Geriatric optometry, which focuses on the unique eye health and vision requirements of older adults, is having a moment in the vision care sector. Within this eyecare specialty, optometrists conduct comprehensive eye examinations specifically designed to detect age-related risks that could result in eye diseases or vision loss. As millions of Baby Boomers enter their golden years, the field of geriatric optometry is experiencing an unprecedented demand.
According to the U.S. Census Bureau, more than 20 percent of U.S. residents are projected to be 65 and older by 2030, up from 13 percent in 2010.
A recent feature in Review of Optometric Business by Richard Edlow, OD, known in the industry as The Eyeconomist, took a deep dive into the vision care needs of America’s aging population. Using VisionWatch and Medicare utilization numbers, applied to census projections, Dr. Edlow estimates that between 2025 and 2030 demand for eyecare will increase by roughly 2 million routine eye exams per year, and 9 million medical eye exams per year (from 70 million to 79 million medical exams)—that’s an increase of about 11 million exams annually by 2030.
Beyond standard optometric care, geriatric optometrists evaluate age-associated ocular conditions and health issues that frequently affect older populations, including diabetic retinopathy, cataracts, age-related macular degeneration, and glaucoma. Their role often encompasses low vision rehabilitation, which supports individuals with vision loss in adapting to their circumstances and maximizing their daily functionality. Additionally, they collaborate in co-managing conditions tied to systemic diseases and refer patients to ophthalmologists for surgical interventions such as cataract extraction, glaucoma surgery, or retinal detachment repair.
While not mandatory, many ODs pursue a 12-month post-doctoral residency in geriatric optometry or low vision rehabilitation to gain specialized experience with this demographic, according to the Association of Schools and Colleges of Optometry (ASCO). By detecting age-related ocular diseases and systemic illnesses early, geriatric optometry serves as a preventive cornerstone, playing a vital role in preserving senior independence, minimizing systemic healthcare expenses, and managing the expanding demographic demand for vision care.
Viola Kanevsky, OD.
“With our population aging, and Medicare adding roughly 100,000 new members to its rosters each month, it is crucial that all primary care physicians, optometrists included, add geriatrics to their practices,” said Viola Kanevsky, OD, Acuity NYC, a boutique optometry and vision correction center located on the Upper West Side of Manhattan. “Caring for older patients’ vision and ocular health is incredibly rewarding for the practitioner. While they can take extra time, the pleasure I get from helping them see and stay independent is priceless. But even putting aside the sheer joy of the endeavor, financially, these patients can help practices thrive. Medicare, even with all the cuts and insufficient cost of living increases, still pays competitively and certainly is more sustainable than vision care plans.”
A Rewarding Opportunity
Specializing in geriatric optometry offers a highly rewarding career path, allowing professionals to make a profound difference in their patients’ lives by focusing on visual safety and autonomy alongside standard vision care. This field requires a unique type of practitioner who possesses patience, empathy, and sensitivity necessary to handle complex cases.
Because older adults frequently need more than traditional eyeglasses or contact lenses, geriatric optometrists must be prepared to evaluate a host of systemic comorbidities and other age-related concerns during a routine examination.
In geriatric optometry, time can be a significant factor, meaning ODs may need to proceed at a slower pace when testing. “I see a lot of parallels between geriatrics and pediatrics,” said Meghan Elkins, OD, FAAO, chair, AOA Strategic Communications Committee and past president of the Association of Armed Forces and Federal Optometric Services (AFOS). “You may need to have multiple visits to accomplish everything a patient needs. Learning how to talk with geriatric populations about their complex health needs (both systemic and ocular) is also a barrier to becoming a quality geriatric optometrist.”
When interacting with geriatric patients, practice staff should remember to communicate clearly by speaking more slowly and loudly, enunciating distinctively, and avoiding medical jargon. It is also vital for staff to maintain direct eye contact rather than looking at a computer screen, as some older individuals with hearing impairments may rely on reading lips.
“It is crucial to have low vision and prism prescribing skills, and helpful to have handheld devices and equipment to accommodate wheelchair bound and mobility challenged individuals,” said Dr. Kanevsky. “Optical staff needs to be versed in multifocal and prismatic lens and frame selection. And of course, everyone must be patient and polite with both patients and their caregivers.”
Meghan Elkins, OD, FAAO.
Challenges and Requirements
To properly accommodate senior patients, it is vital to refine the physical layout of your optometric practice by ensuring barrier-free mobility, eliminating trip hazards, and maximizing lighting quality. “We are taught how to give eye examinations to every age group, but I recognize aged patients come with additional challenges,” noted Dr. Elkins. “Is your exam room equipped to handle wheelchair-bound patients? What do you do when someone is bed bound and wants to come for an examination? How do you handle patients with medical power of attorneys or limited decision making capacity?
Dr. Elkins continued, “If you assess your community needs increased access to geriatric care, you already know how to do the exams. You just need to be able to adjust the logistics. Geriatric optometry is certainly a viable (and necessary) specialty for ODs. I think doctors who want to work with geriatrics need to be able to look at the big picture. Geriatric optometry requires no more unique skills than other practice types. Patience, understanding, and efficiency go a long way to have success in geriatric eyecare.”
Dr. Elkins also reminds ODs that low vision is also a part of geriatric optometry. “If you do not offer low vision services, become acquainted with the closest low vision optometrist to you so that you can set up a referral network. As we age, blindness risks increase. Macular degeneration, diabetic retinopathy, glaucoma, corneal dystrophies, and a host of other ocular diseases can permanently decrease sight. Even the patients with cataracts who cannot (or will not) have cataract surgery may require low vision interventions,” she said.
Serving Those Who Served
Delivering eyecare services to older adults has long been an inherent part of the role for Dr. Elkins, who currently serves as a staff optometrist at the Hershel “Woody” Williams VA Medical Center in Huntington, W. Va.
“Providing essential eye health services for the geriatric population is the bread-and-butter of my every day practice at a VA hospital. Geriatric eye health is all about preventing blindness. We have no better time than now to incorporate more services for our continually aging population,” Dr. Elkins said. “I feel we have gaps in access to glaucoma care and assessing for ocular complications of systemic diseases like diabetes. Ocular disease rates increase as we age, so offering geriatric eyecare for your community may be essential.”
She added, “Being inquisitive, diving into a patient’s general health records to find the answers, picking up the phone to call a PCP or a specialist—all of these are essential in geriatric optometry. If you already have a primary care optometry practice, then you need to commit to age with your practice. Your patients already know and trust you, so make the effort to grow with them as they age.”
