WRITER Alan Saks

Passionate clinicians and researchers are looking to the future; harnessing the power of emerging drugs and technologies that will enable us to deliver ever better eye care to our patients. This is why we are here.

The old adage, prevention is better than cure, has never held truer. In eye care this applies to myopia, glaucoma, macular degeneration, gene therapy for inherited eye diseases, and much else. Artificial intelligence is already opening new doors, and the pace of development is accelerating.

In myopia control, a new biometer includes data from 300,000 cases with metrics like the axial length/corneal radius (AL/CR) ratio, providing immediate predictions of myopia development or progression risk in a specific patient. An AL/CR greater than three indicates high myopia risk and is considered more accurate than axial length alone for predicting myopia, especially in children.

My Dad, Sid Saks, pioneered myopia control in the 1960s, with custom designed PMMA (polymethyl methacrylate) hard lenses, hand-drawn graphs, and manual data collection and analysis. Today, we can scan an eye with biometry, optical coherence tomography (OCT) and topography in minutes, upload this information, and have an orthokeratology lens designed and manufactured within days. We can also assess whether a myopia controlling soft lens, spectacle lens, or atropine treatment is likely the best option for a given patient profile.

Yet patient/parent personalities, among other considerations, remain vital to the art and science of prescribing and management. Despite all the technological progress, there’s still an art to what we do!

NEW KIDS ON THE BLOCK

Amazing thin film technologies can now mimic one, or a combination of myopia lens designs, and potentially apply a unique design to specific lens materials or prescriptions. New lens technology can make a -12.00D lens look like a -3.00D lens with almost uniform thickness and fairly flat form, with aberration control built in. I expect these technologies will become mainstream soon.

Colleagues are working on new contact lenses and developing technologies that detect, diagnose, and manage dry eye disease; some are about to enter clinical testing in the lead-up to commercialisation. Early detection to prevent frank dry eye is one such goal, though asymptomatic patients may be less motivated to take on a preventative approach.

LOCAL IMPACT

There’s a truckload of research across all spheres of eye care. Our Australian and New Zealand researchers continue to make an impact – current myopia controlling soft lens designs, among others, came from our Kiwi and Aussie-based colleagues. A locally developed artificial intelligence chatbot is being developed and rolled out for patient and practitioner use in myopia management.

The hyperparallel OCT (HP-OCT) is another impressive Australian development. It’s now owned by a global eye care power and undergoing further development. Elsewhere, we see an increasing range of instruments providing topography/tomography, scleral mapping, pachymetry, posterior corneal analysis, and anterior segment imaging.

Numerous people have complained about the service and total cost of traditional gold standard equipment. Large, traditional perimeters occupy expensive real estate within a small practice. However, we’re now seeing compact, portable headset-based visual field devices with virtual reality that are ideal for small practices, multiple offices, locums, and remote eye care providers.

The long-awaited objective perimeter is also stirring up interest. This could be a game changer for glaucoma practices with older, cognitively impaired patients or those with motor difficulties, perception, and other complications that make accurately monitoring visual field changes difficult.

And so it goes. The worm turns. We improve our offerings, make optometric examinations more thorough, dig deeper, and at the same time, provide less onerous care for patients.

But questions surrounding eye care delivery remain. Ten years since his passing, we continue to see progress in Professor Brien Holden’s global goal to eliminate preventable blindness. However, delivery of eye care to the masses is only part of this. To facilitate eye care outside major metropolitan areas, we need portable solar-powered instruments, and we need to consider the use of remote services.

In theory, it’s better to have a practitioner in every setting. But is providing some care by remote control, so to speak, better than no care at all? And what should the standards be?

Like my ancestors who fought for optometry’s rights, others continue that fight today. We strive to deliver the ultimate in eye care, we are grateful for the amazing developments that make it possible, and we embrace the opportunity to make a difference.