EyeWorld India March 2012 Issue

57 EW NEWS & OPINION March 2012 The software revolution in ophthalmology EyeWorld looks at how innovations in software technology have changed the profession “ S oftware is eating the world,” Netscape co- founder Marc Andreessen wrote in an essay published in the Wall Street Journal in August 2010. He was referring to how software has been transforming major industries from books to music to recruiting—think Amazon, iTunes, and LinkedIn. Software is in everything, from the exploration of oil and gas that fuels our cars and homes, to the navigation functions in our vehicles, to our everyday financial transactions in stores. In Mr. Andreessen’s view, healthcare and education are “next up for fundamental software-based transformation”. Indeed, in ophthalmology, it is clear that a software revolution has taken root. Software is not only responsible for the vastly improved functionality of technology from diagnostics to treatment to treatment monitoring, it has also changed the way ophthalmologists interact with each other, learn from each other, and how they communicate with patients. Driven by software “More and more of what we do is driven by computers,” said Stephen G. Slade, MD, director, Laser Center of Houston, Texas, USA. “More of it is integrated such that we have tests that give us input on how to address a specific problem, and we didn’t use to have that.” He continued: “Now we have much better ways to measure aberrations and treat them, measure topography of the cornea and treat it, measure astigmatism and treat it, and determine exactly what intraocular lens to put in.” Describing the sophistication of today’s software-based technology, Stephen S. Lane, MD, clinical professor of ophthalmology, University of Minnesota, Minneapolis, Minn., USA, said that IOL power calculation is not necessarily only based on the physical measurements in the eye, but also on past results in patients with similar measurements and what results were achieved with a certain power lens. “Today’s technology can suggest a treatment, it can guide and monitor the treatment, and then it can track results,” Dr. Slade said. Software has also provided surgeons with customization capabilities, said Mark J. Forchette, president and CEO, OptiMedica, Santa Clara, Calif., USA. “We see it in phaco systems with custom parameter settings that physicians can work with, and they can make the system really efficient and usable,” he said. Cataract surgeons are not the only ones noticing software’s influence in their practice. Glaucoma expert Nathan M. Radcliffe, MD, assistant professor of ophthalmology, Weill Cornell Medical College, New York- Presbyterian Hospital, New York, NY, USA, said software solutions are providing a lot of new value in a way that’s backward compatible. He explained: “Backward compatibility is the method of taking old data that was collected 5 or even 10 years ago and being able to use it in a meaningful manner today.” A problem highlighted by the development of the Fourier domain optical coherence tomography (OCT) is the fact that all of the OCT data previously collected by a time domain system would now be basically useless, he said. The Humphrey visual fields analysis package (Carl Zeiss Meditec, Dublin, Calif., USA) has made data collected years before available and available for very powerful analyses, Dr. Radcliffe said. Carl Zeiss Meditec has continually upgraded its software without any changes to the hardware perimeter and, because of this, physicians can now perform a trend-based analysis of visual field performance over time. They can determine not just whether their glaucoma patients are progressing, but the rate at which they’re progressing, he said. The development of new tools for analyzing fundus photographs has also been great for his practice, Dr. Radcliffe said. Instead of determining a patient’s stability by comparing photos taken today to photos taken 5 years ago in a traditional side-by-side manner, new software systems automatically align photos taken several years apart and allow practitioners to flip back and forth between the photos; the human brain is able to detect very small amounts of change in the process, Dr. Radcliffe said. The programs not only enhance the ability to detect glaucoma, but their low cost means this type of analysis could be applied in third- world countries, Dr. Radcliffe said. From an industry perspective, Mr. Forchette said, “Physicians’ expectations of systems have become higher. One of the things that we think about is physicians don’t live in an ophthalmic vacuum, they interact with software that is good and software that is bad in every aspect of their lives, such as their automobiles, stereos, and home air-conditioning systems. Everything now has a software element so they recognize things that work well for them and things they like, and all of that gets transferred to their expectation of surgical systems.” He continued, “We need to not only be a great provider of simplicity in the way software works in ophthalmology, but it needs to also stand up to the expectations that are driven by experiences elsewhere.” Everything is digitized Perhaps one area where software has had a more disruptive effect in ophthalmology is with EMR. “We have changed our entire way of record-keeping over the past 3 years and are still adapting to patient flow issues and how the record-keeping influences how we take care of patients,” said John A. Vukich, MD, surgical director, Davis Duehr Dean Center for Refractive Surgery, Madison, Wis., USA. Many who are using it can see the value of it in terms of not having lost charts and being able to call up data. Other specialties are able to do spreadsheet-like processing of linear records of pressures over time or look at visual acuities in a snapshot that gives progression of loss or improvement over time, he said. The issue with most databases and software is that they need to be managed in order to get valuable output, one has to put energy into providing the right informational data, and that’s the part that has impacted his practice in a demonstrable way. Software has also changed the way physicians interact with each other and with patients. Personalized doctor apps on smartphones allow physicians to OptiMedica’s Catalys Precision Laser System for cataract surgery Source: OptiMedica by Enette Ngoei EyeWorld Contributing Editor continued on page 58