Digital healthcare in optometry

Adopting this new model of care may allow optometric practices to thrive and may enable earlier detection of the conversion from intermediate dry AMD to wet AMD.

Optometry has been skeptical of the digital models of eye care that have burst onto the scene over the past decade. This skepticism, rooted in the reality that online eyeglass and contact lens sellers were eating away at retail revenue from optometric practices, may indeed be justified for technology services offering digital eye care such as online refractions.

And this may be reinforced by concerns that these eye care services are fundamentally unable to match the quality of in-person interaction, examination and assessment.

However, the digital health models of care provide an opportunity to increase the scope and services of a practice in a way that some eye care models have not.

By viewing digital healthcare as a series of complementary tools that complement – ​​rather than replace – a clinician’s expertise, optometrists could reframe their understanding of digital healthcare as a structure to be embraced rather than a threat. to mitigate.

Additionally, by adopting digital healthcare models as part of a practice paradigm, optometrists can increase their reputation in their local market, differentiate themselves from the competition, and provide a uniquely high standard of care, all without rely on heavy capital investments that could take years to recover.

Embracing digital healthcare can be particularly effective in caring for patients with potentially vision-threatening retinal disease.

Related: The best digital resources for prescribing

Because retinal disease requires treatment that can only be given in an eye doctor’s office, optometrists (OPs) have little opportunity to engage with these patients when they are referred.

The use of digital home healthcare platforms such as the ForeseeHome AMD (Notal Vision) monitoring program could be the key to expanding an optometric clinic’s offerings into the retinal space.

By enabling DOs to detect the conversion of dry to wet Age-Related Macular Degeneration (AMD) early, a monitoring platform enables DOs, commonly referred to as the gatekeepers of eye care, to play an instrumental role in rapid intervention .

Digital healthcare in optometry

A number of digital healthcare platforms have proven effective in monitoring eye diseases while being user-friendly, resulting in a high degree of patient satisfaction.

For example, iCare Home (iCare Inc), a home tonometer used by glaucoma patients to track daytime intraocular pressure (IOP), has been shown to be “reliable [detect] Treatment-related changes in IOP in patients with glaucoma and ocular hypertension” in a pivotal study.1

Additional research has shown that patients find the device intuitive, real-world patients are able to accurately collect IOP data with the device, and 89% of patients would recommend the device to other IOP patients. glaucoma.2

Related: Meeting the need for better access to vision care

iCare Home promotes a hardware solution at home. For a software solution, consider the various platforms that use artificial intelligence (AI) and machine learning for diabetic retinopathy detection.

Diabetic patients who undergo fundus photography can have their imaging results reviewed by the AI, which then identifies any signs of diabetic retinopathy and, if found, grades its severity.

This AI-based image interpretation has proven to be an effective method for screening patients with diabetes, especially among large populations.3

Although this software-based system requires patients to visit a clinic, removing the convenience of home monitoring through a device like iCare Home, it clearly illustrates the value of AI-based monitoring systems in detecting disease. eye pathology.

The ForeseeHome AMD monitoring program includes a physical device that patients use at home, which uses AI, and the results are automatically transmitted to the Notal Vision monitoring center.

Thus, it is a marriage of domestic hardware and AI innovations. By enrolling patients in home monitoring, earlier detection of the conversion of intermediate dry AMD to wet AMD can be achieved.

Patients actively engaged in home monitoring remain within an optometric clinic’s orbit, allowing the reach of a physical practice to extend beyond the boundaries of its physical location.

Related: Embrace new technologies without sacrificing practice space

If routine testing indicates a patient may be transitioned to wet AMD, the prescribing practice is alerted that an in-person examination may be warranted, strengthening the patient-clinician relationship rather than replacing it.

Home AMD Monitoring

Patients with intermediate dry AMD and a best-corrected visual acuity (VA) of 20/60 or better are eligible for referral to the ForeseeHome AMD Monitoring Program, with the majority of patient costs covered by Medicare because the device is FDA approved.

The Notal Vision Monitoring Center helps the patient set up the platform and guides them through the steps of routine testing, removing any burden for patient support from benchmark optometric practice.

Additionally, the center monitors patient compliance (contacts the patient if compliance has dropped and resolves technology issues in real time) and analyzes patient test results through an AI algorithm.

If AI concludes that an aberration from baseline (and possible conversion from intermediate dry to wet AMD) has occurred, the software determination is verified by internal healthcare professionals before the clinic of the patient is contacted.

If the in-house clinician agrees with the AI’s interpretation, Notal Vision Monitoring Center contacts the prescribing provider, who then determines if and how to contact the patient for a clinical review.

Related: Viewpoints: Remote monitoring centers for dry AMD

It should be emphasized that prescribing home monitoring for AMD conversion does not require any cash investment from the prescribing physician or time investment to install the device in the patient’s home, resolve hardware issues or review daily tests. For more information on billing and coding, see sidebar, “A few questions about billing and coding.”

The value of early detection

Two recent contributions to the literature illustrate the importance of early detection and treatment of wet AMD, which can be accomplished more effectively in patients who undergo follow-up at home

A 2020 retrospective study that looked at real-world patients diagnosed with wet AMD found that patients with at least 20/40 VA at baseline maintained an average VA of 20/40 or better after the 1st and 2nd year of treatment with anti-VEGF therapy.4

Among this same population, patients who had a baseline VA of less than 20/40—approximately 66% of real-world patients in the study—were unable to achieve a mean VA of 20/40 or better at year 1 or year 2.

With these data in mind, it becomes clear that early detection of wet AMD conversion, which enables early intervention, is critical to maintaining patients’ visual function.

Related: Case report: the “other” AMD

In 2021, researchers looked at data from real-world patients enrolled in a regimen that included both in-person examination in a clinical office and home monitoring through the ForeseeHome AMD monitoring program.5

All patients in the study had at least 20/60 VA at the time home monitoring was prescribed. A total of 306 patients in the study transitioned from dry to wet intermediate AMD, 69% of whom had their conversion detected by the Notal Vision Monitoring Center.

Note that the patients in this 2021 study were not prescribed only home monitoring; on the contrary, the hybrid diet required in-person and home supervision.

Using the ForeseeHome AMD monitoring program has allowed the clinic to provide consistent monitoring services while preserving (rather than replacing) the clinician-patient relationship through regular office meetings.

Retaining patients with dry AMD to the point of conversion to wet disease provides additional opportunities for diagnostic imaging with fundus cameras and optical coherence tomography devices.

Practice growth through technology

While not all technological advancements lead to practice growth, there are services that will expand the scope of a practice and improve patient care while strengthening the relationship a clinic has with its patients.

By defining a platform as a digital healthcare service that practices can offer patients, such technology can be seen as an asset – rather than a threat – to the financial integrity of clinics and elevate optometry. to a new level of care. Clinicians may wish to adopt these technologies as their practices evolve.

1. Scott AT, Kanaster K, Kaizer AM, et al. The usefulness of iCare Home tonometry for detecting treatment-related intraocular pressure changes in glaucoma and ocular hypertension. Ophthalmotic glaucoma. 2022;5(1):85-93. doi:10.1016/j.ogla.2021.05.007
2. Ogle JJ, Soo Hoo WC, Chua CH, Yip LWL. Accuracy and reliability of self-measured intraocular pressure in patients with glaucoma using the iCare Home tonometer. J Glaucoma. 2021;30(12):1027-1032. doi:10.1097/IJG.0000000000001945
3. Pei X, Yao X, Yang Y et al. Effectiveness of artificial intelligence-based screening for diabetic retinopathy in type 2 diabetic patients. Diabetes Res Clin Pract. 2022;184:109190. doi:10.1016/j.diabres.2022.109190
4. Ho AC, Kleinman DM, Lum FC, et al. Baseline visual acuity at diagnosis of wet AMD predicts long-term vision outcomes: an analysis of the IRIS registry. Lasers for ophthalmic surgery Retinal imaging. 2020;51(11):633-639. doi:10.3928/23258160-20201104-05
5. Ho AC, Heier JS, Holekamp NM, et al. Actual performance of a self-contained home monitoring system for the early detection of neovascular age-related macular degeneration. J Clin Med. 2021;10(7):1355. doi:10.3390/jcm10071355

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