If you practiced optometry in March 1978, when our first technology issue appeared, your exam room might have seemed as empty as a racquetball court compared to today. Then, optometrists used a few simple tools—most of them operated manually—that required expertise and careful consideration by the doctor. Now, gadgets are so pervasive that many have long since spilled out of the exam room into the pretest area, with use delegated to a tech. 

Is there any room left, in your budget and in your brain, for more? This 40th installment of our series highlights technical advances spanning everything from the most fundamental areas, like refraction, to specialized tools such as dark adaptometry, corneal hysteresis, ERG and all manner of OCT. The latter category moves quickly—no sooner had we prepared a CE article on cutting-edge OCT technology than news broke about another iteration, called line-field OCT, which may allow imaging at the cellular level. Don’t miss our news story on page 3 about that.

If you’re leery of such tech-heavy care, you’re not alone. Anxiety about the relationship between doctors, patients and devices has been present for decades. The cover of the March 1978 issue was an illustration of an OD cowering beneath a huge, intimidating computer under the headline, “Automation: Will it Click With Today’s OD?” Inside, a reader survey on attitudes toward new technology opened with this provocative sentence: “It killed the cobbler and the weaver, and some ODs think they may be next.” It, of course, was automation. “The idea that patients may some day be able to click, buzz and whirr their way into an accurate prescription at their local department store worries many ODs,” the author continued, expressing a fear that still pervades optometry, as online refraction seems potentially able to deliver what the department store couldn’t.

The tech boogeyman of ’78 was the autorefractor, a recent introduction at the time. Opinions were decidedly mixed. Just 44% of readers favored automating such a core responsibility. While 61% expected it to improve efficiency, only 34% said it would improve quality of care. In the article, ODs worried about the erosion of the doctor-patient relationship (“The patient feels rushed; he feels the doctor doesn’t care because he turns him over to an assistant who doesn’t care either”), overreliance on devices (“I’m afraid of the quickie exam, where there is no case analysis of a patient’s needs”) and accuracy (“When you can prescribe the results obtained by an automated refractor, maybe I’ll consider one. Otherwise, they are very expensive retinoscopes.”).

Many readers of that first technology issue could conceivably have left their office and found a theater showing Star Wars, released 10 months prior but still a smash hit. It became a cultural event because it tapped into our man-vs.-machine dread, letting us exorcise our demons as we watched an intrepid human take down a technological terror. Four decades later, it’s a story we still need to hear: technology alone is never enough. We at RO love tech, but keep that in mind as you read this month’s coverage.