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The 3-D printers are making complete eyeglasses, and this technology will only improve. Drugs to push back presbyopia will also be here soon, thus dampening the bifocal market. Autorefractors and automated subjective systems are already here, and they too, will continue to improve. Eyeglasses are heavily promoted for as little as $6.95! The Department of Veterans Affairs (VA) now has operational programs in place in which laypersons are trained to perform essentially full eye examinations, including refraction, and patient satisfaction is reported to be “high.” For decades, ophthalmologists have had high school graduates performing their refractions, and people flock to their practices. Based upon this reality, one could rationally and accurately assume that the public’s quest for competent, thorough, medically-oriented eyecare is valued far more than just “refraction.” This is a powerful observation, and one that we should take to heart. NO TIME TO WASTE A comprehensive consensus of these observations should compel thinking optometrists to reevaluate their practice modus operandi and develop strategies to remain viable in the face of these tidal waves of changes coming our way. Our relatively straightforward plan is to simply begin keeping all the patients who present to us. Stated another way, it is imperative that we stop hemorrhaging patients through referrals, and that we provide a much broader base of comprehensive medical care services; this is critical to our survival as a profession. For perspective, the table at right is a near-comprehensive list of medical eye conditions that attentive and caring ODs can readily address. If you think you can rely on dispensary income and routine eye exams, you may be in for a rude awakening. MEDICAL EYE CONDITIONS ALL ODs SHOULD MANAGE • Assessing hydroxychloroquine (Plaquenil) retinotoxicity risk • Diabetic retinopathy • The glaucomas • Acute symptomatic posterior vitreous detachments • Acute red eyes: allergic, bacterial, viral, chlamydial • Injuries and abrasions • Blepharitis • Meibomian gland dysfunction • Dry eye disease • Zoster ophthalmicus • Eye pain: trichiasis, ectropion, entropion, lagophthalmos • Bell’s palsy • Corneal dystrophies • Optic neuritis • Macular degeneration • Presurgical cataract care • Epiphora • Post-op care for numerous surgeries • Lid infections: acute hordeola, styes • The gamut of contact lens complications • Episcleritis/scleritis • Giant cell (temporal) arteritis • Recurrent corneal erosion • Contact blepharodermatitis • Superior limbic keratoconjunctivitis • Phlyctenular keratoconjunctivitis • Eroding tarsal concretions causing foreign body sensation • Thygeson’s superficial punctate keratopathy • Transient vision loss from carotid artery disease • Ocular migraines • Corneal infiltrates and ulcers/CLARE • Giant papillary conjunctivitis • Epithelial basement membrane assessment and monitoring THREATS TO OPTOMETRY • Bargain-basement tactics by eyewear discounters • Online refractions • Online contact lens sales •
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