Optometrists

Three parts of your work where AI is already doing real lifting, and what stays yours.

• Spectacle making1800–1901

  Spectacle making and trial lens sets (trade-era refraction)

  Before licensure, the "optician" was primarily a craftsman and retailer of spectacle frames and lenses. The core instrument was the trial lens case: a set of calibrated lenses in a frame the practitioner held before the patient's eye, asking which combination produced the clearest vision. Keratometers for measuring corneal curvature had existed since Helmholtz's ophthalmometer (1851), and retinoscopy had been described by Cuignet in 1873, but these were not yet standard practice tools in American optical shops. The refraction was as much art as science: an experienced optician could reliably produce useful prescriptions, but there was no standardized training, no clinical examination, and no pharmaceutical capability. The trial lens set and its successor, the phoropter (introduced around 1912), would remain the defining instruments of optometric refraction for the next century.

• Slit-lamp biomicroscope + Goldmann tono…1901–1971

  Slit-lamp biomicroscope + Goldmann tonometer + phoropter (licensed clinical era)

  Professional licensing transformed the optometric examination from a trade transaction into a clinical encounter. The slit lamp, invented by Allvar Gullstrand and manufactured by Zeiss (1911), became widely taught in US optometry schools during the 1920s after B. Groves and L. Koeppe demonstrated its diagnostic value. Hans Goldmann's applanation tonometer (1954) gave optometrists a reliable tool to measure intraocular pressure, critical for detecting glaucoma, though they could not legally treat it. The phoropter replaced individual trial lenses with a consolidated instrument housing all corrective elements, dramatically speeding subjective refraction. The ophthalmoscope, introduced in the 19th century, was refined by the mid-20th century into the Welch Allyn direct ophthalmoscope and the Volk condensing lens for indirect examination. Despite these clinical instruments, all pharmaceutical interventions remained legally prohibited: optometrists could diagnose what they saw but could not dilate the pupil with drops, could not prescribe glaucoma medication, and could not treat the infections they detected. The La Guardia Conference of 1968 formally articulated optometry's case for primary care status, setting the stage for the pharmaceutical authority battles of the 1970s.

• Diagnostic1971–1998

  Diagnostic and therapeutic pharmaceutical agents (state-by-state scope expansion)

  Rhode Island's July 16, 1971 enactment of diagnostic pharmaceutical agent (DPA) authority was the single most transformative legal event in optometric history. For the first time, an OD could legally instill dilating drops to perform a proper posterior segment examination. The effect was immediate: optometrists could now detect and document diabetic retinopathy, hypertensive retinopathy, glaucomatous disc changes, and retinal pathology that had previously required an ophthalmology referral just to see properly. By 1989, Maryland became the last state to grant DPA authority (an span). Therapeutic pharmaceutical agent authority followed a similar arc: West Virginia led in 1976, and Washington DC completed the national map on April 22, 1998. The ability to prescribe antibiotics for bacterial conjunctivitis, topical steroids for anterior uveitis, glaucoma drops, and systemic anti-infectives transformed optometry's patient relationship from "examine and refer" to "diagnose and treat." Optometry schools rapidly updated curricula; clinical pharmacology became a core competency, and the patient volume for optometric medical eye care grew substantially.

• Humphrey Field Analyzer + automated sta…1984–2005

  Humphrey Field Analyzer + automated static perimetry (glaucoma standard of care)

  The Humphrey Field Analyzer I was introduced in 1984 by Humphrey Instruments, co-developed by engineer-turned-optometrist Mike Patella and Swedish glaucoma specialist Professor Anders Heijl. It replaced the manual Goldmann kinetic perimetry bowl with computerized automated static threshold testing, measuring sensitivity at many defined points in the central visual field. The Statpac statistical package arrived in 1986, enabling normative-database comparison that made glaucoma progression detectable before clinical symptoms. The HFA became the global standard for glaucoma monitoring within a decade; in 21% of eyes with glaucoma or ocular hypertension, the HFA detected defects that Goldmann perimetry missed. For the optometrist, automated perimetry transformed glaucoma co-management from an occasional referral to a routine element of every comprehensive exam. Carl Zeiss Meditec acquired Humphrey Instruments in 1991 and expanded the software platform. The HFA II, introduced in 1996, added SITA (Swedish Interactive Threshold Algorithm), cutting test time roughly in half while maintaining diagnostic accuracy.

• First commercial OCT1996–2010

  First commercial OCT (Humphrey OCT 1996; Stratus OCT 2002)

  Optical coherence tomography was first described in the scientific literature by Huang et al. in November 1991, and the first commercial system was released by Humphrey Instruments (through the Zeiss-acquired Advanced Ophthalmic Diagnostics subsidiary) in 1996 as "OCT 1." The pivotal commercial transition came with Zeiss Meditec's Stratus OCT in 2002, which dramatically reduced cost and scan time; by 2004 the cumulative worldwide OCT imaging procedure count had exceeded 10 million. For optometrists, OCT was transformative: for the first time a non-contact, non-invasive cross-sectional image of the retina and optic nerve could be obtained in seconds during a routine exam. Glaucoma structural analysis (RNFL thickness), macular pathology (AMD drusen volume, epiretinal membranes, macular holes), and diabetic macular edema became objectively quantifiable and documentable in ways fundus photography alone could not provide. OCT became standard equipment in full-scope optometry practices through the 2000s.

• Spectral-domain OCT + AI-assisted imagi…2010–2022

  Spectral-domain OCT + AI-assisted imaging platforms (Topcon Maestro, Heidelberg Spectralis)

  Spectral-domain OCT (SD-OCT), commercialized in the early 2000s, achieved faster imaging than time-domain systems, enabling 3D volumetric scans and dramatically improving axial resolution. By 2010, SD-OCT had largely replaced time-domain OCT in clinical practice. The subsequent generation of instruments integrated AI-assisted analysis: the Topcon Maestro2 (fully automated alignment, focus, and capture with single-button operation) and Heidelberg Spectralis combined automated image acquisition with structured diagnostic report generation, including glaucoma structural analysis (Hood Report correlating RNFL thickness with visual field defect pattern), macular AMD layer segmentation, and OCTA capillary network visualization. These platforms automated the acquisition process, removing the operator-skill dependency that had previously limited OCT to trained technicians, and generated templated diagnostic reports that structured the optometrist's interpretation workflow. The effect was to raise the diagnostic floor: even modest practices could produce research-quality retinal imaging without specialized imaging technicians.

• Autonomous AI diagnostic systems + ambi…2018–present

  Autonomous AI diagnostic systems + ambient documentation (FDA-cleared era)

  In April 2018, the FDA authorized LumineticsCore (formerly IDx-DR, by Digital Diagnostics) under De Novo pathway as the first fully autonomous AI diagnostic system cleared for any medical specialty in the United States: an algorithm that analyzes fundus images and determines whether a patient has referable diabetic retinopathy without any clinician review in the loop. Eyenuk's EyeArt received FDA clearance (K200667) in August 2020, and AEYE Health received clearance for portable handheld deployment in April 2024. All three systems are reimbursable under CPT 92229 ($40.28 Medicare base; $127.81 commercial median). A parallel wave of ambient AI clinical documentation (Eyefinity EncompassScribe, trained on optometric terminology) began automating post-exam note generation in 2025-2026. The AOA/RevolutionEHR 2025-2026 survey found 67% of optometrists familiar with AI and 65% willing to use AI tools in practice. This era represents the first time a discrete task within the optometrist's exam has been formally transferred to an autonomous AI system by federal regulatory clearance: the screening interpretation for diabetic retinopathy. The OD's role shifts from making that screening decision to overseeing the AI output, managing secondary pathology review, billing CPT 92229, and conducting the patient conversation around results.

  Effect on the work

  CPT 92229 Medicare claims grew from near zero to approximately 15,097 claims in 2021-2023 (Ophthalmology Science 2025), making autonomous AI DR screening the second fastest-growing AI medical procedure in the US. Early deployment concentrated in Federally Qualified Health Centers and urban academic medical centers. Adoption remains limited as a share of the total eligible diabetic population, but growth rate suggests broad penetration is plausible within several years.