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Thread: Optometry in 2035. Does it exist?

  1. #1
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    Optometry in 2035. Does it exist?

    In 20 years, will optometry as we know it still exist?

    Eye health aside, any optometrist honest with herself will concede the primary purpose of an optometrist is to refract. Refraction, although definitely a skill, is at risk of extinction due to advances in technology. Although technology is a threat to many aspects of modern eyecare, and while one can argue about the timing/immediacy of such events (i.e. are we on the cusp of wholesale change now, or is the landscape going to largely be the same 10 years from now?), I consider refraction particularly susceptible to obsolescence in the continuum of facets of eyecare (which includes things like eye health assessments, appliances for seeing, and surgery).

    I consider visual/seeing appliances to eventually be at the mercy of technology as well, but I believe that era remains farther off. But when we have the world's most wealthiest corporations such as Google blurring the line between technology and every-day consumerism/physiology (e.g. Google Glass), and predicting that the human brain will be embedded with data chips by 2030 (while actively pursuing that goal), it's hard to see how human-performed refraction will continue to be a paid-for service in the future. Kiosks already exist for refraction today in the U.S., not to mention an iPhone app.

    How long do optometrists have? For those who will not be "retired" in 20 years, how much longer will the practice of optometry be able to sustain an optometrist's career? Will those early in their careers today have to eventually re-educate themselves and re-enter the workforce in another capacity?

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    2035???

    I think it will evolve to be radically different by 2025. Your post is very interesting.
    Last edited by RIMLESS; 08-11-2015 at 09:46 PM.
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    What "radically different" changes are you predicting? What do you believe an optometrist will be doing in 2025?

    I chose a time horizon of 20 years over 10 years, because in 10 years, I believe refractive error will still be corrected by glasses. If refracting robots do eventually replace optometrists, this will take time and money. Time, for laws to catch up to modern technology, and money to put these robots into each refraction lane in the country, as they will not be free. In fact, this "robot-scenario" may never really happen, and if it does, may only be temporary. Thus, I don't think it's guaranteed we'll see such changes in 10 years, but 20 years is anyone's guess as there will be new non-3-O players involved. "Optical lenses" may very well not be the primary means for correcting refractive error by 2035 either, as corporate behemoths such as Google and Apple will probably be involved at that point, and they are all about providing technology to the masses (unlike ophthalmology, whose refractive interventions are prohibitively expensive for most, and will thus not be the primary reason why glasses become obsolete at any time in the foreseeable future).

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    I've heard this for 25+ years. Yes it will but it may not be exactly what it is today.
    Did anyone think ODs would be using OCTs or VFs in the late 80s?
    Careers evolve as do most things in life.

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    Quote Originally Posted by Chris Ryser View Post
    From the site:

    What changes will we see in the next 20 years? Here is what I believe optometry care will encompass by the year 2035:

    1. Optometrists will largely separate into medical and refractive specialists.
    2. Optometry residencies focused on ocular disease will continue to further incorporate co-management with ophthalmology.
    3. 75% of all states will have certain laser (SLT, PI’s, yag etc) and injectable privileges.
    4. 5% of all states will have posterior segment laser privileges and intravitreal injections.
    5. A “medical school track” will be established to allow optometry graduates an opportunity to complete an ophthalmology residency without having to complete formal medical school training.
    6. Optometry and Ophthalmology will get along (for the most part). Ophthalmologists will still petition against all of the procedures listed above, but the two professions will work harmoniously to provide the best care for the patient.

    My predictions might be completely wrong, but I don’t think so. States with large rural populations will slowly jump on the bandwagon to reform optometry laws. The greatest resistance will come from states with large metropolitan areas where patients have easier access to ophthalmologists.


    Nothing in this author's opinion considers the role technology will play in vision. In fact, we could have his exact 2035 scenario TODAY through legislation alone.
    Last edited by optio; 08-12-2015 at 11:05 AM.

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    Quote Originally Posted by David_Garza View Post
    Careers evolve as do most things in life.
    You're right, "careers" do "evolve" although mouthing platitudes doesn't mean optometry necessarily will. Some careers evolve better than others. Some careers don't evolve at all. Professional typewriter repairmen probably aren't doing too well today. That's the point of my OP.

    Apple and its iPhone has effectively put an end to all traditional low vision reading gadgetry, that just a few years ago, cost literally thousands of dollars more. I hardly believe those Sherlock-Holmes-magnifying-lens-makers have evolved into Apple Inc. technicians.

    You're right about OCTs and VFs but you're also wrong. Most ODs aren't using them as their patients can't afford them.

    Some ODs will be able to survive in a human-performed-refraction-free world, but will everyone?
    Last edited by optio; 08-12-2015 at 11:38 AM.

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    Everything changes, I suppose, but I do not agree about a few things you said about refraction. In my mind, refraction is not just determining the best sphere, cylinder and axis. True, most people can be taught to do that, and even a dumb-phone can be programmed to do it.

    PRESCRIBING, on the other hand, is another matter. Certainly for a large majority of patients, simple myopes,... a quickie refraction might suffice, but there are many patients with anisometropia, latent hyperopia, muscle imbalances, medical issues affecting best acuity, that are quite problematic. Medical decision making skills are needed here.

    I think the State Boards of our professions will be fighting an uphill battle to stop these online refractions...just look at what is happening with online glasses and contacts. It seems we live in an age where the "rights" of the consumer outweigh public licensing laws and the concept of public protection.

    I don't see Optometry today as primarily a refracting profession. I have so many technological aids that help me to determine refractive information...it is more a matter of making the right decision as to what to prescribe based on all factors including the habitual Rx and symptomatology.

    Medical care is a BIG part of optometry today. Ophthalmological residencies are down across the country, those who do become OMDs tend to have more surgical practices. Optometrist numbers are increasing.

    So, will the delivery of refractive services and materials change over the next 20 years?...probably. Will the need for optometrists decrease?...not likely.

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    I think your perspective is still within the "refraction" box. I'm an optometrist so you don't have to tell me about the skill of refraction. I'm talking about changes that don't involve the current three-Os. For instance, everything about "prescribing" you describe above can be applied to selecting low vision reading aids. But all that training goes to the wayside, when you use an iPhone with a real-time magnifying glass app. So no, in terms of low vision reading aids, prescribing skill doesn't save the prescriber from advances in technology.

    I'll mention there are already modern or contemporary challenges today that didn't exist before. Internet dispensing is one, but what about over-supply? There's more graduates coming out these days than 10 years ago, so supply/demand alone makes it harder for ODs to get by now, than before. Evolution is one thing, but supply and demand is another. If there's too much supply, salaries go down. Are we to blame new grads for their under-employment that they haven't been adept at evolving?

    What I was referring to, however, to larger outside-the-scope changes. Google has been developing driverless technology to make roads safer. An Alberta mine is using this technology to drive its mine trucks.

    http://www.cbc.ca/radio/day6/episode...work-1.3119963

    Are those now-unemployed drivers supposed to evolve into public-transit drivers? There are already public transit drivers. Those people will simply be out of work. What was supposed to be an innocuous means of helping reduce traffic deaths will now bankrupt several hundreds of families.

    At some point, Google will invent a contact lens that you put in your eye that will allow you to get a real-time Iron Man virtual-reality interface, that is independent of optometric refraction. I think that's in play for 20 years from now. Things like that are the game changers I'm talking about that will make optometric refraction obsolete.

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    I'm going to mention that the point of this thread isn't to try to prognosticate WHAT will replace glasses/optometrists, but that my position is human-performed refraction will end within a generation. Current IT specialists estimate by 2050, artificial intelligence will have reached a point that we will be able to have relationships and marry robots. I believe if a robot is capable of fornication, it will be capable of refraction. That's 35 years from now. I didn't want to discuss 2050 because that's probably going to be mostly irrelevant to most of us. I didn't want to discuss 10 years from now either, cause the point wasn't to get into whether humans can or should be replaced by autorefractors. Although I guess I can address that now briefly.

    Non-human (auto) refraction already exists. In the US, some OD is marketing a system that is an auto-refraction signed off by an OMD, and it's apparently already legal in some 20+ states.

    http://www.streetinsider.com/Press+R.../10751137.html

    If we expand the scope to outside North America, optometry in fact doesn't even exist in many countries. Glasses are prescribed by autorefractors or eyeglass-peddlers (refractionists?), so the non-optometrist paradigm already exists in the world today. Legislation is responsible for the existence of optometry in North America.

    At some point, people won't pay $95 to have a human do a refraction on them because they'll be able to get a reliable refraction done somewhere else for less. Go to some other countries (Japan, France) where refraction is treated like the measuring of feet to size shoes, and hell-no they won't pay for a refraction (so optometrists in France are "unemployed" in that they don't even exist there). Any advances in 3-O technology will inevitably protect ophthalmologists more than optometrists. As an aside, it's not as though medicine is completely immune to tech either. If my understanding is correct, there is now not enough work to go around for cardiac surgeons because of the advances in stent technology. "Non-surgical" heart-docs who do get their training through internal medicine channels - these folks are called cardiologists (as opposed to surgeons), are able to apply stents very uninvasively. So gone are the days where every blocked artery required a cardiac surgeon to open a guy's chest to do a bypass. Again, I'm not a heart guy, so pardon any inaccuracies.

    But the point is, refraction at it's most basic form, is an algorithm. A computer can be taught to apply an algorithm. And even if there's still some residual "human-experience" component, it's not as though it is infallible either. We all know of a local optometrist who gets paid to routinely prescribe less-than stellar Rxs for his patients. In that case, a smart computer may in fact be able to do the job better, and soon enough, for less. So no, human refraction isn't necessarily always going to be better than a robot.

    The current paradigm has companies like Luxottica and Zeiss as king. If it remains that way, then perhaps optometry very well may be able to sustain itself going forward. However, this will not last forever. Google and Apple combined have what, 10,000X the market capitalization of Luxottica? If they get involved, things will change fast. They not only have the wealth, but the talent to to change the game. Is ANYONE at Luxottica even intelligent enough to be hired to work at Google? Chances are, no. And they are working on the visual experience. There's already Google Glass. Even if it isn't Google, or Apple, this isn't the point. There will be a game changer within our lifetimes that makes human performed refraction obsolete, whether due to robots, or a new refractive "solution", and it will come from outside the 3-Os. At that point, optometrists won't necessarily go obsolete, but there will be a much reduced need for them.

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    Quote Originally Posted by David_Garza View Post
    I've heard this for 25+ years.
    I'll mention that this is impossible as Google was founded in 1998. If you think there'll be optometrists toting around phoroptors in 2035, then we'll just agree to disagree.

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    I guess you'll just have to carry on a discussion with yourself.....

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    Quote Originally Posted by fjpod View Post
    I guess you'll just have to carry on a discussion with yourself.....
    Actually I was done until you replied. Your point?

    Also 700 views in just a couple days. It seems there's a lot of folks interested in reading what I have to say. Including yourself. Thanks for perusing this thread.
    Last edited by optio; 08-14-2015 at 10:30 AM.

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    Blue Jumper Essilor and Luxottica who now definitely have entered the direct to consumer market.

    I am always wondering that new developments in any field are given only interest on what is happening on this continent instead of looking at a world wide situation.

    The North American continent has become the play and testing ground for the 2 biggest players world wide in the optical manufacturing field, namely Essilor and Luxottica who now definitely have entered the direct to consumer market.

    Eye care training develops livelihoods in rural India -
    "Thanks to a new public private partnership agreement recently signed in Rajasthan, 4,000 youths are expected to be trained over the next three years in that state alone. “Since the beginning of the year we have equipped 70,000 new wearers, with EMO responsible for putting glasses on the faces of over a third of those wearers,” explained Saugata Banjeree, Head of 2.5 NVG India, “We have now partnered with several local skills and livelihood development agencies to roll out the training of EMO.”

    - See more at: http://www.essilorseechange.com/deve....7370ZEaf.dpuf

    Knowledge share is a two way street in India
    In January, Essilor organised its first Eye Mitra annual convention for local entrepreneurs. Weeks later, the Group’s Advanced Management Program brought in 33 senior staff from 12 countries to learn about developing markets on the ground at Indian rural eye clinics.


    “There is no age limit for learning new things. I successfully completed my training and am now doing well and conducting vision screening camps regularly,” said Mr Nand Kishore, a previously unemployed 57 year-old at the Eye Mitra (“Friend of the Eyes” in Hindi) Convention.
    One of the first wave of Essilor trainees, he has acquired the skills and knowledge to become a “friend of the eyes” in his local community, and given a starter-kit to help set up his new business. He was one of around 100 individuals at the convention near Delhi. Many had travelled long distances to swap ideas with their fellow Eye Mitras and interact with Essilor managers.


    - See more at: http://www.essilorseechange.com/know....MFiTAxLa.dpuf



    Chris Ryser
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    Quote Originally Posted by fjpod View Post
    I guess you'll just have to carry on a discussion with yourself.....

    I just noticed that you are the same person who replied above. It didn't occur to me when I replied to your post (my last post above). My apologies. I thought you were some outside observer posting a "troll" post with nothing better to say. Given you had already replied with your opinions above, that totally changes the context.

    I think everything you have posted here is reasonable, even your last remark.

    Anyhoos - 25 years ago, we weren't in the digital age yet. 25 years from now, we'll almost be 50 years into the digital age. EVERYONE in this thread has referred to inevitable changes/evolution of our profession. If so, why is there resistance to the idea that some of these changes may be bad for practicing optometrists? I won't post again unless prompted.

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    Blue Jumper If so, why is there resistance to the idea that some of these changes may be bad

    Quote Originally Posted by optio View Post

    EVERYONE in this thread has referred to inevitable changes/evolution of our profession. If so, why is there resistance to the idea that some of these changes may be bad for practicing optometrists?

    Life has been too good for the status quo, just about forever, specially for the ones who are also selling glasses.

    The internet and technologies have been and will even more change the world over the next years to come. New ways of testing eyes automatically for prescriptions are being developed and refined as we go along.

    In the meantime your largest optical suppliers are doing their best to push you off the map when the time comes and it might be even earlier than you predict.
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    Anyone know why this average-salary-information website says most people in optometry "move on to other positions" after 20 years? What do you think it's referring to?

    "An Optometrist earns an average salary of C$87,781 per year. Most people with this job move on to other positions after 20 years in this field."

    http://www.payscale.com/research/CA/...metrist/Salary

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    as an optician I would love to earn that average annual salary. Why would an optometrist move to another position unless it was related to the field and they were making more money

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    I have absolutely no doubt the website is wrong (about moving on to other positions). I just don't understand why they would be so wrong about that fact, and what led them to believe it was true to begin with. I'm almost certain that historically, most optometrists stay as optometrists after 20 years of work.

    I'm also curious to know where they get their salary stats.

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    http://www.jobs4ecps.ca/JOBS4ECPS_Sa..._20150210.pdf?

    According to that survey done by jobs 4ecp's optometrists average salary is actually higher than what was listed

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    Redhot Jumper For official statistics you go on industry Canada .........................

    Quote Originally Posted by optio View Post

    I have absolutely no doubt the website is wrong (about moving on to other positions). I just don't understand why they would be so wrong about that fact, and what led them to believe it was true to begin with. I'm almost certain that historically, most optometrists stay as optometrists after 20 years of work.

    I'm also curious to know where they get their salary stats.

    That website belongs to a private firm that asks for opinions.
    Go and look for it:

    Contact
    Payscale Inc
    1000 1st Ave, South
    Seattle, WA 98134ACT
    PayScale, Inc.
    1000 1st Ave South
    Seattle, WA 98134



    If you want official statistics you go on industry Canada look for a profession, and do your own search. Then you will get the real facts, but they are usually about 2-3 years behind times.
    Last edited by Chris Ryser; 02-07-2016 at 01:06 PM.
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    Well, clearly (no pun intended) people will still need medical and refractive eye care in the future. I believe that the driving force in the US and Canada as well as the rest of the developed nations will be driven by economics.

    Optometry and Ophthalmology will soon merge into a single profession and the "new" eye doctor will manage a large clinical staff of ancillary personnel who will perform all the drut work such as refraction, tonometry, visual fields, fundus photos and all the rest of the acquisition of data and metrics which allow the eye doctor to make medical decisions. We already see this business model in some large ophthalmology practices where technicians, technologists, APRN's and PA's perform 90% of the work.

    We will also see an increased utilization of Temporary Foreign Worker Program ( TFWP in Canada ) and Foreign Workers Visas in the US. This use of foreign workers is already quite prevalent in nursing homes, physical therapy and hospitals.

    Clearly, the cost of health care at its present state is, in the long run, unsustainable and the possibility of a single payer system in the US looms on the horizon. Canada is already sucking the hind teat.

    There will be a few of you who will be able to hold on to the old ways but for most the party is nearly over.

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    Redhot Jumper Greed can still exist even in a big medial box environment.

    Quote Originally Posted by rbaker View Post


    Optometry and Ophthalmology will soon merge into a single profession and the "new" eye doctor will manage a large clinical staff of ancillary personnel who will perform all the drut work such as refraction, tonometry, visual fields, fundus photos and all the rest of the acquisition of data and metrics which allow the eye doctor to make medical decisions. We already see this business model in some large ophthalmology practices where technicians, technologists, APRN's and PA's perform 90% of the work.
    Revenge of the Opthalmo

    ................... I have lived through one of those right here in Naples a few years back, they even have an optical store off the waiting area.

    After having gone through the mill, I saw the doctor who told me that I had a cataract in my left eye, and that he was going to fix it for $ 4,000.

    I said no thanks, and that I was having it done back home in Canada under the national medicare for free.

    He gave me the exam results in a sealed envelope which I delivered to the license bureau, were after opening the envelope I was told that he suggested that I have to redo the physical driving test.

    ........I agreed right away, did it and passed with flying colors and got my license back validated for a few more years.

    Greed can still exist even in a big medial box environment.
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    I think rbaker might be right when he says "Optometry and Ophthalmology will soon merge into a single profession". I'm still something of a novice in the optics world, but to me this makes some sense...

    Doctors will fulfill the medical role (whichever title they want to use). Comprehensive eye exams are important and we should all have them on a regular basis - stuff like glaucoma, macular degeneration, etc requires a highly trained medical professional to diagnose and treat, and probably will for some time. But refracting itself is going to be less and less dependent on a highly trained medical professional as technology moves forward, and someone who is just having trouble seeing out of their old specs really just wants to have a new rx and a new pair of lenses. They don't want and don't need a comprehensive medical exam for what they're trying to do. They should get that exam on a regular basis, but we can't make them do it. We should all go in for regular physical checkups too, but again a lot of people don't and we can't make them. Does that mean they shouldn't be able to get a bottle of Tylenol for a headache? Of course not, and someone who doesn't want to bother getting a comprehensive exam shouldn't be restricted from getting a pair of glasses. A healthcare system where people didn't have to pay an arm and a leg for medical care would go a long way towards getting them in the door for a comprehensive exam, but that's another issue.

    Also - getting a pair of specs with a bad rx isn't going to cause medical issues is it? It's just a redo and lost money for the optical, which provides the incentive to get it right. If tech gets to the point that autorefraction (or something like it) becomes really reliable, what's left for optometrists to do? There will be the doctors for full exams and fixing any problems those exams find, and then there will be the local optical where you can get a refraction and a pair of glasses, or get a pair of glasses using an rx generated by a doctor at a comprehensive exam that may include refraction. I don't see any problem with that...

    Again I'm not an industry veteran by any means, and I'm happy to be corrected if I'm wrong, but... am I?

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    Blue Jumper major changes in all of our eyecare professions over the next few years.............

    Quote Originally Posted by optio View Post

    There will be a game changer within our lifetimes that makes human performed refraction obsolete, whether due to robots, or a new refractive "solution", and it will come from outside the 3-Os. At that point, optometrists won't necessarily go obsolete, but there will be a much reduced need for them.

    ..............interesting discussion

    The start of that future will begin in about 2 1/2 month from now, probably around the end of June 2018, when the now world wide accepted merger between Essilor and Luxottica will happen.

    This will create a similar situation in the optical retail business around the globe, of what happened in the oil industry not so long ago. There no more small service stations that sell the gaz and make repairs, the retail outlets consist now of multiple pumps, self service and some of them have also a car wash and, or a food store.

    In the optical trade the merging main players have also played politics for a long time, by supporting professional associations as well as governments on many levels.

    We should be seeing major changes in all of our eyecare professions over the next few years.
    Chris Ryser
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