Guest blog by Gregg Draudt
Introduction: Early detection is the best way to prevent blindness
At Fearsome we leverage cutting-edge technologies and interdisciplinary approaches to develop new surgical, drug delivery, and diagnostic solutions - aiming to improve outcomes, enhance patient care, and address unmet needs in ophthalmology, orthopaedics and other MedTech markets.
Diagnostic equipment and user interfaces are an important area of focus for our team. Removing the complexity and the physical, temporal and emotional barriers to achieving punctual diagnosis has never been more possible. In eye care, especially, we see exciting possibilities for lowering the barriers to more timely awareness of dangerous vision issues for patients.
The patient journey today - from their recognition of an eye related concern through to the appropriate therapy having been delivered - has many moments of indecision, concern and unnecessary complexity - especially when the technology exists to help. Each step along the way can be made easier, and less fraught by unnecessary travel, time wasting and in-clinic anxiety.
Removing the friction in Eyecare Diagnostics
The first step in the process is for a patient to realise there is an eye problem requiring professional attention. How can we better accommodate folks who think there might be an issue with their eyes but for a variety of reasons – don’t act until the issue has gotten much worse?Â
Two years ago, Luis Diaz-Santana and I (Gregg Draudt) Co-led a Future of Ophthalmology Workshop hosted by Cambridge Consultants on Cape Cod.
We brought together a remarkable group of internationally recognised experts including KOL’s from retina, cataract, and glaucoma - Leaders from industry including Alcon, Bausch and Lomb, and Hoya – As well as EMR leaders and CEOs from exciting ocular device start-ups.Â
Together, we covered a great deal of ground imagining some of the big changes for eye care that could be possible in the next 10 - 20 years…and then discussed strategies that could be implemented over the next five years to achieve these holistic visions. It is fair to say that everyone involved left the workshop with their perspectives and priorities changed.
One of the most profound areas of change we discussed - was the impact of digital technology and how it could improve the quality of care and the health care economics for both clinics and patients and for both surgical and diagnostic ophthalmology. Both areas are evolving in amazing ways.Â
This article focuses on the remarkable progress in diagnostics, particularly in remote monitoring and home health, while an upcoming piece will explore advancements in surgical assistance through robotics, AI, and other digitally augmented procedures.
Eyecare: Remote Monitoring and Home Health
Today, when you ask patients why they hadn’t visited the optometrist or ophthalmologist sooner, even when they knew there was an issue, they provide many reasons, including:
The clinic is too far away or takes too much time
I can’t take time off work unless I’m certain there is a problem
No appointments available for months – by then, things will have changed
I’d be embarrassed if it’s not a real problem
I don’t like to complain about small things
It didn’t seem like a big deal, so I thought I’d wait until I was sure
There is a wide array of medical options for slowing or stopping the progression of eye problems – and many are simple and non-surgical.
So, if there were easy ways for patients to check their eyes when they have even a small concern – without imposing on others, without taking a lot of time, without being a big expense, and when they actually have free time (evenings and weekends – when clinics are typically closed) – the friction against doing the right thing could be eliminated, and many more people could receive early care, which could greatly improve outcomes.
Fortunately, there are numerous start-ups and others working hard to develop home diagnostics, local kiosks, surgical implants, and wearables – all empowered by the promise of a connected digital network that can transfer the identification of any serious issue directly to their primary doctor or eye care professional (ECP). (In this article, I will mention a few of these companies – but there are many working to improve diagnostic opportunities for people. I will also point towards other potential visions.)
Nearer to Home Diagnostics: Challenges
One main challenge is developing diagnostic tools that can be accessed by people without the need for appointments or assistance from a professional while being tested. As we noted, a few of the biggest barriers to early detection are:
The distance to the clinic, finding a convenient time, needing to engage with others, and the cost of a formal appointment.
Additionally, the specifics of the diagnostic interaction cannot be overlooked. When a procedure or piece of equipment looks too technical, complicated, or intimidating, that will be the end of it for many.
From the patient's perspective, the interaction needs to be simple, clean, and understandable. This is a difficult challenge from the design perspective, as the cognitive and physical capabilities of people vary greatly – so solutions need to be simple, intuitive, and welcoming.
Retail type Kiosk Systems
There are several start-ups working on kiosk-type systems to be found in pharmacies and other easily accessible locations. Some of the most mature ‘clinic in a box’ options are being offered by companies like Pursuant Health, EyeCheq, and Eyebot. Most of these are designed to help with more straightforward eye tests, such as prescriptions for ordering glasses or contact lenses, but they are beginning to screen for more serious conditions through retinal scans and photographs. From an entrepreneur’s perspective, finding (or creating) reimbursement models for the use of these new diagnostic options is a critical aspect of the challenge. Much is being done to create dedicated CPT codes to help realise these vision-saving innovations.
The hope for many of these more autonomous kiosks is that they can begin to offer a more holistic examination by adding a broader spectrum of tests, including OCTs, fundus imaging, slit lamp examinations, and more. Technology is advancing in some of these areas. Remidio, for instance, offers portable slit lamp and fundus cameras – though these still require a technician's expertise. Perhaps, in the near term, a hybrid retail system will offer some assistance (via a remote ECP) for patient support during more complex device interactions.
AI is advancing so quickly that the scope of diagnostic capabilities will increase rapidly. How quickly that translates to more holistic remote eye exams is a complex question. That said, the early diagnosis of diabetic retinopathy, wet and dry age-related macular degeneration (AMD), cataracts, increased IOP, glaucoma, and other gradually debilitating ailments is greatly needed, and easy-to-access kiosk systems – or systems like them – could hold the key to saving eyesight for those who would otherwise remain untested, for one reason or another.
In Home Ocular Diagnostic Tools
Another exciting area for ophthalmology is the advent of in-home diagnostic devices that can communicate internally and externally. It focuses on providing patients with tools to monitor their eye health from the comfort of their homes, with the potential to dramatically reduce their need for frequent clinical visits. The biggest challenges are not so much in finding an interest and market for these product ideas but how to make the technologies required to perform the diagnostics - affordable, easily usable, and properly integrated with clinicians and health record systems. Key innovations in this area include:
Artificial Intelligence (AI) based platforms (and the heart of most of the in-home technologies) are helping in-home diagnostics by automating the interpretation of retinal and ocular imaging.
Telemedicine and remote monitoring solutions, especially in glaucoma and AMD, can allow patients to communicate and send data directly to healthcare providers.
Portable and Wearable Devices such as handheld tonometers and autorefractors, along with wearable AR systems, are becoming more common for at-home diagnostics.
Home-based Monitoring Systems can provide direct-to-patient solutions for self-monitoring of conditions such as AMD and glaucoma.
Current Development of Home Diagnostics
Early detection would be best when you don’t have to leave home to get it. There are many mature and start-up companies already engaged in making their technologies suitable for this cost sensitive market. Each has a slightly different focus, setting out to address different aspects of maintaining eye health. Some of these companies are Notal Vision, iCare, and Verana Health but the list is growing quickly.
Notel Vision has been innovating in the space with equipment that helps monitor patient’s macular function for AMD patients. They, and innovators like them, have been on the forefront of addressing many of the trials and tribulations of developing business models within this new space. Their product solution's elegantly address many of the cognitive and physical challenges that AMD patients can have. This underscores that carefully considered user interfaces are equally as important as the technology inside when addressing this technician free and ’consumer-like’ market.
A larger opportunity will be bringing many of these technologies into a unified system.
Solving each diagnostic challenge with separate remote devices is a remarkable start but can begin to offer other challenges. At some point patients/ consumers/ people just cannot keep up with 5, 10 even 20 different home diagnostic devices (not only ocular but also blood pressure, temperature, weight, saliva, etc.) all doing something a bit different and all with a cognitive load on often ageing patients with diminishing capabilities.
Similar to the clinic in a box kiosks - the refinements of these technologies and their ease-of-use profiles will continue to offer opportunities to free people from today's - appointment based - clinic / patient relationships.Â
Other remote ocular monitoring innovations
There are remarkable implantable and mobile systems being invented, refined and brought to market leveraging both digital technologies and micro electro-mechanical innovations. For glaucoma patients, for instance, Implandata Ophthalmic Products has an implant that monitors patients intraocular pressure (IOP). The device is intended for permanent implantation in the ciliary sulcus (a small space between the ciliary body and the base of the iris). It accompanies an external handheld reader that enables wireless measurements of IOP and with a wireless power supply. Measuring IOP properly and often has always been challenging and - while innovations like Impantdata’s are In their early days - they offer a big step toward confidently and consistently tracking the progression of ocular symptoms.Â
What’s Next for Ocular Diagnostics?
The developments discussed here and other promising technologies are making the eye health ecosystems broader and more sensitive to the small changes in eye health that - when noticed - will make an extraordinary impact on people's lifetime independence and fulfilment.
Remote Diagnostics and Monitoring Technologies will continue to advance to the point that most people's eye health can be maintained with less stress, health system complexity, time and cost. But, while we begin to see solutions to individual health concerns we must keep in mind how a swarm of those physical and digital interactions scattered throughout the house would, perhaps become overwhelming – reducing the likelihood that users will use them.
It is important to remember to keep our eyes on the big picture and the ultimate user experience. As a mentor of mine wisely coached us - ‘simplicity rests on the far side of complexity’ and when you stop your development too soon – that can produce complexity that your customers will experience’. As we build this exciting future of dramatically improved ocular diagnostics –we will need to be careful not to exchange one flawed patient journey with another.Â
Integrated Systems
We will need to broaden our view of the potential solutions - and begin to imagine a master plan - that can combine many assessments and tests into a more elegant user friendly solution. For instance, one can imagine - with technology that is very close at hand - a way to envision a system that will be working in the background. This ‘silent butler’ idea could, for example, evaluate many of your eye health parameters while you are concentrating on reading off your smartphone, looking at the bathroom mirror, working on your computer or driving. This type of smart, connected ecosystem can include metrics for many other attributes of health as well. Of course this is just one of many possible futures.
A Fascinating Future
While no one can actually see the future, together we can and will end up taking these next steps - one solution at a time. It will take many of us - and lots of trial and error - to get it right. But the possibilities are thrilling and we look forward to working with you and other ocular industry innovators to help make it happen.
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