You may already have seen our recent report ‘Towards 2040 – a vision for the future of ophthalmology’, which was the outcome of a full day of structured discussions with some of the most influential clinicians and industry leaders in ophthalmology. As the workshop closed, we all agreed that ophthalmology has a digital future. And that it is unavoidable. This future comes with the promise of improved patient access, better quality of care, reduced workloads, optimised efficiencies and improved quality of life for patients and HCPs.
But… the key learning from this memorable and significant day of collaboration was that the path we choose to take to reach this digital future can shorten and speed up our journey. Conversely, if left to serendipity, it can lengthen the time needed to get there. And every day we delay adds more sight loss that we could have avoided.
Towards 2040 - a vision for the future of ophthalmology
The shortest path calls for collaborative action across all industry members to forge a roadmap to that digital future. And while multiple strands will need to be addressed – such as regulatory processes, economics, knowledge transfer and education, development cycles and investment – the one thread that will bring it all together is the development of clinical workflows that can incorporate digital technologies. Workflows and technologies need to be developed in tandem to maximise the benefits from new technologies.
In this article I want to give an example of how technology, data requirements and workflow are tightly entangled, and are sometimes impossible to pull apart. Creating a new technological solution that fails to accept these constraints is forcing serendipity into our roadmap. Accepting them and designing the service, the benefit, the workflow and the interactions between patient, clinician, and machine before choosing the technology to collect the data or perform the intervention is a step in the right direction.
Home monitoring devices for ophthalmology
I will focus on home monitoring devices and the patient journey when using them. Elevating the journey is valuable for product differentiation and crucial to market adoption. New treatment options must respond to two main objectives. One, reduce the number of touchpoints between the patient and healthcare provider and two, increase the patient’s independence by allowing them to self-manage their treatment.
These very welcome and powerful benefits often benefit and sometimes necessitate the need to monitor the patient remotely, so that the healthcare provider is alerted to the need for intervention when necessary. This brings me to a vital question: what is the key to unlocking successful home monitoring in ophthalmology? I have a succinct answer to this multilevelled and complex problem – seek the broadest possible viewpoint and tap into a comprehensive blend of competencies to understand the task expected from the device, and make sure it does that task perfectly and seamlessly.
As the graphic here shows, a new hypothetical kind of home monitoring device relies on system design that encompasses a great swathe of influences. The patient group and the visual need in question are just the beginning. Devices to be used at home need to deeply understand the behaviours and journeys of the patient and their support network. They must consider important usability factors, from age to mobility, serviceability and much more besides.
To glue everything together, of course, it is vital to have a firm grasp of the science and technology that will ensure the operation of any device is reliable, predictable and safe – as well as transformative for clinicians and patients. For home monitoring, that should include an understanding of the role of off-the-shelf devices such as smartphones. It is possible to use their functionality to monitor a number of body parameters, such as heart rate, activity, gait, eye movements and breathing patterns, to mention just a few. Often, this is possible with out-of-the-box sensors in the device, but sometimes an ergonomic holder is needed. In other instances, the smartphone might just be used to process, log or transmit information.
Smartphones and tablets lend themselves to visual tests such as the classic Snellen eye chart, colour vision tests, the Amsler grid test and so on. The team here at Cambridge Consultants has plenty of experience in this area, including the development of an innovative perimetry testing concept capable of offering simple, affordable and fast glaucoma screening. It’s a smart approach, by the way, to consider gamifying a test – which is a great way to improve patient engagement and adherence.
Home monitoring innovation
I’ve taken part in many ‘smartphone versus standalone’ debates when it comes to home monitoring innovation. Take an application such as fundus photography, for example. It can be achieved with the camera of a smartphone along with a simple lens/flash adaptor. This approach has a lower development cost and quickens time to market. But on the downside, it is difficult to use unassisted, gives a very small field of view (up to 10°) and does not give access to the raw data that’s needed for better analytics.
Depending on the quality of the data required, it may be better to use a standalone device that is able to produce high quality data consistently. What might appear a slower, more expensive route would actually be more robust and easier to control in future generations. In both cases the device must be easy to use and minimise the risk of user errors to ensure high quality data consistently.
My advice would always be to consider market and user needs, and don’t leave out any of the other stakeholders involved in that patient’s journey so that the most appropriate medical device can be deployed accordingly. Stakeholders downstream that may use the data in the future must also be considered. We often work in silos as an industry and forget that the patient has to move between silos. We must facilitate their journey.
Optical coherence tomography (OCT) imaging is an example where a smartphone is not suited to collecting data. Here, a home monitoring system would require the specialised technology of an independent, standalone device to collect and process the data. Technical, ergonomic and safety considerations dictate the form factor of the device. For example, head-worn versus tabletop devices are both possible options, but factors such as age group, dexterity, lifestyle and frequency of data collection would need to be carefully considered.
Certain parameters may need to be monitored very frequently, making a strong argument for smart implant devices that can monitor eye health continuously. Intraocular pressure (IOP) is a case in point, as it varies significantly across the day. In glaucoma patients, an implant to monitor IOP day and night will significantly improve their care and outcomes. But once again, specific product specifications will be dictated by a host of factors, all of which need to be understood before development begins.
As I said at the start, an exciting race for success is definitely on – but I’d urge entrants to pause long enough to view their potential opportunities from the broadest possible perspective. And don’t forget that the patient needs to walk from one form of care to the next on their journey. Data, efficiencies, improved quality of care and so on will need to travel with them. We cannot stay disconnected and siloed any longer.