In a few short years we’ve seen a New Millennium and now find ourselves completing the first decade of the so called ‘noughties’.
What will the next decade deliver?
As we’ve now entered 2010, I expect something from Nathan Efron regarding his predictions on the demise of RGP lenses by 2010. I’ve detected a softening on his original claims of RGP ‘obsolescence’. He accepts their use for irregular corneas and ortho-K but claims a general decline this past decade. Studies Nathan is involved in show that RGPs still have significant use in some countries.
I don’t see RGPs becoming obsolete for a while yet and I have a significant number of RGP wearers.
Granted, soft lenses are better than they’ve ever been. The latest generation high-Dk versions allow custom designs to be made that deliver adequate levels of oxygen for complex cases. Specialised custom silicone-hydrogel designs for irregular corneas are now becoming available: In their infancy, we’ll see significant evolution of these options.
Will we see the advent of antimicrobial surface coatings in 2010?
Will we beat MK this decade? I think not.
As far as I can see myopia control could be the biggest thing this year and in years to come. It may also be - as with Ortho-K - that oblate corneas created by LASER refractive surgery may also be providing myopia control as a positive, unintended side effect. Whether LASIK will be used as a form of myopia control remains to be seen. ‘Hyperopic defocus’ in the peripheral retina is the buzz word in myopia control but I suspect that this is not the be all and end all of myopic progression.
Will we see the advent of soft lenses designed specifically to control myopia in 2010? One of the reasons some studies showed myopia control with RGPs could have been due to their multicurve designs which may have provided a modicum of peripheral focus modification.
Customised wavefront lenses will in my view remain ‘lenses of the future’ much like safe extended wear has been for the past few decades…
Tear film instability alone can increase higher order aberrations by 44%. By their nature such aberrations are practically and relatively ‘impossible’ to correct. Check out Trusit Dave’s excellent TVCI paper on various aspects of aberrations.
We’ll see new, improved contact lenses and materials as well as an increasing range of single use silicone hydrogels. Contact lens disinfecting solutions should improve but will likely continue to show a decline with the swing to single use lenses.
It will be interesting to see the effect of the recent majority takeover of Alcon by Novartis.
The rampant commercialisation of the eye care professions will continue but essentially the more things change the more they stay the same.
Top class independent practitioners who deliver professional service and quality will thrive. I’ve seen this in many countries. My family practice in South Africa and our practice in NZ continue to do well. Two decades as a director and partner in two large, established, respected, successful, proactive, practices shows me that much of what is done by corporates is what we’ve done before. The main differences are that they have better economies of scale. They get more bang for their buck thus enhancing profitability, which is after all what they’re all about. They have dedicated marketing and management teams too. Smaller independents cannot afford such luxuries and tend to try and do most of the management themselves, between patients and after hours. This level of commitment (and potential lack of expertise) is one of the reasons so many independents have taken the easy way out and opted in to franchised or chain store eye care. They reckon they’re getting back a lifestyle by handing over the bulk of mundane practice management.
For those who prefer to stay in control and find it challenging and rewarding, they can increase the rewards and satisfaction by utilising the many great strategies espoused by the Optometric Management journal. They’ve been at it for decades. My Dad, who recently celebrated sixty years in practice reckons OM is the best practice management and general optometric journal around.
See what the late and legendary Irv Fatt had to say about lenses in the new millennium in 1994!
Enough crystal ball gazing and predictions.
By the time you read this I will have completed my speaking engagements at the Ski Conference in Rusutsu, Japan and the GSLS in Vegas. A week of additional skiing at Aspen will be a nice end to what’s been my most hectic speaking schedule ever. It started in January 2009 with fantastic skiing and lectures in Italy and France and some R&R with family in Africa. After that there were talks at SRC in Melbourne and CLIC in Sydney. I was also involved in some consulting, advisory boards and contact lens launches in ANZ. From mid ’09 until October I delivered lectures at TVCI in Bangkok, Hong Kong and Shanghai.
November and December saw me embark on a round the world trip that encompassed both hemispheres. It kicked off with my first and long awaited trip to New York. What a city! For those that know NYC, I need say no more. For those who don’t it’s quite simple; Get your arse over there! Three days was not enough so I plan to return but I did get a hell of a lot done.
For Blues aficionados Terra Blues on the legendary Bleecker Street is worth a visit. There’s even a Kiwi owned bar just around the corner.
From NYC I headed to London to co-host and present the 6th BCLA Pioneers Lecture at the Royal Society of Medicine – a humbling pinnacle of my speaking career and a great honour. It was well attended and covered in the December ‘09 issue of NZ Optics. I was blown away to find my publishers, Maryanne and Anita, had amazingly made a surprise long haul trip to cover the meeting. They immediately uploaded the story and images and within hours the presses were rolling in NZ, spitting out the year end issue. Thanks guys! From there it was on to Glasgow (one of my ancestral homes), to present to the Scottish Contact Lens Society.
Another highlight of my UK trip was a day at Contamac in Saffron Walden near Cambridge. One of the benefits of my international speaking is that from time to time I get to see some top class facilities. Contamac manufacture polymers from high quality monomers. They supply numerous laboratories around the world who fabricate a broad range of soft and RGP lenses, as well as IOLs. A complete facility encompasses polymer R&D right through production to quality control and despatch, with precise process control, much of which has been designed and created in house. Impressive.
Over the years I have written about some of their RGP polymers – notably Optimum Extra, which along with Boston XO remains one of my favourite high Dk RGP polymers. A large diameter RGP button suitable for semi-scleral designs is another product. I’ve also recently started using their custom silicone-hydrogel polymer, Definitive. UltraVision UK also uses Definitive in their KeraSoft range. CLC make me some interesting lenses too.
A website redesign now provides a ‘Professional Services’ area with some excellent cases dealing with numerous aspects of speciality contact lenses. Surf around to find the various soft and RGP case reports.
They have a great team and I expect more good things in the future.
That smaller ‘boutique’ players can thrive in competition to the ‘Big Four’ lens manufacturers, multinational pharmaceutical and IOL suppliers, tells me the industry is in relatively good health. Smaller, leaner, meaner companies are in fact light on their feet and more able to adapt to rapid changes in the eye world. They are not bogged down by layers of management that affect their bigger counterparts. Large companies have sometimes been unable to adapt and taken some big hits. Some have never quite recovered from their monopolistic complacency of the 1980s. It’s like turning a fully laden oil tanker. Unlike a nimble Cinquecento.
From London I headed back to NZ via ZA where the night I arrived we celebrated my Dad’s 60th Anniversary in Optometric Practice. Another highlight. Mazltov Dad! There are not many practitioners on the planet with that kind of track record. He’s been a contact lens pioneer since 1957, still has long waiting times to see him and has fitted 1st, 2nd, 3rd and now 4th generation contact lens patients within the same family.
Next stop was a ‘7 star’ private game reserve owned by an old friend from the optical industry. What a place and his dream come true. I well recall him telling us that one day he’d have his own game farm as we sat around a campfire almost three decades ago. Little did I know he would do it on such a grand scale and with such panache.
A 1st Class upgrade had me comfortably back in NZ with a full appointment book and nose to the grindstone with a vengeance the next day. There were also a few Keynote presentations to build, deadlines for my monthly columns and a review of a paper for a journal. There hasn’t been too much time for relaxation. It has however been great to catch up with friends and family and try and claw back a few victories from my daughter in Scrabble.
Here’s a Scrabble app for iPhone.
The tomatoes, veggies and fruit trees are productive. Catching up in the garden hopefully aided ski fitness...
I collected my high-spec MacBook Pro in NYC so am now a full convert to Apple. It’s impressive and has some great features. Packaging, design, function and marketing are top class. The biggest weaknesses? Sales, after sales service & support. I had a few sales & support issues that were badly handled. I ended up solving the problems myself. Painful. Hyperlinking too is more like ox wagon trekking. Far too long winded. Some Mac Nerd will probably tell me there’s a five sequence keystroke ‘shortcut’ that only an octopus on acid could get right.
Decent customer service is imperative and NYC is one of the few places it exists. Too many companies are guilty of poor service. Offshore call centres add to the pain.
It’s a hard act to maintain 100% perfection all the time!
More on quality & service in future columns.
So far the MacBook’s been a great machine. It is of course not perfect but I’m surviving without MS Office. I managed to convert and rebuild a PowerPoint on the train from London to Glasgow and did a glitch free presentation from Keynote on Mac at the Scottish meeting just days after taking delivery
I was pretty happy with that.
Have a great 2010.