future practice
Great Expectations
From smart contact lenses to changes in managed care, experts speculate on the practice of the future.
RENE LUTHE, Senior Associate Editor

Predictions for this year's economy may still be less than rosy, but not so for optometry. Optometric Management asked a handful of experts what they thought would be the most significant developments in various aspects of the field over the next 10 years and found a sure optimism. "Current advances in eye care will revolutionize clinical practice in the next 10 to 20 years," OM's Clinical Director James Thimons, O.D., F.A.A.O., said. "The use of genetic testing for diagnostic assessment, the development of pharmaceutical agents that are designed for specific disease therapy and a raft of new equipment technologies are just a few of the ways that our practices will change in the new millennium." Here's what other optometric sages had to say.

EYE EXAMS: Technological advances

"Advancing technology will allow us to take direct patient response out of more testing and rely on objective, reliable, and most of all, consistently repeatable data. This can only enhance the quality of patient care. The more objective data we can gather, the more we can use technician help and thus become more of a profession in which the doctor analyzes data and determines treatment, instead of concentrating on the gathering process. The biggest single improvement I'm anticipating is a totally objective visual field measurement where the patient does not participate any more than they would in an X-ray."

Jay D. Petersma, O.D. Johnston, Iowa

"This (objective, normative data-based diagnostic testing for the early detection and management of ocular disease) would include routine screening and evaluation of nerve fiber layer and optic disc topography, some means of objective early detection of macular degeneration and other maculopathies, blood flow analysis to the optic nerve and retina, etc. With this will come the associated elimination of subjective tests such as perimetry. Technology will develop to make these tests affordable enough to become routine parts of an ocular health assessment. Effective early treatment modalities will be coupled with these diagnostic tests."

S. Barry Eiden, O.D., Deerfield, Ill.

	ILLUSTRATION BY PATRICK GNAN

"I think the technology to diagnosis disease and vision correction will advance faster than the devices that will be available to correct the conditions. Our instrumentation will consolidate to include topography, automated refraction incorporating wavefront technology, nerve fiber analysis, lens and corneal clarity and macular sensitivity.

"Additional information such as intraocular pressure, electronically measured pupil responses, optic nerve and macular topography, retinal laser scans and digital fundus photos will probably be accomplished with one instrument.

"Trained technicians will gather much of the information and doctors of optometry will analyze the data and make treatment recommendations and/or perform needed laser corrections, vision therapy, chemical therapy, light therapy and genetic counseling."

Bobby Christensen, O.D., F.A.A.O., Midwest City, Okla.

"An aging and growing population, along with increased rates of systemic diseases, will dramatically increase the demand for comprehensive retinal exams. Emerging technologies will allow optometrists to become the leaders in early detection of retinal disease and signs of systemic problems such as diabetes."

Karen E. Miller Gillis, Optos North America

OPTICAL DISPENSING: Lean and mean

"The theme for the next five years is 'lean and mean,' You'll see more attention paid to the business aspect of running a dispensary. Understanding things such as margins, cash flow, inventory management, marketing, merchandising and business plans will be the critical buzz words in the tight and competitive dispensing arena. You'll see a trend towards tapping vendors for more than just product -- help with training, product positioning, research on market trends, and other business-focused strategies will become deal breakers when it comes to selecting vendors. Training for the dispensers will be critical. Vendors are marketing directly to the consumer, so dispensers must stay close to the explosion of technology and understand the value of communicating the benefits of numerous product choices in order to attract and keep patients."

Rene Soltis, optician, The Vision Council of America

BUSINESS: Strategize and streamline

"The 80-20 rule will be in full force, with 20% of practices providing care to 80% of the population. These fiscally strong practices will be managed-care free since those who tried to survive with managed care's continually plummeting reimburse- ments will have long since withered away. These practices will have prepared way in advance for their 'managed-care free' futures and started doing so now."

Gary Gerber, O.D., The Power Practice, Hawthorne, NJ

"Instrumentation and software development have enjoyed constant advancement during my career. To date, however, much of what we have [in the area of practice management] has been developed as individual or stand-alone platforms. The future will simplify or join all computerized tools into one effort. Paper charts and paper output from instrumentation will be a thing of the past. Over a wireless interface, all patient-related components will intelligently interface from the doctor's web site to the moment the patient walks in the door, to the ordering and fabrication of products. Redundancy will be history."

Frank Puzio, O.D., F.A.A.O., South Dennis, Mass.

"Independent optometrists focus on the negatives that, in reality, they cannot control. Managed care, fixed fee programs, phone order contact lenses and expansion of corporate optometry are here to stay. The financial future of our profession is in specialty optometry and increased medical services.

We will see the abolition of all closed medical panels in the near future, which will open up all medical markets to O.D.s. This requires that optometrists start now with preventive management techniques before the spectacle industry goes the same way as contact lenses: The future will see consumers ordering spectacles through the Internet."

Richard S. Kattouf, O. D., Optometric consultant, Warren, Ohio

"We will see a lot more employed O.D.s versus private practice O.D.s. There are far fewer graduates going into private practice today, and that will really start to manifest itself in 10 to 20 years. The O.D.s who receive the highest compensation will own their own practices and do a good job of managing them like businesses."

Jerry Hayes, O.D., Hayes Consulting, Ponte Vedra, Fla.

CONTACT LENSES: Correcting refractive error and more

"Technology will provide the opportunity for dramatic advancements. It is my opinion that we must develop contact lenses that are no longer associated with risk to ocular health, but that support and enhance ocular health. We must continue to push the envelope of the contact lens's ability to provide support for the eye and it's functions. In doing this we will see contact lenses continue to not only be a viable medical device to correct refractive error, but a prescription medical device to sustain optimum ocular health."

Howard Purcell, O.D., Vistakon, Jacksonville, Fla.

"We're going to see more and more products developed from silicone hydrogel materials. One such product with great promise is bifocal contact lenses. With the characteristics of silicone hydrogel not dehydrating or depositing as easily, it's a material that will serve the presbyopic population, which is growing larger.

"Additionally, strides made over the last two years in corneal refractive therapy give promise of a bright future for reshaping the cornea with gas permeable (GP) materials."

Walter West, O.D., Brentwood, Texas

"What will contact lenses be like in 2022? For fun, contact lenses will change color on the eye, depending on a person's mood -- think "mood ring" lenses. More importantly, contact lenses will be "bio-smart," delivering tears when the eye is dry and delivering antibiotics when irritation occurs to prevent infections.

Contact lenses will be easier to handle, handled less, more comfortable, provide the sharpest, most consistent vision possible and be the safest way to correct vision."

Janice Jurkus, O.D., Chicago, Ill.

"Contact lenses in the next 10 to 20 years will include a molding device placed on the eye with a series of drops instilled to form a new ocular surface that will correct all corneal irregularities, progressive diseases, refractive errors (including presbyopia), UV abnormalities; etc.

As refractive errors change, the 'new surface' will be removed and replaced with another to modify the current condition. We'll be able to accomplish managing the ocular surface with nonsurgical methods."

David W. Hansen, O.D., F.A.A.O., Des Moines, Iowa

SURGICAL: Customized options of the future

"I believe that the future is exciting for optometry. As recently as one year ago, many surgeons offered only laser-assisted in situ keratomileusis (LASIK) and no other surgical alternatives. Optometry has always understood multiple options (contact lenses and types, spectacles and types -- progressive add lenses [PALs] bifocals etc, refractive surgery) and in the future all of these options will blend -- offering the best procedure for each patient becomes the key.

"The most significant change will be the super vision (20/10 or better) and options to that end. There will be supervision in contact lenses, refractive surgery, intraocular lenses (IOLs) and spectacles.

"Children will develop better pathways to enhanced vision based on better images, even emmetropic individuals may benefit with driving glasses, contact lenses for sports or refractive surgery gaining far greater acuity than currently possible.

"Optometrists are well positioned to offer all options and determine the best fit for each patient's needs."

Paul Karpecki, O.D., Kansas City, Mo.