AS INTERNET, SOFTWARE and artificial intelligence technology continue to integrate into the world of optometry, we in the profession are challenged constantly to measure the benefits of potentially transformative innovation against the costs – both literal and figurative. Although it’s natural to express some concerns about what technology might be taking away from the profession, it’s also important to acknowledge the components that are benefitting a great deal from increased integration of technology, especially as it relates to collecting crucial information to treat disease. Fundamentally, I believe that instead of fighting new technologies, we must focus our energies on the issue of how to utilize them, mindfully guiding the transformation of optometry so that we can provide the best patient care possible.
Improving Diagnosis and Care
Health care is increasingly shifting its focus towards preventative medicine, and optometry should be no exception. However, an individual’s access to an eye care provider may be challenged by their health insurance status, socioeconomic and transportation barriers. The forms of technological advancement in optometry that I am most excited about are those that emphasize personalized patient care and promise to increase doctors’ access to patients.
Retinal imaging tools have advanced significantly in recent years. With short training, medical assistants or staff in non-optometry medical offices have been able to complete retinal screenings. Historically, remote consultation of these retinal images have made eye care more readily available; however, this may still require a lot of time and effort from an eye care provider to review. Currently in research, artificial intelligence (AI) and machine learning have been on the rise to be used in concert with retinal imaging tools to detect conditions, such as diabetic retinopathy or macular degeneration, for eye care referral. With machine learning, this can eventually be expanded to other underdiagnosed conditions including glaucoma.
Additionally, this may also reduce human error from remote consultation and possibly identify new disease trends that were previously not noted before. Along with earlier diagnosis and screening, AI can analyze data at a faster rate with improved objectivity. This allows for doctors to focus their attention more on personalized care and may free up appointment slots for patients who need to be seen more urgently. It is exciting to see how AI will integrate itself in not only retinal imaging but also optic coherence tomography (OCT) scans, fundus autofluorescence (FAF) photos and visual fields. It is important to note that AI should not replace patient and doctor interactions as there are nuances of patient care that cannot be fully understood by AI. However, we can certainly utilize it as a tool to support decision-making in the exam room.
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Remote Monitoring and Telemedicine
Another way these tools expand doctors’ resources is through remote monitoring. As we know, many ocular conditions are managed based on data obtained in the exam room, but having the capability to monitor patients outside the office can be extremely powerful. A few examples of this are home monitoring devices include head-mounted VR perimeters, iCare Home (iCare,Vantaa, Finland) and Triggerfish (sensimedAG, Lausanne, Switzerland) contact lens sensors which can track intraocular pressure (IOP) trends throughout the day. If we are able to monitor conditions beyond the office walls, whether it be through wearable devices or apps on a phone, optometry can progress more towards personalized medicine and better patient outcomes.
I cannot fail to mention how, just as in many other disciplines in health care, software and internet technology are allowing for the expansion of telemedicine across the country. While I do not believe telemedicine will replace in-person eye exams, I do think it has a special place in our practices. Optometrists can utilize telemedicine to expand reach to rural settings or to consult with patients in urgent settings. With the help of at-home monitoring, optometrists can improve retention of patients (especially in rural settings) and can ensure tracking and management of conditions are completed appropriately. Nowadays, patients will actively seek out medical practices that provide patients easy access to health records, appointments, and open correspondence with doctors. These types of electronic health records (EHR) systems can be costly, but by having patient portals and incorporating telemedicine, doctors can potentially triage issues more readily and devote more exam time to patient consultation during in-person visits.
Data Security and Cost
There are several challenges that come with integrating eye care with technology, and it should come as no surprise that I believe security is perhaps the largest. Data privacy is on all our minds these days, and we understand that when it comes to health data, people have two major questions: the first is, how will my sensitive, private data be kept safe from hackers or other bad actors? And the other is, how do I know my sensitive, private data is not being profited from without my knowledge?
I previously mentioned how important imaging is to the practice of optometry, which raises the question of how these images will be stored safely and cost-effectively. With our smartphones using telemetry and facial recognition to ID us, our need to protect the unique data specific to an individual’s eye is essential to give patients peace of mind. While optometrists must consider the storage and protection of sensitive patient information for the safety of their patients, they must also consider how to protect themselves against potential lawsuits. Understanding the limitations of new technologies is crucial before implementation into practice. Optometrists should understand the risks and benefits of telemedicine, AI, and other new tools including providing thorough patient education on the expectations and limitations of each tool. Data safety also extends beyond our optometry offices. Third-party health technology corporations that employ cloud services, AI algorithms and machine learning must be regulated carefully, so that the data they possess is kept secure as well.
Cost is another major challenge. In addition to the cost of implementation into optometry practices and integration into patient care, there is the cost associated with understanding, interpreting, and managing the information produced by these technologies. This means training staff, storage of data, and security. There are also the costs associated with a catastrophic failure of the technology or breach of data. If a great deal of a patient’s health condition is stored in “the cloud,” what happens if suddenly a healthcare provider is unable to access it? Safeguards and backup storage must be put in place to ensure patient care does not get affected.
Trends and Challenges
As an educator at a college of optometry, one of my highest priorities is emphasizing that optometry is an ever-changing profession that continues to rapidly develop innovative technologies. This includes introducing students to our current gold standards of practice, but also identifying gaps that continue to challenge the field. Additionally, our patients have the right to know upcoming novel technologies, treatments, or medications that can benefit their health. I hope to encourage optometrists to explore new technologies to incorporate into their practices so that ultimately, the are using technology as a means to improve efficiency, cost and patient outcomes.
About the Author
Dr. Jessica Yuen graduated from the University of California, Berkeley with a Bachelor of Arts in Public Health and minor in Molecular Toxicology. She later returned to Berkeley to complete her Doctorate of Optometry. After receiving her OD degree, she completed a residency in Primary Care/Ocular Disease at the San Francisco VA Medical Center where she worked closely with UCSF ophthalmology in various sub-specialties including oculoplastics, cornea, glaucoma, and retina. In 2020, she joined the Southern California College of Optometry at Marshall B. Ketchum University as a full-time faculty with clinical and laboratory teaching responsibilities in the Primary Eye Care and Ocular Disease service. Dr. Yuen is a fellow of the American Academy of Optometry and member of the American Optometric Association and California Optometric Association.
