Optometry’s Future and the Need for Change, with Randall Thomas, OD, MPH

At the 2025 American Optometric Association Conference in Minneapolis, MN, Randall Thomas, OD, MPH, Educators in Primary Eye Care, LLC, presented his lecture on emerging therapy options for various ocular diseases. He sat down with HCPLive to discuss the horizon of upcoming treatment advancements and the overall state of the optometry industry.1

Thomas discussed the importance of continuing to practice existing therapies with long and successful track records. Rather than swapping them out entirely for new treatments, Thomas suggests folding new techniques and therapies into existing practice.

“The one thing that’s important to realize is that pharmacological dilation of the pupils is still the gold standard,” Thomas told HCPLive. “It’s important that patients are dilated on a pretty common basis, particularly if they have any symptoms. The good news is that we have an eye drop now that will reverse dilation, called Ryzumvi. If we have a means to reverse that and get them back to baseline more quickly, then that’s a good thing.”

Looking ahead, Thomas discussed potential future treatments for a variety of diseases, highlighting dry eye disease for its relatively limited trial-and-error treatment strategy.

“We know all about dry eye,” Thomas said. “We know all the pathophysiology, we just don’t know how to treat it. I mean, there is no algorithm for treating dry eye, and in many cases, it’s hit or miss, trial-and-error, and that’s state of the art. There’s probably 20 different approaches, and one will work for one patient and not work for another. It’s challenging.”

Concerning barriers to implementing new medications and therapies in optometry, Thomas spoke on the priorities of pharmaceutical companies and the struggle of getting prior authorizations.

“I’m hoping over the next several years, with different administrations, that we can get rid of prior authorization,” Thomas said. “And electronic medical records are a two-edged sword. It can be beneficial, and yet it can really hamper the doctor-patient relationship.”

Thomas called for optometrists to take a more proactive stance in approaching and treating patients.

“Optometrists need to realize that they are truly doctors and therefore need to be on call for their patients. I know good optometrists that are on call and anyone that calls them, if it’s a true medical emergency, they will see them,” Thomas said. “They say it’s one of the best ways we have to grow our practices: being available to people in need.”

Circling back, Thomas advised clinicians on important considerations to keep in mind when analyzing and attempting new therapies or treatments. He pointed out that frontline use of new therapies often ends up uncovering glitches or bugs in the system.

“Every new drug, every new technology, is still working out the bugs. Nothing is perfect when it’s first approved, and we learn things about both drugs and devices after a year or two of widespread therapy,” Thomas said.

References

1. 1: Thomas R. Current and Emergine Therapies for Ocular Disease: A Clinical Update. Presented at the 2025 American Optometric Association Conference in Minneapolis, MN, June 25-28, 2025.