IN TODAY’S CONSTANTLY evolving landscape, there is no doubt that each of the health care professions is integrating technology in novel ways to provide their patients with comprehensive care. Many new technologies are able to extend the providers’ expertise beyond the examination room, allowing for increased accessibility to care and improved outcomes. The profession of optometry is no exception, as doctors in our field are leveraging telehealth and other innovative technologies to meet patient expectations. This is particularly true in my own area of practice: low vision rehabilitation.
I currently serve as the Chief of Low Vision Rehabilitation Service at MBKU’s University Eye Center, where we are participating in a multi-center clinical trial funded by the National Institute of Health. This trial is investigating the use of telehealth platforms to assist patients with low vision outside of the doctor’s office. If we can reach patients without their having to come in for another visit, it represents a considerable benefit to them, since individuals with low vision often have inconsistent transportation options. They typically are not able to drive themselves, so they have to arrange to receive a ride from others or take public transportation, which is itself no easy task.
Therefore, utilizing telehealth platforms to see these patients – through a secure video platform for instance – enables us to perform follow-up visits that accomplish our goals remotely. One of the most common forms of care that low vision patients receive is assistive devices that help them navigate day-to-day living with severely impaired eyesight. Following up in a telehealth appointment allows us to inquire about how they’re doing with their device in their home environment and give them advice or additional instruction on how to use it correctly if we observe that they are not doing so. This is a common challenge in low vision rehabilitation: A patient will receive a device, take it home and for various reasons do not use it correctly. They may get frustrated because it seems like it’s not working, and– since it’s so difficult to come in, they put the device in a drawer and never use it, resulting in them not receiving the benefits of the device.
Telehealth also serves the profession of optometry in ways that echo the other health care professions. It is a useful tool for triaging patients withan eye irritation, for example; we can discern from afar how serious their condition is and whether an in-person visit is necessary. Another way that telehealth increases accessibility for patients of all health professions and certainly for optometry is the way that it enables providers to connect with rural or otherwise underrepresented populations.
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The use of digital technology in the treatment of low vision patients is not limited to telehealth. In addition to adaptive technology, another particularly intriguing development has been the rise of smartphone and tablet applications and how artificial intelligence is being integrated into these applications to augment their usefulness considerably. For example, it’s long been common to use a smartphone camera to magnify elements in a person’s environment. But with these applications, the camera can be aimed at a paragraph of text, zoomed in and read aloud to the user. The apps can scan barcodes and instantly deliver audible information about the product. For a person with severely reduced vision, there are apps that can recognize color, scenes and individuals, along withtheir emotions. For example, with the camera and the app, you take a picture and it will say something like, “You’re in an office. There’s two people sitting on the couch. One is a male, about 30 years old. He looks happy.” And it gives information on the person’s environment.
Another app is designed to assist individuals with low vision if they ever find themselves in a tricky spot. For instance, the user could connect with a sighted volunteer and use their phone to show them their surroundings, which the sighted volunteer could help interpret for them. With AI empowering this application, this can be done without the volunteer which greatly increases the probability that assistance will be available to the user immediately. Artificial intelligence has also greatly boosted image recognition software so that low vision users can have immediately helpful information in real time.
Naturally, the potential issues with these technologies are the same with the profession of optometry as they are with the rest of health care. Issues of privacy are of the utmost importance, whether it be the patient’s data or the security of the video platform being used. Accessibility also remains an issue, as not all patients have access to smartphones or the higher internet speeds required to have an effective telehealth session.
As exciting as the potential benefits of these technologies are, what does not change is the need for in-person examinations and compassionate, humane care while the patient is in the physical presence of the optometrist. If you have two patients with exactly the same impairment in their vision, they will still be totally different. The optometrist must understand things like how long they’ve had their vision loss, how well they’ve adapted to it or how well they’ve accepted it. Can they support themselves? Do they have jobs? Do they have transportation? Are they isolated because they can’t meet with their friends? Are they suffering from depression, and do they have a support group? Do they have mobility issues? These are all the kinds of things that a doctor simply cannot perceive entirely through a camera, and which have an enormous impact on the health outcomes of the patient.
About the Author
Patrick D. Yoshinaga, OD, MPH received the Doctor of Optometry degree from the Southern California College of Optometry and a Master of Public Health from California State University, Fullerton. He has worked in private practice, as Director of Contact Lens Services at the University of Southern California Doheny Eye Institute, and as coordinator of the State of Nevada Bureau of Services to the Blind and Visually Impaired Las Vegas Low Vision Clinic. Currently he is a Professor at the Southern California College of Optometry at Marshall B. Ketchum University and Chief of the Mary Ann Keverline Walls Low Vision Center and teaches in the areas of public health, low vision, and ophthalmic optics. He is a Fellow of the American Academy of Optometry, a Diplomate in the Academy’s Section on Public Health and Environmental Vision and has served as Chair of the Vision Care Section of the American Public Health Association.
