Digital Connectivity within Ophthalmics

8th July 2020

A quick scoot around your favourite internet encyclopaedia will give you all the important dates you need to know about the creation of the ophthalmoscope, its evolution to the binocular device, the addition of light sources and a joystick. It’s equally easy to establish key dates in the field of photography (discounting the pinhole camera, with evidence of its invention dating as far back as the 11th century). That the two devices should finally meet seems logical now, but the beginnings of the relationship were somewhat stuttered.

From early retinal photography in the 1900s, to random attempts at slit lamp photography either sides of both wars, ophthalmic photography didn’t become manageable until the camera was manageable. But what did you do with the images? My dad was a photographer and specialist hand printer, I can attest that having your 35mm or medium format film developed in the 70s and 80s wasn’t an instant process, so no, the patient wasn’t getting a copy and you weren’t saving your test results to a database.

During the 70s there were the two key developments that (hopefully) provide the connectivity part of this story. The US Defense Advanced Research Projects Agency (DARPA) was developing its computer networking protocol TCP (Transmission Control Protocol), which would become TCP/IP (Internet Protocol) in 1978. Further up the US East Coast, Kodak were developing the first handheld digital camera. It still took another decade before the internet was genuinely born, appearing from a squawky modem in your friends’ nerdy brother’s bedroom. Again, it took another few years for the digital camera revolution to really take hold, destroy artisan businesses (yep, sorry Dad) and make a photographer out of anyone. They looked like normal cameras, had auto or manual modes and no film or processing required. With the right software you could make a poor photo look amazing. This was progress. In the time it took to make a cup of tea, I could upload my new camera photos and email them across the world. We now had digital images and a means of connection.

WiFi, cheap storage and smartphones have transformed this ability, bringing speed, amazing photographic capability, convenience, and ubiquity. Your OCT or digital slit lamp can upload and store your hi-res images in the cloud. Patient data can be exported to your EMR, and slit lamp adapters for mobile phone ophthalmic imaging are readily available. Telemedicine with image analysis is actually here. It all seems so easy, but what are the risks?

The risk lies at the foot of the software or platform you are using to send, receive or store your (or rather, your patient’s) data and images. For instance, should you be using a popular messaging app (yes, that one) to capture and send photos? Have you checked its registration as a medical device? Hmm. Are its servers HIPAA compliant? And did you send the patient name with that image? Did you delete the images from your gallery afterwards? Did the recipient? These are questions you should be asking. Your favourite messaging app is encrypted for each chat or group and nothing is stored on the transport servers, but your images will remain in yours and your recipient’s galleries. If those galleries are backed up to the web with any info you’ve included with those images, these apps and services whilst brilliant, weren’t built for medical use. Clearly, I’m painting a grim picture, and it’s one that software and platform providers go to great lengths to avoid featuring in – and right now they want your business.

Apple and Google developer kits allow quick creation and deployment of apps, AWS, Azure, and the larger ophthalmic hardware providers have compliant, device-agnostic platforms ready to store your images. Telemedicine platforms allow you to see your patients from the comfort of home, no mask required. This may be limiting for some examinations, but for follow ups and triage where the patient can securely send you images of their own eye, this is healthcare coming to a lounge near you soon. Now is the time, (almost) post-Corona, to take a serious look at what these systems can do for you and your business.

Perhaps the ophthalmic industry has been slow to adopt fully connected services because with so many standards, ethics and regulations to adhere to, it’s quite an undertaking. There are some truly impressive platforms available and now seems an apt point in time to take advantage of them. Telemed, remote or virtual appointments are going to be part of this new normal (and vocabulary), so let’s embrace the technology that’s taken so long to evolve. And why not consider offering care plans? Subscription-based services are hugely popular already; just sign on the line and have your lenses delivered. It’s not such a big leap to taking the entire appointment at home, but what would that mean for actual physical connection and in turn, the high street? I’ll leave that for another post.

By Gerard Kool