(Editor’s note: INVISION Magazine has partnered with Marshall B. Ketchum University to examine the field of optometry. This column is the sixth installment in the monthly series.)
As the United States’ aging population grows, every health care profession in the country will face an increasing demand to provide care. This especially will be true for health care professionals who work in the field of optometry.
The number of individuals in the U.S. with visual impairment is expected to double over the next few decades. To address this demand, our health care system will need to rely on all eye care providers that provide full-scope treatment and disease management. We also will need an increasing number of low-vision providers to help patients address vision loss and maintain independence.
Fortunately, technology advancements on the horizon should ease the burden of health care providers. In optometry, we can look forward to remarkable advancements in assistive and adaptive technology, as well as the growth of precision medicine, to deliver individualized and optimal care.
Low-Vision Advancements
The optometry field already has experienced advancements in technology that can be used to address the needs of patients with visual impairment. Over the past decade, there has been an explosion of low-vision devices available on the market that incorporate robust text-to-speech software. With this, wearable head-borne devices with augmented reality capabilities now allow digital visual enhancement of viewed text or scenes.
Of course, artificial intelligence (AI) technology, which is ever-present in the news these days, also is being developed for use in low-vision devices. We are currently seeing the incorporation of AI to assist patients with the interpretation of text and images. This includes summarizing text, finding specific information within a page and real-time translation. The availability of ride-hailing apps has improved transportation options for patients who cannot drive. Needless to say, fully autonomous self-driving vehicles will provide additional options for independence.
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Precision Medicine
We also will see huge advancements in precision medicine in the near future. Otherwise known as personalized medicine, this is an approach to disease prevention and treatment that considers an individual’s genetics, environmental factors, and lifestyle.
Precision medicine already is being applied in the diagnosis and management of inherited retinal dystrophies (IRDs). Current guidelines recommend genetic testing for all patients with IRDs to identify the genetic cause of the disease. This allows for gene-specific management, including the delivery of more accurate prognosis and genetic counseling of inheritance patterns for patients and family members.
In addition, identifying the genetic information is necessary for patients to know if they qualify for currently available gene therapy and gene-specific clinical trials. For instance, identification of their specific genetic variant(s) allows patients with retinitis pigmentosa and Leber congenital amaurosis to know if they are candidates for the currently FDA-approved gene therapy for RPE65 gene mutations.
Precision medicine already is being applied in the diagnosis and management of inherited retinal dystrophies (IRDs)
Research Continues
Make no mistake, the development of the first gene therapy for an IRD was an exciting breakthrough for those who are eligible for this treatment. There are, however, more than 300 different genes associated with retinal conditions for which we do not have an FDA-approved gene therapy. We are at a stage where we can identify most of the genetic causes for patients with IRDs. However, in order to treat everyone who has a blinding retinal condition, there is still a lot of research to be done on the genetic basis of eye conditions and treatments for these diseases.
Thankfully, we can be encouraged by the abundance of current research focused on developing new and innovative methods for diagnosis and treatment.
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Currently, within eye care, in-office genetic testing is being used primarily for patients with IRDs. This enables patients to identify if they qualify for any of the dozens of clinical trials. As the scientific knowledge of genomics continues to grow, we will see increasing clinical application of genetic testing for the diagnosis and management of a plethora of other ocular and syndromic conditions, as well as the use of genetics to predict the developmental risk of specific conditions.
There are more than 300 genes associated with retinal conditions for which we do not have an FDA-approved gene therapy.
Facing the Challenges Ahead
It is predicted that between 2020 and 2030 the number of people with age-related macular degeneration is projected to increase by 1.2 times and the number of people with glaucoma by 1.3 times, not to mention the growing prevalence of diabetic retinopathy within the U.S.
There are several significant ways that optometrists can embrace these challenges before us and help meet the coming demands of our aging population. For instance, the optometry industry will need an increased number of practitioners to offer low-vision rehabilitation as a service within their practice. We also will need more optometry students to consider this essential and expanding field of study.
Optometrists are trained and perfectly positioned to identify patients with vision loss and direct them toward the most appropriate technologies and treatments. As precision medicine further develops, optometrists will play an important role in its application by recommending and conducting genetic testing and informing patients of their treatment and clinical trial options.
Additionally, optometrists can educate patients with IRDs on natural history studies to help contribute to the body of knowledge that will lead to expanded treatment options in the future.
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The number of people with age-related macular degeneration is projected to increase by 1.2 times this decade.
Final Thoughts
Eye care providers must continue to work together to meet the challenges our medical system will face in the coming years.
We need to continue building the network of low-vision providers, retinal specialists, occupational therapists, orientation, and mobility specialists and genetic counselors to work together to provide optimal care for patients with visual impairment.
There is great potential in our new and developing technologies. It remains crucial that we begin laying a strong foundation today for their use in the future.
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About the author: Rachelle Lin, OD, MS is a full-time Assistant Professor at the Southern California College of Optometry (SCCO) at Marshall B. Ketchum University (MBKU).
Rachelle Lin, OD, MS
She provides patient care in the clinical departments of Low Vision Rehabilitation and Acquired Brain Injury at the University Eye Center at Ketchum Health in Anaheim, CA. Additionally, she conducts genetic testing for inherited eye conditions.
At MBKU, Dr. Lin teaches courses in low-vision rehabilitation, genetics, clinical methods, and nutrition. Her lectures cover topics such as traumatic brain injury, vision rehabilitation, genetic testing, and gene therapy.
Dr. Lin is an active member of the American Optometric Association and the California Optometric Association (COA), where she currently serves as COA Trustee. She has held positions as Chair of the COA Low Vision Rehabilitation Section and President of the Orange County Optometric Society. She is also recognized as a Fellow of the American Academy of Optometry.
She earned a Doctor of Optometry and Master of Science in Vision Science degrees from SCCO and completed her post-graduate residency at the VA Long Beach Healthcare System, specializing in low-vision, traumatic brain injury and primary care. In recognition of her achievements, Dr. Lin was named the 2019 COA Young Optometrist of the Year.
