing doctors of optometry to spend more time on patient care rather than administrative tasks. 

“AI algorithms are already being utilized to analyze diagnostic images such as retinal scans with high precision, even identifying patterns that may be missed by the human eye,” says Dr. Starkey.  

“Using AI to evaluate both fundus photographs and OCT images has been proven to assist in the early detection of eye diseases such as diabetic retinopathy, glaucoma and age-related macular degeneration. AI systems can streamline the insurance claim and billing processes by automatically verifying insurance eligibility, processing claims more efficiently and reducing billing errors. This not only speeds up reimbursement but also reduces administrative burdens on the practice.” 

Altogether, this revolution helps practices and patients, says Karoline K. Munson, O.D., AOA Trustee. “The technology revolution will help doctors of optometry take better care of their patients by freeing up the portion of the exam that is consumed with data collection and allow the doctor to use their skills and knowledge to interpret this data and formulate a treatment plan,” Dr. Munson says. 

“Doctors need to look at the types of diseases they already manage in their patients and plan for an evolution of their care plans as technology affords them alternative paths to care,” Dr. Munson says.  

“Optometrists need to use their skill sets to evaluate the emerging technology to ensure patient safety and reliable data from this technology. Effective communication with patients is paramount to making sure that everyone on the care team is on the same page and that the patient will ultimately benefit from whatever technology an individual practice uses.” 

How is the AOA helping to support doctors during this transformative period?  

“The AOA is at the forefront of integrating artificial intelligence into optometry, emphasizing ethical considerations and patient safety in the adoption and implementation of these technologies,” Dr. Starkey says. “The AOA has charged volunteers within our association structure to continually monitor new information, technologies and data collection in order to stay informed on developments in the field.” 

Harnessing the power of augmented reality  

As it always has, optometry will pivot and embrace new technology such as virtual/augmented reality (VR/AR) that benefits patients, says AOA Trustee Paul M. Barney, O.D.  

“Advancing technology has always been a part of health care, whether it be new medications, new instrumentation or new techniques in care delivery. As technology has advanced over the years, optometry has embraced and adopted those changes to elevate the quality of care and the patient experience.” 

Consider VR/AR in vision therapy today. The technology is already being embraced in eye care. It’s used: 

• In eye care training programs to teach clinical and surgical skills.  
• In vision therapy, as doctors of optometry use VR systems to diagnose and treat visual efficiency, stereopsis, amblyopia and visual perceptual problems.  
• In vision field testing to support patients who are disabled or who have suffered a traumatic brain injury and have a difficult time doing a traditional visual field test.  

“Even though the current explosion of electronic devices and technology can be helpful in the delivery of quality vision care,” Dr. Barney says, “this technology is also pervasive in gaming and can sometimes be the source of vision problems. Excess use of VR and AR headsets in gaming can contribute to ocular surface issues, divergence insufficiency, loss of peripheral awareness and to the development and progression of myopia.  

“Doctors of optometry should look for ways to use this technology to help them diagnose and treat their patients’ visual problems, but it is also incumbent upon optometrists to educate their patients on the harm that can be caused to the visual system when VR/AR is overused recreationally,” he says.  

AOA Vice President Teri K. Geist, O.D., says technologies such as these disrupt the status quo in positive ways and sometimes challenging ways. “The goal of these technologies is to visually simulate a true environment, posing potentially more cost-effective training, diagnostic and therapeutic options. However, implementing these technologies clinically remains an evolving field, and the technology is advancing faster than the science and evidence we need to evaluate it,” Dr. Geist says.  

“Longitudinal studies are necessary to properly identify potential options for us as doctors, as well as the impact using VR/AR has on individuals.”  

“One critical area of opportunity we are evaluating is in education and diagnostics, advancing the care we are able to deliver and further strengthening our connections with our patients,” she adds. “Today, we can use VR in our practices to simulate disease states, giving our patients a deeper understanding of how those conditions may affect their vision. We are also able to enhance our clinical skills through VR simulations.”  

While there have been positive results in VR applications designed to improve eye coordination, depth perception and focus in patients, Dr. Geist emphasizes caution and concern about the impact screen time has on patients, particularly in the development of myopia. More research is needed to understand VR’s role in progressing—or maybe improving—myopia, she says.  

“The AOA is continually assessing new technologies and tools, and as part of the AOA’s  

Telemedicine in Optometry Policy statement, a long-standing tool providing delivery guidance for the physician community, payers, policymakers, the media and industry, we are actively seeking input on the role VR applications play in our practices and advancing care today and in the future.  

“AR, VR, AI and current technologies are tools we need to harness responsibly to advance care, all while looking toward the future and the technologies and innovations we haven’t imagined yet. The AOA will continue to be a leading source of guidance for the profession and the public at large as we explore these new frontiers.” 

Pharmaceutical advances 

Advances in treatment options for myopia (atropine eye drops) and presbyopia (pilocarpine eye drops) are fueling opportunities for doctors of optometry, says AOA Trustee Curtis A. Ono, O.D.  

“The revolution in pharmaceutical refractive management is poised to have a significant impact on health care and optometry in providing greater convenience to the patient in presbyopia medications and ocular health maintenance in the area of myopia management,” Dr. Ono says. “As advancements continue, it’s likely that primary eye care providers will increasingly integrate myopia management and other refractive treatments into their practices.  

“This integration could lead to improved patient outcomes, particularly in addressing public health concerns such as high myopia and its associated sight-threatening conditions, such as retinal detachments, glaucoma and macular degeneration.”  

Dr. Ono encourages doctors of optometry to learn more by taking continuing education courses, staying informed on the latest research and clinical developments, and collaborating with fellow professionals to share knowledge and best practices. Taking those actions, he says, can enhance optometrists’ ability to provide comprehensive care to patients, address any questions and potentially implement treatments in their practices.  

Here, too, the AOA plays a crucial role in supporting optometrists.  

“Through the provision of credible and unbiased education and clinicalguidelines/recommendations, the AOA ensures that optometrists have access to the resources needed to stay updated and proficient in pharmaceutical refractive management and other evolving areas of eye care,” Dr. Ono says. “Additionally, the AOA facilitates networking opportunities that enable optometrists to exchange insights and collaborate on implementing new approaches in their practices. By staying informed, collaborating with peers and leveraging resources provided by AOA, doctors of optometry can embrace these changes positively, enhance patient care in their practices and contribute to addressing important public health concerns related to ocular health and vision.” 

Smarter contact lenses  

Contact lenses that deliver medication to the eye or biosensors that monitor glucose levels or detect glaucoma’s biomarkers in patients—that’s the future, say AOA President-elect  

Jacquie M. Bowen, O.D., and AOA Trustee Marrie S. Read, O.D., Ph.D.  

“As a rule, optometrists fully embrace new technology, and smart contact lenses are no exception,” Dr. Bowen says. “Controlled and more effective drug delivery, biosensing and monitoring neurological changes are all going to be new tools to help us expand care for our patients.”  

Dr. Read notes that drug-eluting contact lenses are being tested to administer steroids, antibiotics and NSAIDs. 

“What is so exciting about these advances in contact lens technologies is that these devices are well within our wheelhouse to fit, prescribe and monitor,” Dr. Read says. “The possibilities are endless, and optometry is well positioned to embrace and implement these advancements in contact lenses that will provide better monitoring and treatment of our patients resulting in improved outcomes.”  

The AOA has been monitoring this progress for a while, they say.  

“We will continue to be on point as the technology evolves,” says Dr. Bowen, noting another “wearable” technology of interest: what she describes as “recreational smart lenses.  

“Beyond medical indications for smart contact lenses, we are also watching the emergence of smart lenses that provide the wearer with something similar to augmented reality,” she says. “Technology is embedded into rigid and soft lenses and can provide a MicroLED display with motion-tracking technology. With a glance, a wearer can launch applications such as a calendar, navigation, airline stats, fitness tracker and even a visual field expander or contrast enhancers. Optometrists need to be at the front line of this kind of technology to ensure ocular health and safety.” 

The AOA’s New Technology Committee has explored advances in smart contact lenses and drug-eluting contact lenses.  

“As more of these devices are approved and available in the marketplace, the expert volunteers in the AOA’s Contact Lens and Cornea Section are poised to provide information and guidelines to members on fitting and monitoring these devices,” Dr. Read says. “The AOA and its many partners, particularly those in the contact lens industry, will continue to inform our members on these technological breakthroughs and educate members on fitting, monitoring and implementing these devices through articles, lectures and webinars on the AOA EyeLearn platform.”