When I started writing about optometry in the early 1990s, the bread and butter of the field was refractions, dispensing and anterior segment care. There was also a growing recognition that glaucoma was a good fit for optometry and would become integral to practice once the state laws finally came around. Retina, however, was still kind of a niche. Beyond performing basic posterior segment exams with a binocular indirect, there wasn’t much an OD could do. 

Optometric retina luminaries of the 1990s like Jerry Sherman, Lou Catania and Larry Alexander worked diligently to elevate the profession’s capabilities and interest in retinal disease, but it was never quite an equal partner to anterior segment care back then. OCT was brand new and only made sense for researchers and subspecialists. Anti-VEGF was still over a decade away. The AREDS study had begin recruiting but wouldn’t finish until 2001. 

Fast forward three decades and various trends are moving retinal disease assessment from niche pursuit to mainstream optometry.

Start with the elephant in the room: optometry’s two-to-one advantage over ophthalmology. A growing and aging population needs ever more health care, and stagnation in the population of ophthalmologists does nothing to quell demand. More patients need primary eye care every year, and that can only happen in optometry offices.

In 2023, OCT is now an essential device in optometry as well as ophthalmology, giving ODs access to the single most significant tool for retinal disease assessment. The much-vaunted coming wave of AI-powered diagnostic devices will only help demystify retinal conditions even more and give optometrists more reliable diagnostic resources for disease identification and long-term follow-up.

Probably the biggest catalyst right now for optometry’s more prominent role in retina is the emergence of therapies for geographic atrophy. With one drug on the market and another expected later this year, GA is suddenly a hot topic. There’s finally something to recommend—but the strike zone for what constitutes a viable candidate is rather small. Patients have to be well selected and properly educated on expectations and outcomes. That’s not just an invitation to optometry, it’s practically an imperative to act. ODs see the lion’s share of primary eye care patients and will be the first-responders who screen, identify, triage and prep GA patients for what’s to come.

This parallels a similar impetus in diabetic retinopathy screening, as the 2021 Panorama study found value in prophylactic treatment of severe NPDR as a means of preventing vision loss. Again, it’s the ODs who are out there in the trenches finding these patients day in and day out. 

Lastly, today’s new optometry grads come out of school fully read in on retina. It’s as much a part of their world as anything else.

Add it all up and it’s clear that optometric retina care is rife with opportunity. I wish there were stronger financial incentives—or, to put it more equitably, I wish insurers valued your role commensurate with the societal gain it represents. You may never make a killing in retina, but you can really make a difference.