The clinical practice of optometry has been defined and redefined throughout its history—shaped sometimes by technological advances, legislative actions, and often by the needs of the public. What has remained constant is that optometry provides essential vision care for people around the world. At its beginning, optometry was limited to merchants providing products, optical aids, benefitting those with refractive errors. Contact lenses transformed the profession, expanding clinical practice and requiring clinicians to better understand health and diseases of the anterior segment. Optometric education expanded to include anatomy, physiology, and pathophysiology of the anterior eye, and adnexa. Researchers in optometry and vision science, pursuing questions related to contact lenses, expanded our understanding of the cornea, its unique anatomy, physiology and ocular surface responses to inflammation.
Diagnostic and therapeutic pharmaceutical use in optometric practice further transformed the profession. Use of these agents is still relatively new (roughly 30 years, or one generation). Since then, the profession has begun to embrace a medical model of practice, and educational scope has expanded to follow suit. However, the profession has yet to fully embrace the increased scope of practice. Adopting a more medically oriented model of clinical practice will require further changes to existing educational and clinical training programs as well as new investments in research and discovery.
Biomedical sciences are applied basic sciences—immunology, microbiology, cellular and molecular biology, and other fundamental sciences: genetics, optics, engineering, and other disciplines focused on health and public health matters. Biomedical sciences are not the history of optometry, but must become a prominent part of our educational institutions if the profession is to transform again and take full advantage of a biomedical model of clinical practice. This will mean that future faculty will look different from the current generation of educators. Education in visual sensation and perception, will have to be balanced with additional emphasis on ocular and systemic disease management. While most clinical training programs today teach biomedical sciences, their faculty are often trained in vision science; they do not come from program related to applied biomedical sciences.
Recruiting future faculty who are trained in biomedical sciences and who can expand the current boundaries of research conducted at optometric educational institutions will create additional opportunities. Faculty capable of basic biomedical research, addressing current problems in vision science, will not only contribute to shaping a culture of clinical practice that is more soundly rooted in basic biomedical sciences, but will also possess the training and pedigree needed to build competitive research programs. A cultural shift will be required to accept this new new direction.
The future of optometry will depend on many things, economics, politics, disruptive technologies, and other factors that may be difficult to foresee or control. However, leadership in clinical practice, eduction, and research will always be required. A sufficient number of capable students who can see themselves as the next generation of leaders is just as essential. The future shape of the profession will also depend on educational institutions that take full advantage of the current scope of the profession while encompassing modern biomedical sciences. Future clinical interventions (e.g., medications, stem cell therapies, etc.) will depend on this knowledge and optometry must be educationally equipped to fully participate in a clinical practice model rooted in modern biomedical science. This future vision of professional scope and clinical practice will be forged by educators and investigators who can create and convey an expanded knowledge base that includes the latest biomedical discoveries and their intersection with vision.
Michael D. Twa
Editor in Chief