Digital technology and collaboration focus physicians on greatest patient need
As Carl Zeiss Meditec’s James V. (Jim) Mazzo sees it, ophthalmic practitioners must assess each patient’s unique condition and diagnose based on the patient’s greatest needs, which generally fall into three categories.
“Some patients are of stable health while others have conditions that need a referral, perhaps to a retina specialist. Then there are patients who have complex issues needing further diagnosis and understanding. Doctors usually look at diagnostic images with patients and educate them to better understand their specific needs and options for care,” says Mazzo, global president of ZEISS’s ophthalmic devices business unit.
“The challenge is, doctors end up spending sufficient time with all types of patients when limited clinic hours would be better suited if time was spent focusing on the patients they can help the most,” Mazzo adds. He believes technology can help identify the needs of patients prior to meeting with the doctor – which is critical for increasing efficiency and meeting rising patient need.
James V. (Jim) Mazzo
Over the past few years, ZEISS has developed a wide range of technologies that help make the daily ophthalmic practice more efficient by producing, capturing, displaying and, increasingly, organising and analysing data. These include cutting-edge diagnostics, such as the new Swept-Source OCT IOLMaster 700 that measures both anterior and posterior corneal curvature, and the PLEX Elite 9000, which provides a new level of detail of retinal blood vessels.
The ZEISS FORUM workflow software pulls together data from many kinds of devices and EMRs into organised presentations on work stations optimised for glaucoma and retina, and for large and small practices. “Our job is to make sure the physician can arrive at the correct diagnosis using all available data,” Mazzo says.
On the treatment side, FORUM is enabled to forward data to surgical planning modules, such as Veracity for cataract surgery planning and to engage in data transfer with treatment devices, including the OPMI Lumera cataract microscope and the Callisto toric IOL alignment system, and the MEL80 LASIK and VisuMax SMILE® refractive lasers.
To better utilise the data collected by these devices, ZEISS sponsors the Advanced Retina Imaging (A R I) Network, allowing PLEX Elite users to share data and collaborate on new algorithms for interpreting and displaying data. This data has greatly enhanced retinal specialists’ ability to customise how they use the data to identify, assess and treat progression of diseases, such as age-related macular degeneration, as the physician can use the shared information to aid in identifying neovascularisation before it advances to the exudative stage, resulting in closer follow-up and better vision outcomes.
The A R I Network also helps ZEISS engineers accelerate development of imaging technology. A similar collaboration for glaucoma, the Advanced Nerve and Glaucoma Imaging (A N G I) Network, was launched at the 2018 AAO Annual Meeting.
“What does this mean in day-to-day practice? It means ophthalmologists have a much better idea of a patient’s need before they enter the examining room, enabling more efficient handling of cases,” Mazzo says. And when they get to surgery, they can be more confident that their data and calculations are correct, leading to higher efficiency and better outcomes.
Images can help patients see how their disease is progressing so they can better understand and care for their conditions. “ZEISS is the leader in capturing data and providing machines that inform the doctor and that helps patients every step of the way. That’s our focus,” Mazzo says.
“ZEISS is leveraging data to improve ophthalmic practice efficiency and effectiveness, but much more can be done,” Mazzo says. “Home monitoring of patients is one path ZEISS is developing,” he adds.
“We want to eliminate unnecessary visits. Patients no longer need to get in their car, drive to the doctor’s office and sit in the waiting room if a home network can scan images. The patient can stay at home and the doctor can receive these images remotely and analyse the images,” Mazzo said.
Artificial intelligence-aided analysis is another new technology that could greatly improve practice performance. Data from thousands of images from hundreds of patients with similar conditions may help identify new patterns and associations that can generate predictive algorithms. These may help identify patients who are at risk and when they should be called in for additional examination and treatment.
Chaired by Philip Rosenfeld MD, PhD, the A R I Network has developed more than 10 algorithms and currently supports 150 research collaborations across 120 research sites. “The A R I Network has already advanced the understanding of retinal disease progression and changed the way retina specialists follow and treat patients, and design clinical studies,” Dr Rosenfeld says.
“Another critical concern is protecting clinicians and ensuring they are not overwhelmed by the sheer mass of new data,” Mazzo notes. Organising images and facts, such as correlating OCT retinal findings with ongoing treatment, gives clinicians new insight into long-term patterns of progression, helping separate the effects of natural history from treatment effects over years of treatment.
“Such systems will augment, rather than replace, physician judgement,” Mazzo says. “Our job is not to tell the doctor what to do. Our job is to give the doctor the data and the context to make a better decision, helping patients every step of the way.”