Walking the exhibit floor at the recent SECO conference, I was struck again by how revolutionary optometric technology has become, especially in glaucoma. A colleague and I stopped to watch a demo of one of the latest OCT devices, which could integrate data and images from retinal nerve fiber layer and ganglion cell layer scans, visual field testing and fundus photography. With the press of one button, serial findings popped up onscreen for instantaneous trend analysis. The device compared the results to a normative database and gave its assessment of the risk of glaucoma. It seemed like you didn’t need to know anything about the disease or the patient to have a pretty good idea of their status.
And that’s the problem. Technology never has all the answers—you do, or at least you need to.
Just a few days earlier, this magazine had given its annual career achievement award to Tom Lewis, OD, retired former president of Pennsylvania College of Optometry and a leading light in glaucoma education throughout his distinguished career. In his day, he had to make do with perimetry, tonometry, a fundus exam and little else. As incredible as OCT is, I can’t help but feel that clinicians of Dr. Lewis’s generation have an ability to intuit the status of a glaucoma patient better than someone who never learned how to make a diagnosis “the hard way.”
OCT is now among the standard of care for glaucoma management. Just a decade ago, it was mostly confined to retinal disease and the specialty practices that needed it. Now, it seems, everyone needs one.
The ascent of OCT is one of eye care’s biggest success stories, with incalculable benefits for practitioners and patients. If you don’t have one yet, run, don’t walk, to your nearest exhibit hall and plunk down your credit card. But when you do, remember that it’s nothing more than a tool and you’re the doctor. As you start using it in your practice, try doing the assessments mentally and then see if your results sync up with what the device tells you. Even if it’s just an exercise, that feeling of having your neck on the line can force you to learn the craft more deeply.
Technology often occludes knowledge that way. I sometimes marvel at the realization that my two-year-old son might never drive a car. The big automakers and tech companies are all working fiercely to perfect self-driving vehicles. Will they get there in the next 14 years? There’s a good chance they will. No matter what, the experience will be safer, simpler and more reliable than today. As a parent, I’m relieved that he’ll be protected in ways I never was at that age. But I do feel a twinge of loss on his behalf at the things he’ll lose as automobile travel shifts from an active to a passive experience. There’s a thrill, and a responsibility, to being behind the wheel.
Younger ODs may be better equipped—in the sense of literally having better equipment—than older ones, but diagnosis should never become passive and automated. No matter how fancy your gear gets, you’ll always be in the driver’s seat.