Eyes: The Window into the Future of Telemedicine

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When it comes to telemedicine, few medical specialties are more suitable than ophthalmology and optometry. The need is great: according to the World Health Organization, an estimated 285 million people worldwide are visually impaired. It’s an issue that affects all ages, genders, and ethnicities, and it places a difficult burden not only on the individual, but on the family, and often on society as a whole. But the prognosis is excellent: 80 percent of these visual impairments are treatable and can be prevented with access to even basic vision care services. 

Compared to other specialities, the tools and technology in ophthalmology and optometry are in abundance. “Ophthalmology has always been one of the most technology heavy medical specialties,” says Dr. Billy Pan, an ophthalmological resident at LAC+USC Medical Center in Los Angeles, California. “Recent decades have included tremendous advances in every sub-specialty within ophthalmology, from improved intraocular lens designs to advanced imaging in the form of optical coherence tomography (OCT), to name just a couple.”

Another common ophthalmology tool is one you probably already own. Mobile phone camera technology and internet adoption has reached the point where 3.6 million global cellular phone owners already possess a device sufficiently capable of addressing most basic eye and vision care needs. Here’s a review of three new devices which use mobile technology to bring advanced eye care directly to consumers.

DigiSight
One company that is leveraging smartphone technology to enhance vision care for doctors is San Francisco based DigiSight Technologies. For the physician, they’ve developed the Paxos Scope, a smartphone attachment and app that allows doctors to perform a routine fundoscopic exam practically anywhere. It consists of an adapter that houses a powerful light and a lens to illuminate and magnify the front and back of the eye. Images and video can be captured with the smartphone’s camera, which can then be securely archived or sent to another party. Paxos Scope can examine both the posterior and anterior of the eye and provides a 56 degree field of view. And unlike many similar medical tools that utilize a smartphone camera, the Paxos Scope can fit practically any smartphone. By keeping the tools simple and affordable, Paxos is able to reach a greater number of eye care professionals who can in turn serve a greater number of patients.

Smart Vision Labs
While empowering more ophthalmologists and optometrists with better tools will certainly improve access to vision care, it is often the patients themselves who are not motivated or are too busy to see their optometrist regularly.

Smart Vision Labs, based out of New York, has addressed this point with the recent launch of the SVOne Enterprise, a system that uses the company’s smart autorefractor, the SVOne Pro, with a self-guided test to conduct eye examinations without the need for on-site doctors. The SVOne Pro, which Smart Vision Labs has already sold over 500 since its launch in 2014, is a handheld, iOS-based tool that utilizes advanced wavefront aberrometry technology to measure vision imperfection and generate refraction in a matter of seconds. Though it uses an iPhone camera and has a vastly smaller footprint than traditional tabletop autorefractors, the SVOne Pro has been shown to be just as accurate, with a measurement error of one percent compared to the gold standard. And while the SVOne Pro itself can wirelessly print test results or archive them, the new enterprise component sends the data for analysis to a remote network of eye doctors who can write a digital eyeglass prescription for a patient within 24 hours or recommend a full eye exam. Smart Vision Labs hopes to place its systems in workplaces, schools, designer eyeglass boutiques, and even in countries like Haiti and Guatemala, where their SVOne Pro has already been used.

Notal Vision
Even with tools that make vision exams more convenient for patients, there are some eye diseases that require constant monitoring. For many patients, this is a major inconvenience, and for some, like the elderly, it is not possible. For these patients, many who suffer from Age-Related Macular Degeneration or AMD, Notal Vision, a company based out of Tel Aviv, Israel, has developed a device that allows them to monitor the progression of AMD without leaving their home. Known as ForeseeHome, the device consists of a tabletop viewer with a standard computer mouse that runs a Preferential Hyperacuity Perimetry (PHP) test in which the patient moves a cursor to a specific location in his or her field of view. The test results are automatically sent to Notal Vision via land line or cellular phone service. If a statistically significant change in a test result is measured, the patient’s physician will be notified so he or she can contact the patient for a follow up appointment. Doctors can view their patient’s data at anytime and are automatically sent monthly reports.

Conclusion
Compared to other medical specialities, assessing a patient’s basic visual health is relatively simple and doesn’t require highly sophisticated sensors; in essence, a patient simply needs to capture a picture of his or her eye and look at a screen, something that the majority of cellular phones in the world are powerful enough to do.

Dr. Billy Pan thinks we’ll continue to see technological advancements in therapeutics as well: “We will likely see the maturation of many exciting new technologies including laser-assisted cataract surgeries, prosthetic retinal implants, gene therapy, and minimally invasive glaucoma surgery. All of these new devices have incredible potential for furthering our ability as ophthalmologists to provide sight-preserving and sight-restoring therapies to the population.”

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