Eyeglasses have been around for longer than optometry has been an established medical discipline. Times are changing, however, and new technology emerges with each passing day. What does this mean for eyeglasses? Augmented and virtual reality might hold the answers.
Ask any average person on the street what they most associate with both optometry and ophthalmology, and you’ll likely get one answer—eyeglasses. Nothing is more closely associated with our field than humble spectacles.
Associations with the visual aid are numerous and unavoidable. In the United Kingdom, there’s even an optometrist’s chain called Specsavers that once sponsored football referees, who were often accused of being blind.
There has never been a time when eyeglasses have faced more competition than ever as solutions for ocular health problems. Contact lenses are gaining popularity, and refractive surgery has become safer and more accessible. So the question is, could eyeglasses be going the way of the dodo? Are we about to see the demise of the optometry industry’s trusty packhorse, shoved off on its way toward the metaphorical glue factory?
Technology considered this possibility and responded with, “Hold my beer.” Despite the abundance of alternatives to eyeglasses, a tech leap forward is on the horizon.
This will not only provide consumers with more corrective options for their eyesight but also enhance their lifestyles through alternate reality (AR) and virtual reality (VR). Patients with poor eyesight will continue to enjoy vastly improved vision, thanks to their eyeglasses.
Eyeglasses evolution: Navigating the tech leap forward
Eyeglasses have a long history, with the invention of the lenses credited to 9th-century Arab mathematician and inventor Ibn al-Haytham. The first recorded use of eyeglasses dates back to the 13th century.1 This marked the first practical application of magnification in society at large. By the 15th century in Europe, religious paintings depicted saints wearing eyeglasses.2
As technology improved over the years, the use of eyeglasses continued to rise in popularity. By the 17th century in England, a class distinction had emerged. Eyeglasses worn by the upper classes were perceived as hallmarks of intelligence and sophistication, whereas the riffraff of lower status who wore them were roundly ridiculed.2
Fast forward to the present, and over half of the adult population worldwide uses prescription eyewear to protect or correct their vision. Today’s eyewear industry is a massive business, offering a variety of styles, shapes, and sizes for customers across the globe.3 Yet despite all that, it’s not difficult to find articles speculating that eyeglasses are more likely than ever to fade in popularity. So, what’s prompting the industry to say, “Hold my beer?”
“In comparison to conventional eyeglasses and the use of single- vision, bifocal, and progressive lenses, the advancement of integrating AR/VR technology into eyeglasses is truly fascinating and mind-blowing. Simply put, the use of AR/VR eyeglasses signifies a new way of living life with the seamless integration of futuristic ideas with present needs patients experience now,” said Dr. Kevin Chan, senior clinical director at Treehouse Eyes – Myopia Care For Kids in Vienna, Virginia, USA.
Dr. Chan believes that the adoption of new smart eyeglasses could make medical care more affordable, reduce testing time and enhance the overall efficiency of optometry clinics. Rather than heading in the dodo direction, eyeglasses have huge potential, thanks to the integration of AR/VR. This is particularly evident in myopia treatment.
“Robust evidence strongly suggests that peripheral hyperopic blur in the retinal field is one of the key potential culprits of myopia progression, which results in axial elongation of the eyes. Ophthalmic devices, such as Kubota Glass, employ AR/VR technology to enable stimulation of peripheral myopic defocus on the retina, which is believed to exert inhibitory effects against the axial elongation of the eyes,” explained Dr. Chan.
“Other potential parameters, such as luminance, contrast, degrees of peripheral defocus, and spectral levels, can also be modulated by AR/ VR devices that have shown to impact diurnal variations of axial length,” he added.
The role of eyeglasses in myopia management
The rates of myopia are growing exponentially around the world, with projections indicating that up to 50% of the population could be myopic by 2050. This prevalence is accompanied by a rise in early onset cases, which in turn leads to an increased risk of high myopia, increasing the potential for more issues with visual impairment.4 This domino effect of condition to complication represents a significant threat to patients, global healthcare systems and optometrists alike.
“In comparison to conventional eyeglasses and the use of single- vision, bifocal, and progressive lenses, the advancement of integrating AR/ VR technology into eyeglasses is truly fascinating and mind-blowing. Simply put, the use of AR/VR eyeglasses signifies a new way of living life with the seamless integration of futuristic ideas with present needs patients experience now.”
Dr. Kevin Chan
Some professional organizations, such as the College of Optometrists in the United Kingdom, have urged caution against strong responses, stating that “not enough evidence [exists] to support the widespread rollout of myopia control.” Other clinicians have argued that there is an increased risk of serious ocular infections arising from prescribing contact lenses to children.4
However, millions of children around the world still face the potential of serious complications arising from myopia. Can smart eyeglasses help mitigate the impact of the disease?
Evidence is clear that early intervention in myopia control is good for the patient, with benefits including better uncorrected and corrected visual acuity, improved vision-related quality of life and reduced dependence on correction. Therapies, including topical atropine application, have proven as effective as eyeglasses in their most basic form.4
“When it comes to eyeglasses, I’m really excited about new options for myopia management. In the United States, we can prescribe topical atropine drops, multifocal contact lenses, and orthokeratology to treat myopia. But we can’t prescribe glasses for myopia management here just yet. This is despite promising results in other countries where eyeglasses can be prescribed.”
Dr. Elise Kramer
AR/VR and other new technologies could provide significant benefits for patients by themselves. However, optometrists should not lose sight of the fact that eyeglasses still offer clinically meaningful slowing of progression. Depending on where you are in the world, you may find this statement either obvious or a call for a new regulatory approach to myopia management.
“When it comes to eyeglasses, I’m really excited about new options for myopia management. In the United States, we can prescribe topical atropine drops, multifocal contact lenses, and orthokeratology to treat myopia. But we can’t prescribe glasses for myopia management here just yet. This is despite promising results in other countries where eyeglasses can be prescribed,” shared Dr. Elise Kramer.
Dr. Kramer, an optometrist and contact lens specialist at the Miami Contact Lens Institute in Florida, is an expert in myopia control. She has seen increasing numbers of patients with the condition at her clinic, particularly in children. Dr. Kramer believes that this younger cohort stands to benefit the most from eyeglasses options designed for myopia control, especially those that focus on axial length elongation, as outlined by Dr. Chan.
“Some children may find it easier to engage in myopia management when eyeglass options are available. Some kids are afraid of eye drops, or they may not be ready yet for contact lenses. If they don’t use any of these treatment options, then they don’t have any means to prevent the progression of their myopia. Eyeglasses will make the treatment more accessible,” Dr. Kramer explained.
Smart glasses: Are we ready for them this time around?
Smart eyeglasses have been around for a decade, but they never gained popularity for various reasons. Google Glass is the best example. You may be surprised to know that it was only killed off in May this year despite becoming publicly available in 2014.
The heady days of 2014 marked a special time—the world was a simpler place politically, conspiracy theories were relegated to the darkest corners of the Internet, and the COVID-19 pandemic was six years away. It was also the first time that smart eyeglasses made their way into the public domain, and to say that they were a bust would be something of an understatement. At $1,500 a pop, Google Glass was out of reach for the average consumer. Despite subsequent versions of the core product over the years, it failed to achieve widespread popularity.
Times have changed, however, and smart glasses are back with a bang, with most offerings opting to focus on AR/VR as well as social media integration. The idea is to create alternatives to traditional devices like laptops and mobiles, allowing users to manage day-to-day interactions, such as checking emails or catching up on work, directly through eyeglasses. However, the long-term effects of using such devices remain unknown and require further research.
There are also blue-light filtering eyeglasses designed to filter ultraviolet radiation and varying portions of short-wavelength visible light, preventing them from reaching the eyes. These devices claim to mitigate symptoms of eye strain with computer use. While they offer little to no effect on BCVA, this would have been a niche option 10 years ago.5
“I think there’s huge potential for new technologies in eyeglasses, much more so than it was 10 years ago. People are more used to technology, whether that’s with biometrics, day-to-day life, navigation tools like Google Maps, etc. Society wasn’t prepared for technology like Google Glass [then], but it is now,” shared Dr. Pete Kollbaum, associate dean for research at Indiana University.
“This means there’s great potential not just for medical conditions but for diagnostics as well. Smart eyeglasses could be used to monitor conditions like blood pressure, blood sugar, heart rate, etc., all using technology that could be incorporated now. This could also be applied to glaucoma and intraocular pressure (IOP),” he continued.
Eyeglasses are here for the long haul
The point Dr. Kollbaum makes is an important one, as smart eyeglasses have the potential not only to treat but also to diagnose and monitor various conditions. Consistently monitoring IOP could offer several benefits to glaucoma patients, allowing them to exercise greater control over other conditions, such as diabetes. When used effectively smart eyeglasses can provide a more holistic approach to medical treatment and are not limited to the domain of optometry alone.
“Patients will come in asking for this type of technology as it’s already advertised in the mainstream media. This allows people to identify and brainstorm ideas about what could be done with this type of technology,” Dr. Kollbaum added.
Measuring IOP is a dynamic process that can’t be completed solely through an eye exam or by taking a few measurements. Dr. Lisa Ostrin, associate professor at the University of Houston’s College of Optometry in Texas, emphasizes the great potential for developing new technology that will not only measure IOP but also consider related physiological processes. She believes such devices would be widely popular with patients and clinicians alike—a win-win for all involved.
“Smart eyeglasses could be used to monitor conditions like blood pressure, blood sugar, heart rate, etc., all using technology that could be incorporated now. This could also be applied to glaucoma and IOP.”
Dr. Pete Kollbaum
“We’re going to look at the clinical trials when they’re available and the research demonstrating that these smart eyeglasses have a positive benefit. This is undoubtedly an area where technology will help increase our understanding of our patients’ ocular conditions, including their physiological processes and the treatments we can use to address their specific issues,” Dr. Ostrin explained.
However, Dr. Ostrin is also keen to emphasize that, despite the onset of new lens technology and smart eyeglasses, the original and classic forms will remain. Conventional eyeglasses will continue to play a vital role in eye care treatment, especially in less developed countries, where they serve as a dependable method.
“Eyeglasses are always going to be a necessity, and I don’t really see them being replaced by anything. While there’s a lot of novel technology out there that is fun to play with, they tend to make eyeglasses more expensive and complicated than necessary, putting them out of reach of most of the public,” clarified Dr. Ostrin.
Change is a constant in life
Technology always carries the potential for disruption. Yet at times, its power to revolutionize our lives and work can be overstated. When computers first became publicly accessible, it was frequently said that secretaries would lose their jobs en masse. Similarly, predictions about AI tools like OpenAI rendering writers obsolete have yet to materialize. Yet the point remains: Change can be challenging, and the impact of technology can be unsettling.
Eyeglasses are here to stay even if pre-existing alternatives continue to improve in quality and efficacy, and new alternatives emerge. So, what advice do some of our contributing optometrists have for their fellow professionals concerned about change? What pearls of wisdom can they offer?
“I don’t think that new technologies like AR and VR are avoidable, and there’s huge potential for optometry. However, I do think we need to have new privacy policies in place, as there will be a lot more information online about smart eyeglasses. Always consider if something could represent a breach of privacy,” Dr. Kramer shared.
“I think that education is very important. [When introducing new technologies like AR and VR], go over the potentials of side effects, advantages and disadvantages—as you would with any other product. Also consider the following for your patients: Why should they start using something, what could it mean for them?” she added.
“Eyeglasses are always going to be a necessity, and I don’t really see them being replaced by anything. While there’s a lot of novel technology out there that is fun to play with, they tend to make eyeglasses more expensive and complicated than necessary, putting them out of reach of most of the public.”
Dr. Lisa Ostrin
“When it comes to smart eyeglasses or augmented reality, it’s crucial to ask yourself why you are recommending them. What are the benefits they offer to your patients?” Dr. Kramer continued.
“For eye care practitioners, the use of AR/VR technology no longer carves the future, but the present as well. The best way to test out whether these innovations align with your goals and suit your practice is to first experience them yourself,” Dr. Chan said.
“Patients in this era are generally more technology-savvy and they largely embrace innovations. Some patients may be willing to try it out at home as ‘test subjects’ and provide you with feedback before a full-scale plan is implemented in your office. This will help engage their curiosity and build loyalty with your practice,” he concluded.
References
- Tbakhi A, Amr SS. Ibn Al-Haytham: Father of Modern Optics. Ann Saudi Med. 2007;27(6):464-467.
- Roman F. The Invention of Eyeglasses. Br J Ophthalmol. 1993;77(9):568.
- Tian Y, Ball R. Parametric Design for Custom-Fit Eyewear Frames. Heliyon. 2023;9(9):e19946.
- Bullimore MA, Ritchey ER, Shah S, et al. The Risks and Benefits of Myopia Control. Ophthalmology. 2021;128(11):1561-1579.
- Singh S, Keller PR, Busija L, et al. Blue-light Filtering Spectacle Lenses for Visual Performance, Sleep, and Macular Health in Adults. Cochrane Database Syst Rev. 2023;8(8):CD013244.
Editor’s Note: This article was published in COOKIE Magazine Issue 14.
