EyeWorld Asia-Pacific September 2020 Issue

SECONDARY FEATURE 20 EWAP SEPTEMBER 2020 Digital Ophthalmology in COVID-19 by Wong Tien Yin Contact information Wong: wong.tien.yin@singhealth.com.sg T he coronavirus disease 2019 (COVID-19) pandemic that began at the end of December 2019 has now infected over 15 million individuals and killed more than 150,000 by the end of July 2020. This has presented an unprecedented need to harness digital health technology to support healthcare efforts to contain, detect, and mitigate the effects of COVID-19. As countries started and then exited from extensive “lockdowns” to “flatten the curve,” the “reopening” phase has to be conducted with appropriate balance of providing care while balance patient and public health safety, with new infection control and safe distancing measures that was previously not needed prior to COVID-19. This has created an opportunity for digital transformation in many industries, with remote work and continued provision of services while minimizing human contact. Ophthalmology has not been spared of these major disruptive changes. The traditional face- to-face patient-ophthalmologist care model has to be re- examined and ophthalmology has adapted to incorporate a range of digital technology to develop new eye care models. Current state of digital ophthalmology What are the core digital technologies for ophthalmology? Two synergistic and interrelated technologies have been increasingly applied in ophthalmology: telehealth (tele-ophthalmology) and artificial intelligence (AI). Other emerging digital technology platforms, as such the internet of things (IoT) and the use of next generation networks (e.g. 5G) and blockchain, have not been as widely used in ophthalmology, but are likely to gain traction in application over time. Tele-ophthalmology and AI have already been used in some forms in pre-COVID-19 “normal healthcare.” In general, these technologies have struggled to generate sustained adoption beyond research studies and pilot demonstration projects. 1 COVID-19 has now forced healthcare systems to rapidly synergize, scale and expand the applications of these digital technologies. Tele-ophthalmology and AI Tele-ophthalmology increases the availability of specialized ophthalmology expertise and access to care remotely. The classic example is tele-screening for diabetic retinopathy (DR) based on fundus photography and, to a lesser extent, tele- consultation with remote consultation between patient and ophthalmologist using video conferencing and supportive imaging tests (e.g., OCT). There are also innovations such as patient self-assessment with home OCT and other imaging devices, as well as mobile apps, for monitoring and early detection of visual impairment and major eye diseases. 2 AI can be used for DR screening and in other areas of ocular imaging including OCT. 3 AI has shown significant promise with some robust data from Telehealth AI Big data loT 5G networks Blockchain Figure 1. Synergies of various digital health technology domains that can be applied in a complementary manner. Wong Tien Yin MBBS, MMED (Ophth), MPH, PHD, FRCSE, FRANZCO, FAMS Vice Dean, Academic & Clinical Development, Duke-NUS Medical School Provost’s Chair Professor, National University of Singapore Deputy Group Chief Executive Officer (Research and Education), SingHealth Medical Director & Senior Consultant Ophthalmologist, Singapore National Eye Centre Chairman, Board of Directors, Singapore Eye Research Institute