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Putting the robots in their place

We’re often reminded that thanks to the many advances in technology, a number of today’s jobs will soon cease to exist. I’m sure all of us at some point have seen a headline proclaiming robots and machinery will eventually replace doctors.

As an optometrist, I'm more concerned about the general public's attitude to what my role in their health care is than the fact that my job could be taken over by an artificial intelligence system.

We get told that machines are faster, more efficient and less prone to errors than people. However, I'm quite certain that the first thing on a patient’s mind is not how quickly you can get them out of a room.

I’m aware in some countries where optometrists are seen as technicians, readings from autorefractors are used to prescribe glasses without any adjustments. I think autorefractors can be a good starting point, especially in situations where you can't do a reliable retinoscopy, but I do not think they give you a complete picture of what a patient's prescription should be.

I always emphasise to the students that do rotations at our practice that being able to do a good refraction is a key part of being an optometrist. I've had patients who have been elsewhere and present to our practice, frustrated and uncomfortable in the glasses they're wearing, who are surprised when we spend more than a minute checking their refraction.

"There is no machine out there that can give bad news about someone’s vision loss in a delicate way that replicates the comfort of human interaction."

Often their problems can be resolved by identifying binocular vision problems, or even just by listening to what their daily visual needs are.

I think about what a full day of seeing patients involves, and I could not imagine a machine being able to do it all. A visual field test does not mean anything on its own, and a corneal topography map is not a diagnosis.

I see my job as putting together pieces of a puzzle to see a bigger picture, and passing on this information to a patient. There is no machine out there that can give bad news about someone's vision loss in a delicate way that replicates the comfort of human interaction. I cannot imagine a robot telling my 89-year-old patient they do not meet driving standards.

The results we obtain from the machines we use as part of our daily practice are only useful when the person interpreting the results knows both what it means, and how it is relevant to the patient.

Anyone who uses Optical Coherence Tomography (OCT) would be aware of ‘red disease’ – a perfect example of assuming the machine has given a diagnosis, when the results simply indicate that a patient does not fall into a relative normal range.

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OCT and fundus photography should give us confidence as clinicians to assess and manage diseases, as opposed to making up for a haphazard fundus examination or poor history taking. Seeing an epiretinal membrane on an OCT scan isn't the basis for a referral when a patient can read 6/6 and is asymptomatic.

Far from being anti-technology, I'm aware of how the advances in the instruments we use help us diagnose diseases earlier and more accurately. As a clinician who has worked for the last 10 years in a regional town where the nearest capital city is four hours away, technology has helped me make decisions about the urgency of a referral. This in turn has resulted in less unnecessary referrals to our ophthalmology colleagues, and reduces the burden on the healthcare system.

I don't see technology as competition to replace our skills, but rather to compliment them. In fact, if used correctly, I see it as enhancing and widening our scope of practice. This has been beneficial for patients not because it ensures consultations are faster, but because it gives us more time to connect with patients and explain diagnoses.

An optometrist's role is so much more relevant when we see ourselves as data analysers, problem solvers and decision makers. Technology hasn't made our profession obsolete. If anything, it has improved the way we provide eye care.

When the robots come marching in, I think the only types of optometrists who will be left behind are those that find themselves stuck behind an autorefractor.


Name: Angie Trinh
Qualifications: Bachelor of optometry, postgraduate diploma in advanced clinical optometry
Workplace: Eyecare Sunraysia
Special interests: Therapeutics and paediatrics
Location: Mildura
Years in the profession: 12


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