You can track the evolution of optometry’s role in retina care by perusing our annual issues devoted to this category. It began rather humbly, 12 years ago, with just a photo essay of fundus images and an article pondering the implications of the original AREDS study. That’s about all optometry could do circa 2010: perform fundus exams (referring out most suspicious cases) and recommend AREDS vitamins.
Back then, most optometrists didn’t have an OCT, so even those interested in being more active in retina were stymied by significant barriers to entry. In 2010, AREDS2 hadn’t yet come out. There was only one FDA-approved anti-VEGF, Lucentis from Genentech, though off-label use of the same company’s Avastin was widespread. Lucentis and Avastin were pretty much identical in dosing and efficacy, so there wasn’t anything for ODs to weigh in on prior to referral. Anti-VEGF was primarily used for AMD; panretinal photocoagulation was still the mainstay for diabetic retinopathy. The 2010-era literature on pharmaceuticals to treat dry AMD was basically fan-fiction.
Fast-forward to today and we have a robust field of anti-VEGF drugs to consider, for multiple indications—with optometrists right in the thick of the conversation. OCT is now a part of most optometric practices, and in fact many ODs are on their second device, as the advantages of OCT angiography are triggering an upgrade cycle. Excitingly, two drugs to treat geographic atrophy seem poised for FDA approval. Gene therapy for RP and Leber’s is a reality, and others are being explored.
For ODs in 2022, there’s more retina work to do than ever before. The pharmaceutical industry has noticed, too. I still remember the timidity of the drug manufacturers to support optometry’s use of even the most plain-vanilla topical antibiotics and anti-inflammatories in the 1990s. Nowadays, many of the big players in retina advertise their medications directly to optometrists in this publication and others. Retina dinner seminars for optometrists are both commonplace and uncontroversial.
Optometry, in short, has arrived.
For our 13th annual Retina Report this month, we delve into how ODs can take advantage of this rising stature with articles on dry and wet AMD, inherited retinal diseases and diabetic retinopathy. Throughout, the role of the optometrist is active and engaged in ways 2010 docs would marvel at.
Reading over these stories one last time before press, I was struck by the level of sophistication in the discourse from our optometric authors. These aren’t EZ Reader versions of retina articles you might see in ophthalmology publications; in fact, I’ll bet we could slip them into one of our company’s ophthalmology magazines and the MDs would only notice the difference if they looked at the byline. Too many heads would explode for this idea to be anything but a thought experiment right now. But one day, even ophthalmologists will come around and give you grudging respect in retina—provided you put in the work to earn it.