Emerging technologies in Optometry by Arthur Stevens

In 1983 Gerald Hawkins, in his book “Mindsteps to the Cosmos”, wrote about the different “mindsteps” that have, in conjunction with the accompanying technology, revolutionized the world and led to the inventions of writing, mathematics, radios, spacecraft & computers.1 He wrote that “The waiting period between the mindsteps is getting shorter. One can’t help noticing the acceleration.” This notion that the rate of change in a wide variety of systems increases exponentially was explored by Ray Kurzweil in his 1999 book “The age of Spiritual machines” and referred to as the “Law of accelerating returns”.2

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This article explores a brief moment in this accelerating progress and reviews some of the technologies that are currently investigated and their impact in the optical industry in the coming decades.

The article is divided into 3 sections:

  • Retail
  • Clinical
  • Business

 

The retail section will look into areas where we can improve the patient experience from online appointments, to dispensing tools and consumer products.

The clinical section will look at the advances in technology that have recently been introduced or is hoped to be introduced in the coming years to ensure we can provide the best diagnosis and management for the patient.

The business section is specifically tailored to the independent optometrist and will explore how, as small business owners, we can embrace the new technologies to ensure that our business continues to thrive in such a competitive environment.  The latest news, labelled a “retail apocalypse” coming into 2020, that so many retail businesses have shut shop, is of concern so any advantage we can utilise to ensure we continue to thrive will be explored3.

The areas that are discussed are by no means exhaustive but ones coloured by my own interests. There are many other topics that I could have covered and are missing from the review but one common theme is that as we head into 2020 technological advances will only accelerate and make working in the profession even more exciting.

Retail

  • Online appointments

We live in an era where, as a result of the huge amount of available information and wanting to be in control of how we use that information, we prefer to book many of our appointments online rather than spend, potentially many lost minutes of our lives, calling and booking appointments4.  Further studies, in comparative professions, have shown that “when primary care agents book outpatient clinic appointments online it improves outpatient attendance”5.

Some of the options available to the optometric business include:

  • My health1st6 – Is the most used online appointment book and has been adopted as our method of online booking for our customers at Kosmac & Clemens. One of its major advantages is the ease to set up and use and most importantly, integration with PMS (Optomate & Sunix). Anyone implementing this system needs to decide how many and which appointments they will allocate to online booking.
  • WordPress7 – WPForms claims to be the best WordPress contact form plugin.  It provides you with the options of building your own forms that send the booking request as an email. The staff process the email and reply either by SMS or email. Unfortunately, there is no integration with Optomate or Sunix. Their basics package is very good value and if you like to send marketing thru email /SMS then their plus package is even better value.
  • Apointuit8 – is for medical practices only and does not integrate with Optomate & Sunix. It offers a smartphone app that allows for online booking. Perhaps, the optical industry can adopt the features this package offers.
  • Patient tracking9

Patient tracking (also referred to as PSI – patient identification system) is usually used in hospitals for a healthcare provider to monitor the progress of a person in their care. The healthcare professional has access to the patient’s electronic records, it can be used to store a patient’s imaging files, as well as check-in and check-outs.

In private practice, it can inform the healthcare professional if the patient is in the clinic, can send SMS reminders about when a patient can take their medication & by wearing additional smart devices can inform the practitioner if the patient has taken their medication.  This ensures maximal compliance and the best possible outcome for the patient.  The 2 major concerns relate to cybersecurity and interference with a patient’s privacy.

In optometry, I can envisage the system being used to ensure the patient is taking their medication e.g. glaucoma drops, ensuring the patient turns up for an appointment and for marketing purposes.

  • Frames
    • Materials – Up until now, frame materials have been limited to various plastics, metal and wood. Technological progress and concerns with sustainability means we will see biodegradable frames (e.g. made from castor beans10), high-tech lightweight frames and frames incorporating various sensors, often referred to as “smart glasses”11. The introduction of 5G connectivity will see this technology to be taken to the next level. There is a high possibility that smart frames will compete with mobile phones in their functionality.
    • Print your own frame12 – As 3D printers become more affordable customers will be able to print their own frames based on templates readily available for free download or for a small fee. The potential for 3D printed frames comes from the expression ““The only limit is your own imagination” and the fact that 3D printing allows for the creation of very complex structures which would not be possible with traditional manufacturing. 3D technology also makes screwless hinges more accessible10.  Hoya has taken the process one –step further with its “Yuniku”13 system where “the world’s first vision-centric 3D eyewear , combines 3D scanner technology with advanced algorithms, to position the lenses for optimal vision and then 3D build the frame around the lenses.
  • Lenses
    • Rx measurement

Lens measurements have advanced significantly from using a PD ruler to measure interpupillary distance and heights of a bifocal or multifocal. Some of these include:

Hoya’s VisuReal Master system14 has been designed to look like a contemporary wall mirror. The patient looks at themselves in the mirror. The dispenser operates an end device (e.g. an iPad) which is connected via Wi-Fi with the mirror. The 6 cameras behind the mirror capture information such as – PDs, fitting height, frame size (boxing method), distance between lenses, back vertex distance BVD, inclination or pantascopic angle & frame face form or wrap angle. The device is relatively compact 64.5cm x 22cm x 3.5cm (HxWxD). The software can be installed on a stationary or mobile electronic device, including smartphone and most operating systems are supported.

Hoya have also developed the binocular harmonization technology (BHT)15. The technology claims to relieve eyestrain while wearing standard progressive lenses, particularly if there is a difference in prescription between the 2 eyes.  The patented Binocular Harmonization Technology (BHT) recalculates and adjusts the progressive power distribution according to the actual used positions on each lens so that both eyes will experience the same binocular support.  The technology evaluates a Binocular Clearness Index which takes into account Convergence Difference, Accommodation Demand Difference, Magnification Difference and Vertical Prismatic Difference between the two eyes.  The Clearness Index estimates how clearly the wearer sees an image through the spectacle lens. Balancing this enhances binocular clarity throughout the entire lens.

A simpler version of the VisuReal Master system is Hoya’s Spectangle Pro and Essilor’s Eyeruler 2.  Both are very similar in that they use an ipad or equivalent device e.g. EY-stick or parameter clip (that provides a reference that sits on the patient’s frame) to take pictures and make adjustments.  These technologies are considerably faster and more accurate than the older systems that are available and should provide a point of difference to the customer experience than simply using a PD ruler to take measurements.  This is particularly true for the high end free-form lenses that the companies provide.  In addition to a measurement module the app has a lens selection module, a frame selection module and an augmented selection module that allows patients to take certain lens features for a test ride around your office or pre-built environments. Taking the lens selection process one step further and wowing them along the way.

Dr Wolfgang Wesemann16 in 2010 compared 4 high end video centration systems Essilor: ‘Visioffice’, Rodenstock: ‘ImpressionIST’, Ollendorf: ‘Visureal’ & Zeiss: ‘Remote Vision Terminal (RVT)’ with pupilometers. He concluded that “all tested video-based systems measure the PD to a higher precision than conventional pupillometers”. Furthermore, the “video centration devices present as ‘point of sale’ additional information on high-end spectacle lenses and personalised lens designs.”  This argument holds true today as it did 10 years ago and even more so as the technology has been refined to provide even more accurate results with a reduction in error such as when a customer is not positioned accurately.

Equivalent systems exist for Zeiss e.g. Visufit 100017, iterminal 218. The improved software eliminates the use of a frame calibrating clip and increases the accuracy of centration to maximize optical performance.  Zeiss claims that taking measurements is up to 60% faster for the i.Terminal 2 than using manual measuring procedures and that the measurements are 84% more accurate than a manual process.  For the small business owner who wishes to retain customers, in addition to eliminating remake errors this technology offers exceptional “wow” factor.

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Types of lenses

Lens materials has significantly improved since the 1st half of the 20th century from crown glass with an index of 1.523 and a specific gravity of 2.54 to CR39 which is significantly lighter with a specific gravity of 1.32 but thicker with an index of 1.5. Polycarbonate, Trivex, & high-index materials ranging from 1.6 to 1.9 followed, each with their own benefits.  Looking forward we can expect advances in coatings and even higher indices19 up to 5.5 and only one two-thousandth the thickness of a human hair. Some of these are already in production such as permanent antifog coat20, anti-scratch coats (that actually work)21.

In addition to advances in materials, we will also see advances in design. One of these already in circulation is the Myosmart22 lens from Hoya which uses D.I.M.S. (Defocus Incorporated Multiple Segments) technology for myopia control A two-year clinical trial found that MyoSmart lenses were able to reduce myopia progression by up to 59% and halt myopia progression by 21.5%.

It would be great if we can eliminate the biggest bugbear of multifocal lenses, the distortions that are experienced when changing viewing distances from far to near.  Electronic focusing eyewear using liquid crystal display technology has been studied over the last decade and some products are starting to appear23,24.  Currently, they are price prohibitive for most people at ~ US$2,220 a pair – plus tax.

Clinical

Telehealth – This has probably more applications in medicine than optometry but optometry can certainly benefit from expanded use of telehealth. Telehealth offers significant advantages especially in a country as large as Australia with the remote areas having vastly isolated populations25,26. As Telehealth becomes more utilised it is predicted that more virtual clinical trials occur, increased access to healthcare for remote communities, development of paediatric platforms27.

Vision

Myopia

Various studies have acknowledged that we are facing a global myopia epidemic which may lead to various ocular complications including vision loss28, 29.  There have been various technologies available to combat this progression from education, to specific myopia lenses and contact lenses and medications30.  The science on the exact mechanism and treatment options is still unclear but is expected to make significant progress in the coming decade31.

Amblyopia

Amblyopia is the most common cause of monocular visual impairment affecting up to5% of the population. Traditional treatments have included penalisation of the non-amblyopic eye with either patching or pharmaceutical penalisation32-35. Unfortunately, success as measured by visual acuity equalisation or development of stereopsis has been hampered by non-compliance contributing to treatment failures.  Alternative therapies include: vision therapy, binocular therapy, and liquid crystal display eyeglasses have only been sparingly used with moderate success.  The Pediatric Eye Investigative Group (PEDIG) has shown that age should not be a restrictive factor & that “even older patients can show improvement in VA in the amblyopic eye”. Recent studies from Vanderbilt University have learned that visual signals are merged as they arrive in the neocortex to form a singular image36. It was thought that the initial processing happened in the upper layers, but it’s actually in the middle layers. By identifying which neurons are involved in visual processing targeted brain therapies can be developed to treat amblyopia.

Laser correction & IOLs

I’ve put these 2 categories together because I’m referring to patients who want to eliminate glasses and don’t want to wear contact lenses.  With laser eye correction which was introduced in the 1990s first with PRK & then LASIK the techniques have been well refined and the visual outcomes are relatively predictable. The latest option to provide a patient is ReLEx SMILE surgery, (Small Incision Lenticule Extraction), a flapless, minimally invasive procedure. In this procedure, a Carl Zeiss VisuMax laser places a series of precise pulses in the centre of the cornea which form bubbles that are less than 1/100th the width of a human hair, and which outline the tissue that needs to be removed to effectively change the shape of the cornea.  The laser also creates a small incision point through which the surgeon draws out this tissue. No flap is created like in conventional laser eye surgery, so the healing time is significantly faster37.

Clear lens extraction or refractive lens exchange is another procedure that your patient may wish to consider if they do not want or are unable to wear corrective eyewear.  I suggest this procedure to all my patients over the age of 45 who are looking to eliminate eyewear. The merits and complications of this procedure have been discussed but what makes it more appealing is the improved technology of IOLs38-40. The advances to the new IOLs include small aperture IOLs, IOLs that eliminate dysphotopsias, trifocal IOLs, electronic IOLs with the ultimate being an accommodative IOL41,42.

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Electronic low vision aids43-45

The numbers of low vision patients is expected to increase, according to the National Eye Institute, and the prevalence of low vision is expected to almost triple by the year 2050. An excellent article in CEO (2014) reviewed the models of low vision care, past, present and future.  The article mentioned the move from low vision aids to a more multidisciplinary, holistic rehabilitation process.  Nevertheless, the changes that will come will be governed by the advances that technology brings. Some of these include:

  • Advanced telescopic devices, in particular wearable electronic binoculars that automatically focus and come with rechargeable batteries that last all day.
  • Portable vision enhancement systems can be made in the form of a tablet and are ideal for people who want more assistance than non-electronic optical aids can provide, but who do not necessarily want a large, cumbersome CCTV. Furthermore, with the addition of speech enabling technology, the devices can be an all in one calendar, diary, and a magnifier to make daily tasks significantly more manageable with a singular device.
  • Head-worn vision enhancement systems are excellent options for those patients with tremors or muscle weakness. The devices offer wide magnification ranges, vision enhancement options, and they can include voice control or remote control.  In the near future, using artificial intelligence, it will be able to communicate with the user providing a description of their surroundings. The main drawback is cost, which ranges from $2000 to $10000, and Medicare does not yet cover magnification devices.
  • Apps and accessibility hardware offer accessibility features at little to no cost and are easy to use and are available on both Android and Apple devices. These features include text enlargement, text-reading, and zoom capabilities. Voice command is probably the most useful feature and allows the users to make phone calls, hear and send text messages, and store lists and reminders. Additional apps that can provide convenience to low vision patients include features that provide assistance with daily tasks like calculating, managing bank accounts, reading aloud text and handwriting, reading bar codes, identifying currency, recognizing colours, and recognizing people. These apps make separate costly devices no longer necessary.
  • Crowd assistance services connect blind and low-vision individuals with sighted volunteers and professionals through live video calls on smart phones or smart glasses. Depending upon the particular service or version, the app may be free for use anytime in certain locations that pay for the service, such as drug stores, airports and federal buildings, or it may require a paid user account or pay-per-minute fee. Service is available anytime, providing an excellent opportunity for independence and safety for visually impaired individuals.
  • Bionic eyes.

Around 35-40 million people in the world suffer from blindness.  The technology has progressed from the Argus II system (2009) where inbuilt cameras in spectacle frames send a signal to a retinal implant which is then interpreted by the visual cortex to more sophisticated systems like the Orion Visual Cortical prosthesis (2019) where the electronics are implanted directly into the brain.46 The current system takes many weeks of training for the patient to learn to use and the images are still rather low resolution.  There are other systems being developed, some of which are under clinical trials, which assist patients in improving their awareness of their surroundings47,48  It is expected these prostheses will become available in the next 10 years.

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Eye diseases

Artificial intelligence algorithms 49-52

Some would consider it strange that a topic entitled eye diseases starts with AI.  However, the single biggest technological development in the industry, particularly going forward, is the development of algorithms which assist the practitioner to come up with not only the most accurate diagnosis but offer the best treatment outcome possible. AI algorithms are basically computer programs, often referred to as neural networks, that have been

written to “learn” from a specified set of data and they use the new formulated rules to diagnose various diseases or predict the success of treatment outcomes.

AI algorithms have been used as screening tools to diagnose various ophthalmic diseases including diabetic retinopathy, age-related macular degeneration, macular edema, glaucoma, keratoconus, post-LASIK corneal ectasia, retinopathy of prematurity, and cataracts.

In the case of diabetic retinopathy, the sensitivity & specificity of the AI programs has improved from 73% & 91% to 97.5% & 98.5% respectively.  The AI can detect CMO using only colour fundus photography although OCT images improve the diagnosis even more.

In the case of ARMD, the AI can delineate the areas of pathologic retinal fluid and even grade the severity of AMD present.  Incorporating fundus autofluorescence imaging has allowed for areas of geographic atrophy to be delineated.

Furthermore, these programs have been shown to be able to predict the prognosis of various ophthalmic diseases. For example an AI program was able to predict with 96% accuracy which diabetic patients would need laser or surgical intervention versus no intervention at all, whilst another program used OCT imaging to predict the need for an anti-VEGF injection in patients with neovascular AMD or the likelihood that an eye with intermediate AMD would progress to neovascular AMD or geographic atrophy.

Whilst most of the AI research is focussed on the retina there has been significant advances in using AI to:

  • automatically grade cataracts and determine which patients will benefit the most from an IOL implant,
  • in glaucoma AI algorithms use ONH & NFL analysis coupled with visual field results to accurately detect glaucoma and provide options for treatment.

Going forward coupling AI & retinal images allows the medical professional to make medical assessments beyond eye-specific disease that reflect the overall health of the patient such as cardiovascular diseases and Alzheimers.

An advantage of AI is that combining this technology with Telehealth enables it to be used across the nation without transporting specialist across the continent thereby preventing vision loss in remote communities.

Another advantage is that once developed these technologies can be transferred to all parts of the country and are very cost effective, requiring fewer resources than time-intensive and expensive human-led screening programs.

The risks associated with AI include:

  • a risk of deskilling the workforce with implementation of AI technologies
  • despite the impressive diagnostic accuracy of AI programs, some algorithms result in relatively high false-negative rates of detection of disease, which means that the algorithms incorrectly classify eyes as being disease-free or not requiring further evaluation. Hopefully, this risk will decrease as the AI program improves in its diagnostic ability.
  • Potential loss of jobs in the service industry, optometric and even ophthalmological industry.52-54

Contact lens (CL) monitoring

Contact lens technology has evolved greatly over the last half of the 20th century. Since 1987 when J&J introduced the disposable CL, the market has evolved to have options for a variety of needs including reduction of myopia progression, yet dropouts remain high. In addition to new materials, most of which will focus on comfort & wettability rather than oxygen transmission (the technology is such now that any increases in oxygen transmission are irrelevant – the analogy being a car that can go 200 kph in a 100 kph zone) contact lenses will incorporate technologies that will see them being used for medical purposes and for information exchange.

These technologies will be used to monitor glaucoma (like the Sensimed Triggerfish), monitor cancer, as lacryglobin is elevated in human tears in patients with breast, colon, lung, prostate, and ovarian cancers and monitor glucose levels in diabetics.55-57

Finally, contact lenses can be used to administer drugs in glaucoma, diabetes, uveitis and infections in the elderly where continual usage of drops is not possible.58,59

Another possibility is to develop emebedded circuitry so that the CL functions like the augmented reality eyewear used in Google Glass or Focals, the difference being that Mojo Vision’s contacts have the display integrated into the contact lens.60

Glaucoma

The causes of glaucomatous optic neuropathy includes a wide variety of factors that are not fully understood.  The resulting loss of retinal ganglion cells can be shown using OCT imaging and their axons as shown by specific morphological changes of the optic nerve. The corresponding functional loss of the ganglion cell and axon is shown by specific defects in the visual field.

Treatment of glaucoma can be broadly categorised into either medications or surgery (including laser), both of which decrease the IOP.  Many of the medications are used as either monotherapy or combination therapy. Medications to manage glaucoma can be grouped into mode of action or by their pharmaceutical category e.g. adrenergic antagonists such as Timolol or prostaglandin analogues such as Latanaprost. 61

New therapies are continually being developed and whilst the mechanisms are mostly unknown, many of these work by a different mechanism than decreasing IOP and either improve blood flow to the optic nerve or interfere with the mechanisms of retinal ganglion cell apoptosis and provide neuroprotection. There are still no reliably proven neuroprotective treatments related to glaucoma but this is an area which is expected to grow in the coming decade.62,63

A surgical technique that has recently emerged and performed often with cataract surgery is MIGS (Minimally invasive glaucoma surgery). MIGS devices lower the IOP by increasing aqueous outflow through existing anatomical outflow pathways including through the TM into Schlemm’s canal, through the uveoscleral pathway, as well as through alternate pathways, which are created iatrogenically such as subconjunctivally. The main advantage of MIGS is that most devices are non-penetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony.  Various studies have shown that MIGS is as effective as eye drops without the complications of patient compliance.  There has also been complications requiring the removal of the CYPASS device due to unacceptable endothelial cell count loss over 5 years64.  It would appear that MIGS procedures will exist alongside rather than replacing more invasive IOP-lowering surgical options.

I think the biggest advance is glaucoma management is not the medication or surgical methods but the care pathways that have been developed as a result of optometry being able to co-manage with ophthalmology. This collaboration between professions has enabled more people to access eyecare without long wait times and thereby reduce the possibility of irreversible loss of vision.65

Going forwards, the challenge of patient adherence to taking the medication still needs to be addressed but this may be overcome by providing new medication delivery systems for glaucoma which can be broadly categorised as on the eye, in the eye, and around the eye66.

  • On the eye: sophisticated new gel drops, contact lenses, or other technologies that release a steady amount of medication over time
  • In the eye: implants that release drug over longer periods, requiring less total amount of medication, thus fewer side effects
  • Around the eye: punctal (tear duct) plugs that release medication over time in a relatively non-invasive manner

I have included genetic testing in this section, although the technology can be applied to all areas of eye disease which has a genetic basis.  The advancements in genetic testing are highlighted in a recent article which reports that researchers at Flinders University in Australia, have identified 107 genes that increase the risk of glaucoma. They have developed a glaucoma polygenic risk score that predicts the progression of glaucoma. It is envisaged that a saliva or blood screening test, will be developed to determine a patient’s glaucoma risk.67 As more genes and their functions are identified this technology will enable earlier treatment thereby reducing the likelihood of vision loss.

ARMD68

Developments in the treatment of macula degeneration are currently restricted to those with the “wet” (also referred to as neovascular or exudative AMD).   The treatment involves regular injections of drugs that block vascular endothelial growth factor (VEGF) such as Lucentis or Avastin.  Recent developments include:

Abicipar is an anti-VEGF  drug that is long acting drug (lasting up to 12 weeks in Phase III trials).

PDS or port delivery system is a device which stores and slowly releases Lucentis.  It requires a refill every 15 months resulting in fewer office visits and significant cost savings to the patient.

RGX-314 is an anti-VEGF treatment delivered by gene therapy. The gene carrying the anti-VEGF is inserted into an adeno-associated virus and injected under the retina. The treatment has the potential to block VEGF for many years and phase II trials showed no further treatment was required for at least 6 months following the initial injection.

ADVM-022 is another AAV-anti-VEGF gene therapy, but in contrast to RGX-314, it is injected into the vitreous. The advantage being that the procedure can be performed in office rather than an operating theatre.

Like RGX-314, in a phase I trial with 6 patients, none has needed any further anti-VEGF injections in the six to ten months following the initial injection.

X-82 is another VEGF / PDGF receptor inhibitor, but its advantage is that it is delivered orally. These drugs, which are in phase II trials, may work alone or in combination with other drugs injected into the eye. In phase I trials 60% did not require any other treatment whilst 40% required on average 0.68 intravitreous anti-VEGF injections

There are at least 3 combination therapies which usually involve anti-VEGF injections in combination with either Cosopt, OPT-302 (a new form of VEGF) or RG7716 (an antibody targeting Angiopoietin II).  Research has shown that these combination therapies are more effective than anti-VEGF drugs alone.

Additional drug developments are also being tested and some are in clinical trials including the proteins endoglin, activin, and tissue factor. These proteins are involved in the growth of new blood vessels, which is a key process involved in the development of the wet form of AMD.

Whilst no drugs are approved for the dry form of ARMD or geographic atrophy there are several treatments in clinical trials.  These include two drugs which inhibit proteins in the complement cascade.

Apl-2 is a complement C3inhibitor and is in phase II clinical trials. It is injected usually monthly and has been show to significantly inhibit the expansion of the area of atrophy.

Zimura (avacincaptad pegol), inhibits another protein in the complement cascade, C5. In a phase II trials, intraocular injections of Zimura slowed the growth of geographic atrophy by ~ 27% and a reduced loss of vision.

Stem cells are also been investigated and have been injected in trials for the treatment of geographic atrophy. The results appear promising but many more clinical trials are required before this modality can become more routine.69,70

Business

Whilst people will continue to spend their hard-earned money in the future, the small business owner needs to evolve with the changing landscape.  Only those that can quickly adapt to the changing consumer needs and continues to innovate and offer more than just a product will thrive.  To that end I’ve outlined some of the changes that have been identified in the retail sector and have provided examples specific to the optometric sector.

  1. More stores will close as online sales will continue to grow & new stores formats will expand. However, not all consumer transactions will be online. A study by KPMG reported that online penetration is likely to be 35%-40% 10 years from now71 although it will vary across sub-sectors of retail, for example CL, sunglass and frame sales will be significantly higher online than lens sales.  It is important for the small retailer to ensure they have developed their online eCommerce platforms such as Shopify.  See the reference for a list of highly-rated platforms.72
  2. Retailers with tight online to offline integrations will gain a competitive edge e.g. selling Frames & CLs thru website online offers increased revenue for sales & using Facebook/Instagram to advertise will promote the online sales shop as well as the bricks & mortar business.
  3. Independent business owners should be wary of direct-to-consumer stores appearing from major corporates and factor the increasing buying power these corporates have and how, as small businesses, they can effectively survive in such a competitive environment. g. OPSM-Luxoticca  merger73 & Essilor buying out stores in Europe74. Two simple solutions are (i) to acknowledge that these corporations are large and that a small business has the flexibility to rapidly change to changing trends and also (ii) to specialise in areas that the larger retailers do not find financially rewarding75.
  4. Inventory will need to be under tighter control as the cost of rent increases substantially particularly in cities and major shopping centres. An excellent innovation provided by Provision is ProSupply which enables the small business owner to manage their inventory effectively whilst minimizing costs.
  5. A business that is shown to be socially aware and responsible will be viewed more favourably with the current generation of consumers. As a business you will be expected to be part of the circular economy, in an effort to minimise waste and promote sustainability e.g. minimizing CL packaging by recycling, recycling of frames thru organizations such as the Lions Foundation, bioorganic frames made from materials such as wood, beans etc
  6. We will see more private label growth in the retail sector76. In the optical industry, we have already discussed the use of (i) 3D printing & (ii) own labelled frames due to easy access to wholesalers in China especially. This provides increased choice for the consumer & the small business owner.
  7. Social media and retail will be even more intertwined77. In optometry, social media provides the opportunity to educate the patient and Alcon’s initiative is an excellent example where a large corporation has helped expand the industry by increasing the knowledge of eyecare among the public78.  Social media has also been used for education, training and diagnosis in various youtube channels e.g. the excellent myopia resources provided by the Brien Holden Foundation79,80.
  8. Providing your customers with various payment options will become paramount81. Afterpay is one of the standout performers of the sharemarket of 2019 and its buy now pay later model is a growing trend leading to various alternatives which have taken the retail market by storm. It allows the consumer to obtain immediate joy and pay for that in the future without the stress of interest payments.  Optometric businesses where the value of the transaction is on average ~ $500 fits perfectly well into this payment method and should be offered by all small businesses.
  9. In a technologically forward-thinking society where anti-ageing is a hot topic, all aspects of healthcare, including vision will be a top priority82. Your retail strategy will need to take into account your customers concerns of health and vision is considered by many to be their most important sense of all83. Furthermore, recent advances in technology have extended the application beyond the eyes and into the brain where research has shown early diagnosis of Alzheimers may be possible with eye examinations84.
  10. Improvements in IT speeds (introduction of 5G) and faster computer hardware (SSDs), as well as an exponential increase in performance for a given price point, will continue to make inroads into the industry85. This is especially important for telehealth consultations in remote areas or even in cities between colleagues where a nurse or assistant can perform the tests and in real-time a diagnosis can be made. Currently, the data generated by OCT and some other imaging software is too large to transfer in real-time across the internet. Fibre and 5G technology will allow such transfers to occur almost instantaneously86.
  11. The increased convenience that the consumer experiences in the era of food delivery services has altered their mindset to expect similar type services from other industries87. In the optical industry, more retailers will explore subscriptions such as with CLs or dry eye medications where the consumer will order online & receive yearly packages & only come in for an annual eye health check.

 There is no doubt that the retail market is the most competitive it has ever been. One way in which independent optometry can thrive is to join like-minded people in groups like Provision & EyeCarePlus to help the small business owner tackle the challenges they face as we look forward to all the exciting prospects that the 2020’s will give us.

Disclaimers:

  1. The author is a member of Provision.
  2. The author has not received any financial incentives from any of the companies mentioned in the article.

 

References

  1. https://www.goodreads.com/book/show/1038909.Mindsteps_to_the_Cosmos
  2. https://www.kurzweilai.net/the-law-of-accelerating-returns
  3. https://www.businessinsider.com.au/stores-closing-in-2020-list-2020-1
  4. https://www.checkfront.com/5-reasons-why-your-customers-prefer-to-book-online
  5. https://pdfs.semanticscholar.org/1cfb/ed95cb187cd3b1e9bdc93761088d3c94279e.pdf
  6. https://www.myhealth1st.com.au/
  7. https://wpforms.com/
  8. https://appointuit.com/home/
  9. https://www.scnsoft.com/blog/rfid-and-iot-in-a-smart-hospital-benefits-and-challenges-of-smart-patient-tracking
  10. https://monoqool.com/screwless-hinges/
  11. https://www.wareable.com/ar/the-best-smartglasses-google-glass-and-the-rest
  12. https://www.sculpteo.com/blog/2019/08/07/3d-printed-glasses-taking-the-eyewear-industry-to-the-next-level-2/
  13. https://www.hoyavision.com/yuniku/
  14. https://www.visusolution.com/en/visureal-master-en
  15. https://blog.hoyavision.com/eye-care-professionals/what-is-binocular-harmonization-technology
  16. http://www.mmoptik.cz/upload/mmoptik/docs/Wesemann PD measuring devices 2010k.pdf
  17. https://www.zeiss.com/vision-care/int/eye-care-professionals/products/instruments-technology/visufit-1000.html
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