Where Do You See Ophthalmic Technology Heading?
Check out the perspectives and ideas from four generations of actively practicing ophthalmologists and thought leaders in their field.
TRADITIONALIST
Dr. Manus Kraff - We're reshaping the cornea so people don't have to wear glasses and contact lenses. If there's a next revolution in ophthalmology, it'll be on the genetic level. It will not be at the mechanical level. Right now, we're still doing mechanical things, but that'll stop. We're doing mechanical things in retina, mechanical things in glaucoma, mechanical things in cataract and cornea. The next phase is going to be on a molecular level. So if I were to go out today, I think that's what I’d be studying. That will certainly keep me interested for many, many, many years.
Dr. Steven Siepser - I think it's going to be in the information side, the analytical triage. The equipment, of course, will be light years ahead of what we've done. So going forward these devices are going to be more integrated and talking more to one another, and more independent of a physician. That's why being a senior ophthalmologist now is so easy because we’ve got Google and you just need a piece of what you're thinking, and if you're disciplined, you go back and say what other things could this be and where else could this be? I mean, I just had a patient come in with a non-arteritic optic neuritis, and in two seconds I could show him the picture, it's a superior altitudinal effect. This rarely will be a tumor, but I’m going to send you down to a neuro-ophthalmologist. That assistance, from the knowledge base that exists at your fingertip, is enormous. I mean in the old days, I'd have to go look in a book or try to remember something. You don't have to do any of that now, just a few keystrokes and off you go.
BABY BOOMERS
Dr. Cynthia Matossian - I do believe that eventually cataract surgery will probably move into an office-based procedure, just like it went from a hospital procedure where people were actually admitted and spent a few days to an outpatient procedure. I believe it is going to move more commonly into an office based procedure. It's already happening, but it's not standard yet, but I believe it's going to do that. The other thing that I think we're going to be able to trial what looking through a presbyopia correcting lens will feel like. So, just like any other purchase we make; we try out a car, we go and visit a house before we buy it; we should be able to trial what the vision is like and at what distance we wish to see so that we can choose appropriately. The light adjustable lens is coming close to that, but it's a monofocal lens at this point. So, to be able to trial it before getting it in the eye, I think will be a huge evolution.
Dr. Mitch Jackson - I think technology is going to evolve where there will be no true healing responses. We'll be able to put a lens in and that will be perfect. The whole goal is to achieve perfection for that patient. So, I think everything's going to be customized in the future and even be safer with faster healing. Presbyopia, dry eye, glaucoma, macular degeneration are probably the four big ones in my opinion to strive to be able to treat. We can do injections now with macular degeneration, which was a big step, but it would be nice to see all these dry AMD patients get some medicine and see again. That's the future, you know, they’ve even now got gene therapy for these inherited retinal disorders. There are going to be true accommodating IOLs and there’s going to be more beyond that, I'm sure. Already there are presbyopia drops, which will create a nice bridge to more innovation. There are a lot of dry eye companies coming out now. It was just Restasis for 13 years and all of a sudden, we have like 35 different treatment options for dry eye now or ocular surface disease and a lot more on the horizon. It's going to keep getting better. And automation is going to be a big thing for all of us, even as surgeons, an automation learning curve. We want to reduce the learning curve and get better training for young ophthalmologists.
Dr. Nelson Preschel - The compliance factor of the medical treatment will definitely improve medical treatment. The patients won't have to remember to use the medication and won't have to fear an injection. So I'm seeing that the most critical parts of many surgical procedures are being replaced by systems that are computer guided, by real imaging. I was reading about OCT guided retinal surgery today and about lasers to change the refractive index of the cornea. I mean I was even reading about changing the refractive index of the intraocular lens and improving residual refractive errors, even turning monofocal lenses into multi-focal lenses with the laser. Now we're gonna be able to do that in the cornea without having to cut a flap, or remove tissue, or anything like that. So it's very impressive. In summary, I think that things are going to be way, way less invasive and less dependent on hand skill, which is probably what makes a difference between good surgeons and average surgeons, hand skills. I guess one day everyone's gonna be a great surgeon, you know.
Dr. Larry Patterson - You know, technology is a two-edged sword on one hand. It's really cool. I mean, I'm an anterior segment surgeon, but I don't know how we could do without an OCT. When you build a practice, or build out a facility, you're just not really thinking about stuff that hasn't been invented yet. I mean, when I built this particular facility 18 or 19 years ago, nobody had an OCT, so all of a sudden you have technology that requires a room. We're realizing that over the next 10, 20, 30 years more OCT type things will come about, we just don't even know what they are yet, but they're going to happen. So battling costs and space for technology, I think are the challenging facing us over the next 15 years.
GENERATION X
Dr. Laura Periman - I think it's going to continue to evolve, and I pray for increased efficiencies, but because of the big COVID push, I've been able to start this new Institute with a skeleton crew, a lot of virtual helpers, and with all these amazing apps, job forums, and I love it. All these telemedicine platforms, Doximity, Advanced Ocular Systems, and others, are just going to continue to evolve. I see the technology facilitating some much needed independence from the evils of health insurance companies. Did I say that out loud?
Dr. Lisa McIntire - I think refractive surgery is going to be the primary vision care option for people suffering with refractive error. I think that it's not going to be for the elites and the privileged and those who are fortunate enough to have access through financial means. I think in the future, people who can't see are going to be able to have their vision corrected, and then they're going to be able to go out into the workforce and the community and serve in their own capacity. That's what I see coming in the future.
MILLIENNIALS
Dr. Anna Lehmann - One of the areas where I'd love to see that continue to drive forward is in our ability to predict which power is best for patients. So the post-refractive patients who have always wanted that great vision, that's why they have refractive surgery in the first place. They're now in a position where, you know, they're less predictable outcomes, because of their post-refractive status. So I'd love to see these great premium IOLs that work great in their eyes too, with more reliability.
Michael Patterson - I think our technology, as far as teleretinal and telemedicine could change, it depends on if people adopt it, as far as taking photos of the fundus and whatnot. We haven't really changed a lot in our clinic, except for learning more about glaucoma and learning more about macular degeneration. I would really love to see a technology that could slow dry macular degeneration, that would be amazing. I would really love to understand why some peoples still go blind from glaucoma with an eye pressure of 12, no matter what we do. I think what people wish more than anything in my clinic is for somebody to be able to regenerate their geographic atrophy for macular degeneration.
Dr. Alanna Nattis - I think since my career started, technology has just been on this exponential rise in almost every way possible. I think that one of the big things with cataract surgery now and also other surgeries too, is we're moving more towards Intracameral therapies versus topicals. There's also been a lot with artificial intelligence and diagnostics and better-quality diagnostics and being able to diagnose conditions earlier. So, I think those are all going to play a big role and also determine earlier treatment paradigms for our patients. I think it's hard to predict what's going to come next, but I think that I'm continuously surprised by what comes next. So, that's why I love ophthalmology so much because I feel like I'm constantly learning. I feel very privileged that we can offer it to our patients too.
Dr. Jillian Chong - So, I am really excited about SMILE. I think that SMILE has a lot of opportunity to be a really premier refractive surgery procedure. I recognize it still has some kinks to work out and there's definitely a learning curve. But I think that for the early 15-year data on stabilities, it’s really exciting. There's some things in the pipeline people have been talking about, irrigating lenticular and stuff like that. I mean, it's a whole new frontier of refractive surgery, and to be already a very technologically forward profession. Where you're at the dawn of a completely new procedure, it’s really exciting.
Dr. Jennifer Loh - Well, I see that a big evolution in technology is the increase in quality of premium lenses. We're able to get people better, uncorrected vision. It's becoming simpler and more effective. I think that's been a huge benefit. I think that we're also going probably to move towards better, better drug therapies and really hoping that we can get more drug therapies especially in the glaucoma arena whether it be MIGS or implantable devices in order to monitor and treat glaucoma. I really hope that will be the next path in the future because I feel that is it's really an underdeveloped area in some ways that I think there there's a potential for so many better treatments and for growth in our understanding of the disease.
