The emerging role of technology in early detection and patient care

Here, two optometrists and Hakim Group practice directors – Alistair Duff of Urquhart Opticians, and Anthony Josephson of Maskell + Josephson Independent Opticians – tell OT about the technologies they have embedded in practice in the past two years, the learning curves involved, and the patient and business benefits that they have found.

Are there any specific pieces of technology that you have brought into practice in the past two years that have helped you with early detection?

Alistair Duff (AD): Optomap and the Lenstar biometers are the two main things that we’ve invested in these past two years. About 18 months ago, we noticed there was a gap in our clinical services. Everyone had optical coherence tomography (OCT), but we were asking: what’s next?

Optomap was the next obvious opportunity, certainly for early detection. We decided to invest in optomap devices in four of our Urquhart Opticians practices, and also in biometers.

For biometry, it wasn’t just about myopia management – it was also about linking up with private healthcare providers in terms of cataract surgery. We are fairly rural, which meant our patients needed to travel two or three hours to a private hospital to get a pre-cataract check-up.

We now have the machines in practice, and one of our optometrists does the pre-cataract assessment and chooses the lens for the patient. That has really helped keep things in the community, rather than patients having to travel to Glasgow or Edinburgh.

Anthony Josephson (AJ): We have the Azul Optics MP-eye, so we’re measuring macular pigment density as part of our routine eye exams now. We’ve been doing that for nine or 10 months.

Number two is meibography, which we’ve had available for four and a half years as part of our dry eye clinic, and are now starting to use as a screening tool.

We also now offer Valeda light therapy for dry age-related macular degeneration (AMD). If you’ve got macular degeneration, we want to find it early, treat it early, and try and slow down its progression. The nature of something like the MP-eye is that potentially you can anticipate its arrival before it happens and delay it. You’re not going to cure or prevent anything, but you can delay it. So, rather than waiting for there to be macular degeneration that you’re then trying to control, you’re trying to delay the onset in somebody who is higher risk.

We started to offer the Valeda and the MP-eye around the same time, at the start of 2025. Even though the Valeda is treating the problem that you’re hoping to prevent with the MP-eye, it is all around maintaining vision potential. We want to try and slow down any deterioration if it is there, and try to delay or prevent the onset, if we can catch it at that point instead.

What benefits have these technologies brought to the business, and to the patients?

AD: We got the optomap in for a trial at the start of 2025. We lined up all our optometrists and all our staff members, nearly 100 people in total, and optomapped everyone, so they could get a feel for what it was.

Interestingly, we picked up a lesion in one of our optometrists, which turned out to be a small retinal tear. It was good to show that, whilst this optometrist was in her 50s and asymptomatic, it picked up this problem. Immediately, all the staff were bought into it, particularly the optometrists, for early detection.

We do first port of call in Scotland, so anyone with any eye problems comes directly to an optometrist, rather than the GP or eye department. We are using the optomap a lot for flashing lights and floaters. We put the patient on the optomap, and give them peace of mind.

A lot of the time, we’re picking up lesions that have been asymptomatic, and making sure they get to the hospital, to get a bit of laser and tidy up before it turns into a full-blown retinal tear. That’s happening now on a weekly basis.

In terms of the benefits the technology has brought to the business, I think it’s a differentiator. Now, a lot of other practices have OCT, whereas we’ve had it for 10 plus years. Everyone else is catching up, so we need to move to that next level, is how we see it.

It’s good fun, and optometrists want that. They want to be at the cutting edge of technology. It helps recruitment, as well as the patients.

We picked up a lesion in one of our optometrists, which turned out to be a small retinal tear

AJ: Ultimately, my decision when we get any new technology is always about the patient and less about the business. If we are looking after our patients, they will continue to pay us to do so. I don’t shy away from technology because it’s expensive. I shy away from it if I don’t think it’s going to benefit my patients.

If you speak to anybody who offers meibography as part of a dry eye clinic, you’re going to find people who are only symptomatic at the point where their meibomian gland is pretty much completely packed in. If you can anticipate it heading in that direction by screening them and detecting some form of gland loss at an asymptomatic stage, hopefully there are things that can be done to slow down the inevitable decline, so that they aren’t coming in in five years’ time with unbearable dry eye symptoms that you then can’t do anything about.

We’re going to find that in younger generations. Our current 30-year-olds are far more likely to be suffering with severe dry eyes when they’re 40 and 50 than our current 50-year-olds are. It has to be something that is found via screening , as opposed to a specifically age-related test. We’re interested in detecting pathology that will lead to dry eye symptoms before it leads to them, rather than managing them when they turn up.

Hakim Group

Anthony Josephson

It’s a similar concept in terms of the MP-eye. We’re assessing, on those who can do the test, roughly what their risk factors are for developing macular degeneration. If we establish that their risk factors are very high, we can counsel them with a variety of changes that they may be able to make in order to protect their eyes a little bit more.

Some of that can be lifestyle: stopping smoking, diet, exercise. Otherwise, it can be eye protection, whether that’s sunglasses or photochromic lenses,. It allows us to have that conversation with some form of evidence in front of us, rather than just generally explaining its importance.

Inevitably, there will be patients with stable prescriptions who may not feel a strong need to update their glasses. In these cases, discussing aspects such as blue light or UV protection can be a helpful way of broadening the conversation around ocular health and visual comfort, allowing patients to make informed choices about their eyewear. While the primary aim must always be to act in the patient’s best interests, offering appropriate options can also support the ongoing sustainability of the practice.

Clinically speaking, the MP-eye allows you to encourage people to consider glasses, not just as a visual aid, not just as a cosmetic appliance, but also as something that has potential clinical benefits. It opens the door to a conversation that we perhaps should be having anyway: do you smoke? How much do you exercise? Tell me a bit about your diet. These things are very difficult to bring in as part of a structured conversation, but when you've got a machine that measures what those things can influence, it makes having that conversation a lot easier.

I don’t shy away from technology because it’s expensive. I shy away from it if I don’t think it’s going to benefit my patients

Do you think early detection of conditions should be an important area of focus for emerging technologies? If so, why is this important?

AJ: Yes. I tell my patients, now, that the vast majority of eye diseases that we can pick up in an eye exam are treatable.

The big one that was classed as untreatable for many years was dry macular degeneration. For most patients, it is still untreatable. Guidelines mean that, once it reaches a certain point, you don’t necessarily have that conversation about treating it. But most of the conditions that we pick up, whether macular degeneration or glaucoma, are treatable.

The whole point of people coming in for a routine eye exam is to find a problem before it becomes a problem. If you can find that problem even earlier, or find something that could indicate that problem is going to develop before it does, that is life-changing. You can turn around and treat somebody before they’re symptomatic. If you manage, as a result of that treatment, to either prevent them from ever being symptomatic, or significantly delay the onset in which they do become symptomatic, that’s worth it. That’s what it’s all got to be about.

Early detection is critical. It has to come down to detecting something early, but there needs to be something that you can do about it when you do. It’s all well and good having treatment that you can do on early-stage disease, but you need to be able to pick it up at that point as well. It’s a constant juggle between early detection and what you can do if you do find it. There’s no point finding something early if you can’t treat it for another 10 years.

AD: I think it absolutely is important. I had a conversation with my local ophthalmologist. He said, ‘how are you picking up these peripheral issues?’ I sent him the photos of the optomaps and said, ‘we are picking them up due to optomap. I get it – it’s probably increasing your workload in the short-term, but hopefully in the long-term it decreases, because we can look after it and monitor it in community, once you have had a look at it.’

The whole point of people coming in for a routine eye exam is to find a problem before it becomes a problem

What has the learning curve been on these pieces of technology?

AD: We do training on Zoom every Tuesday morning for 45 minutes, across all our practices. We start with that, introducing the technology. It’s important to show it to front of house staff, as well as optometrists and dispensing opticians, because everyone is involved in it, and they all want to get excited and know what it’s about.

We did that first, then we spent a bit of time training the optometrists who work in the four practices where we have optomap, because we have a lot of intra-referrals across our 15 practices.

You’ve got to be using the technology all the time to keep up to speed with the learning curve. It’s been really important to have champions of optomap in each practice that has a device, and that those in practices that don’t have one can refer to an optometrist who does know about it. It’s always continuing learning – it never stops.

Hakim Group

Alistair Duff with a patient in practice at Urquhart Opticians

AJ: There’s a lot of learning going into the actual subject, in terms of why these things are useful to do. Every time we get any new technology, everybody in the practice needs to have a huge amount of training, both in using the device and understanding what the benefits of it are and being able to talk confidently to patients.

Our staff are familiar with all of these conditions to begin with. By incorporating [these technologies] into the routine, it lessens the instances of difficult conversations where they have to explain, ‘you need this because you've got a problem.’ It is a lot more comfortable to say, ‘this is something that we recommend. If you follow this advice, you’re less likely to have a problem.’

The more the team understands not just about what they’re doing – whether it’s capturing an OCT image, administering Valeda treatments, or selling a pair of photochromic lenses – but why all of that has potential clinical benefit, the better.

You’ve got to be using the technology all the time to keep up to speed with the learning curve. It’s been really important to have champions of optomap in each practice

How do you engage the practice team in learning about new technologies? Do you find opportunities or challenges in that area?

AJ: If the benefits are obvious, there shouldn’t be any challenges. If the team aren’t on board with the benefits, they’re never going to recommend it. Not only is that potentially harmful from a business point of view, but you’re also potentially depriving your customer or your patients of their best visual outcome, in which case no one wins.

It’s not our responsibility as clinicians, dispensing opticians, or receptionists, to tell somebody what they can and can’t spend their money on. It is up to us to know that these things have benefits, to explain what those benefits are, and what the cost implications are, so the patient can make an informed decision about whether they think it’s worth it.

If you don’t have team members who understand the benefits, your patients aren’t going to be able to understand the benefits either. It has to start with education. Before you open the door and offer any new test or service, everybody who has any exposure to the machines, the technology, and the patients who are that are using it, need to fully understand it.

In almost all of these cases in primary eye care, they can have it done on themselves first. It’s about having the experience of it, so that they can tell patients and customers what it’s like.

AD: Optomapping everyone was a good start, followed by the training sessions – getting people involved so they know exactly what it’s about.

Obviously, picking up a pathology is an opportunity, but also brings challenges, like an increase in referrals in the short-term. When we get new technology – OCT, optomap, biometry, etc – we over refer. But if you can get a link with an ophthalmologist, that really helps. Rather than just referring it, we’d say, ‘can you check this? Here’s the situation.’ Every time it’s a learning curve, and we share that in our meetings. It’s vital to share challenges and improvements with technology, and how we move forward with it.

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