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Physicians face constant decisions regarding new technology
An ophthalmologist offers a look at how software improvements and imaging technology are changing the way medicine is practiced.
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New devices in ophthalmology range from the disruptive to the disappointing, with lots of incremental gains in between. Capital equipment manufacturers often offer significant upgrades to lasers and phaco machines, but these can come with a significant price tag. In a busy practice, it is important to decide how you will weigh the benefits of new technology vs. the cost.
For existing devices, I like to see upgrades. They demonstrate to me that the manufacturer is continuing to innovate and invest in the technology, and I generally seek out upgrades soon after they are available. With new devices, I consider myself an early adopter, but rarely a first adopter. I like to look at data from clinical trials or international experience and talk and visit with colleagues who have personal experience to help me separate fact from fiction.
My first question whenever I am considering new technology is whether it will be truly better for my patients than what I am currently doing. I like to evaluate all technology based on some key principles (Sidebar). If there is clinical value, I try to find a way to make it cost-effective.
Software and speed
Computerized imaging systems have begun to guide surgical outcomes in ways that we never imaged 20 years ago. With femtosecond lasers in cataract surgery, for example, we are able to see the dimensions and relative position of the crystalline lens and capsular bag and base our surgery on that information. These capabilities are driven not only by the laser and the imaging optics, but by the software that allows algorithms to react to the images quickly enough to be useful to us in surgery. Medicine must look to Silicone Valley now for many of its advances.
We are now seeing great developments in surgical image guidance systems such as Verion (Alcon) and Cassini (i-Optics) that translate preoperative measurements into the intraoperative environment, reducing the number of opportunities for human error. Devices such as the Callisto system (Carl Zeiss Meditec) add digital information right into the surgical microscope, enabling precision registration to anatomical landmarks such as iris markings or scleral vessels instead of to an inherently imprecise ink mark.
Image: Feldman ST
The more “real time” these devices become, the more efficient they make us. Streaming refractive data introduced as an upgrade to the ORA intraoperative aberrometer (Alcon) almost immediately improved outcomes with the device. Recent upgrades to the Catalys femtosecond laser system (Abbott Medical Optics) that include streaming OCT imaging have made the system much more powerful.
Real-time imaging provides an even better view, showing the effects of corneal incisions or patient eye movements as they occur (Figure).
Real-time 3-D imaging turns a machine into something that is truly an extension of the physician’s hands and expertise.
In the future, we are likely to continue to see the Silicon Valley effect in ophthalmology, although the next wave may be driven by tiny, wearable devices instead of major equipment. Smart contact lenses or smartphone apps may collect and communicate health data in ways that help patients better manage diabetes or screen themselves for visual field defects, or help glaucoma specialists remotely identify when a patient is experiencing fluctuations in IOP between visits. These are truly exciting times for ophthalmic devices.
- For more information:
- Sandy T. Feldman, MD, MS, can be reached at ClearView Eye and Laser Medical Center, 6255 Lusk Blvd., Suite 100, San Diego, CA 92121; email: sfeldman@clearvieweyes.com.
Disclosure: Feldman is a consultant for Abbott Medical Optics.
Sidebar: Is new always better?
- More sophisticated imaging software may be better as long as accuracy is not sacrificed. Efficiency can make a procedure safer and more repeatable.
- Who loses? Any cost-benefit analysis should take into account the percentage of patients who do not benefit or who are likely to be dissatisfied with a new technology. That is like a manufacturing defect on the automobile assembly line, otherwise known as a lemon.
- Know the limits. High-tech devices operate under a set of complex assumptions, and there are always circumstances that will cause the assumptions to fail. Get a good understanding of what the technology can and cannot do.
- Algorithms matter. With the volume of information that new imaging technology can provide, the accuracy of device algorithms is critical.
- Presentation matters. When we have access to huge volumes of data from retinal or anterior segment imaging, the data must be presented in a way that adds clarity rather than complicating decision making. Make sure you can see what you need to see quickly.