By Dwain Hebda
In 30 years of practice, Little Rock optometrist Dr. Randall Teague has seen a little bit of everything. And the glimpses he has of the future of his medical specialty have him convinced there are bright days ahead for patients with vision issues.
“There are all kinds of new things, there are new kinds of contacts that let more air in that are healthier and safer, more comfortable,” he says of medical technology. “There are newer tools for diagnosing and treating dry eye, also.
“Even glasses; they’re thinner, they’re lighter. There are polycarbonate lenses that are a lot better than they used to be. They’re safer, and they’re more efficient as far as protecting the eyes, too.”
Like all professions, technology is transforming the way physicians treat their patients and help them live better lives. Specialists of the eye are right in the thick of this technological revolution, resulting in earlier and more accurate diagnosis and less invasive, more effective treatments up to and including surgery.
“For a long time, we didn’t have a lot of options for treatments for glaucoma,” says Dr. Evan Newbolt, a board-certified ophthalmologist with McFarland Eye Care. “Glaucoma usually has to do with high eye pressure. If it got bad enough, it used to be like a big, major surgery that we would have to do. There have been quite a few different procedures coming out recently, and even new eye drops to help us treat glaucoma.”
“We also have what’s called MIGS procedure which is minimally invasive. During cataract surgery, if the patient has glaucoma, I can also offer them some different procedures for that. That’s neat because they don’t have as many risks and side effects, yet you can still control their glaucoma to preserve their vision.”
Scan any industry publication these days, and it reads less like a medical journal and more like Popular Science. In 2019 alone, Optometry Today has announced technological applications from the relatively pedestrian – coatings that make eyeglass lenses essentially invisible – to those that rival anything in science fiction. Visual simulators that mimic a patient’s post-surgical sight and applying artificial intelligence to diagnose glaucoma head that list.
“There are scanning lasers now that actually scan the layers of the retina and the optic nerve for diagnosis earlier,” Teague says. “This helps in the treatment and management of the treatment for glaucoma, diabetes and macular degeneration.”
Devices under development make the future of eye medicine even bolder. Developers of smart contact lenses, for example, include electronics stalwarts Sony and Samsung and technology powerhouse Google. Bandied in the medical technology press as the next big thing for years, smart contacts promise to do everything from taking a photo to recording video to monitoring the wearer’s glucose and other health metrics. Still in development, some manufacturers predict the devices will hit the market as early as next year.
Other trends in the industry have less to do with the tools physicians have than the training of the doctors themselves. As the number of patients seeking cosmetic procedures continues to grow, physicians with multiple skill sets are in higher demand than ever.
Dr. Byron Wilkes of McFarland Eye Care is one such physician. A board-certified ophthalmologist who is fellowship-trained in oculofacial plastic surgery, he’s trained to address both cosmetic and functional issues. At present, he’s one of just a handful of such doctors in the state with this dual training, but he says that’s likely to change in the future.
“The cosmetic procedures that I would do would be to rejuvenate the lower eyelid and mid-face at the same time, as well as maybe doing what we would consider a functional surgery,” he says. “People are coming in and saying, ‘Hey, while we’re here and while I’m under anesthesia, is there a possibility that I could pursue a cosmetic procedure?’ And, oftentimes, we can.”
Wilkes says the makeup of these patients is also trending younger with more 30- to 40-year-olds rounding out the traditional 60- to 70-year-olds. There are also many more men than in the past, as attitudes about cosmetic surgery continue to evolve.
“It used to be that cosmetic surgery had a stigma to it,” he says. “People in this part of the country are very careful not to seem vain, but that trend seems to have shifted a little bit. Now, more men are accepting not only cosmetic surgery but also the functional surgery of the face that can help them not only see better but look better, too.”
This evolution in patient attitudes reflects a corresponding shift in overall health knowledge. Newbolt says patients seek eye care earlier and are better informed about potential diseases and treatment options as a result of taking the time to educate themselves.
“With cataract surgery specifically, for the most part, people are coming in sooner, especially if it affects their daily living, like their driving at night and that sort of thing,” he says. “As we’ve gotten better and better at surgery – less risk, fewer complications – the average age has continued to creep down. No longer do we wait until we’re 80 years old with terrible vision before we have cataract surgery. They’re coming in earlier, and that’s great because it means people are taking care of themselves a little bit more.”
With all of the industry’s technical advancements and special expertise available, the issue of access to such services continues to be a thorny one in Arkansas. Eye care in rural areas, like many other medical services, often does not exist locally, requiring patients to drive long distances for treatment.
Wilkes says in McFarland’s case, the company’s doctors make the rounds to communities outside of Little Rock to help cut down the amount of travel patients have to undergo. But those efforts can only go so far, and he acknowledged more hands are needed on deck with the problem.
“When I was in medical school 12 years ago, they were incentivizing people to try to make it to rural communities,” he says. “It’s tough when you have a shrinking population in these areas of eastern Arkansas and the Arkansas Delta, for instance.
“Our practice, in particular, has made a commitment to have a presence in these areas because we feel it is a very valuable part of the state. We’re happy to be doing that, but certainly, there are challenges to that such as staffing and all of the things that allow for running a successful clinic.”