BLOG: How will we practice in 10 years?
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Those of us who have been in eye care for more than 10 years have seen our specialty become highly technology intensive.
A 90 D lens look at the macula has given way to a routine OCT exam. Today we’re not really looking at the cornea unless we have a topography report in front of us. And a cup-to-disc ratio has given way to retinal nerve fiber layer thickness analysis for every patient with suspected glaucoma. Each of these diagnostics requires a space-occupying machine, each with a five-figure price tag. As utilization of these tests has increased, reimbursement has declined. Yet we practice better medicine when we have better data, and these machines do provide better data.
The COVID pandemic has created opportunity for rethinking diagnostics. While more patient visits used to mean better care, today fewer office encounters reduce the risk for disease transmission and allow better population-based health management of the growing aging population.
The pandemic has also ushered in reimbursement for remote services, but telemedicine visits without diagnostics take more time for doctors and yield less reimbursement than office care — both reasons for today’s prevalent skepticism among eye care providers. It would seem that with no valid way of obtaining remote OCT measurements or other diagnostics, technology has trailed behind this opportunity.
Or has it? It turns out some impressive technology — and some of it from the past — may change disease management. Obtaining periodic macular OCT measurements with a new at-home OCT developed by Tel Aviv-based Notal Vision has been shown not only to obtain images acceptable for diagnosis, but it also allows earlier identification of disease progression in age-related macular degeneration. In one portion of the AREDS2 study, those monitored with Notal’s home-based OCT maintained vision of 20/40 in 94% of patients vs. 62% whose diagnosis was triggered by symptoms or a routine visit. This has favorable implications for care of patients with AMD who require chronic injections, in which there is no reimbursement for exams, as discussed in the cover story of this issue of Ocular Surgery News.
Glaucoma is another opportunity area. The Keep Your Sight Foundation, founded by miLOOP inventor Sean Ianchulev, developed an online perimetry device, Peristat, that showed strong correlation with a threshold Humphrey Field Analyzer in a study published 5 years ago in Translational Vision Science and Technology. Using MDbackline patient communication software, we have also developed an at-home subjective glaucoma surveillance tool that has shown significant predictive value in identifying patients at greater risk for progression of glaucomatous optic atrophy, according to soon-to-be published data.
If we look into the future, technologies that exist today will allow us to coordinate care for more patients with more testing done at home. Artificial intelligence will flag high-risk patients and drive diagnosis. Nothing we have learned so far suggests doctors will fall out of the equation. Competent care cannot (yet) come from a computer, but it’s safe to say that the next 10 years will be as evolutionary as the past 10 years in redefining how we treat patients in our technology-intensive field.
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