Ophthalmology Business

MAR 2014

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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T he foundation is currently fundraising to expand capacity with the goal of screening five to 10 million at-risk people within the next few years, he said. Macular disease Dr. Ianchulev and his team have also developed a web-based Amsler grid-based assessment tool to detect alterations of macular function that might indicate the presence of macular degeneration or diabetic macular edema. This test, similar to the glauco- ma test, presents an Amsler grid at various color and intensity settings, asking subjects if the lines are straight or wavy. The test is also novel in a number of ways—it is not simply an Amsler grid, but an all-around macular function test with grid perimetry, hyperacuity metamorphopsia scanning, and dynamic saturation grid displays. A brief tutorial before the test demon- strates wavy distortions to provide a reference for recognizing the desired endpoint. Neither the glaucoma nor macu- lar tests are meant to be diagnostic. Abnormal test results emailed to the subject simply state that there may be an issue and he or she should follow up promptly with an eyecare provider. For people who have low vision due to macular degeneration or diabetic retinopathy, the iPad may be able to help. "The iPad has 10x image magnification ability," said Shailesh Gupta, MD, University of Florida, Jacksonville. "We conducted a study to evaluate the iPad as a low vision aid in improving the reading ability a s well as quality of life of patients with poor vision." They evaluated 228 patients with best corrected visual acuity <20/200, in whom the median dis- tance acuity was 20/400 and near acuity was N30 (worse than 20/200). Subjects read an article from the New York Times on the iPad and were instructed to magnify the image to a comfortable reading size. "With the assistance of the iPad," said Dr. Gupta, "94% of sub- jects were able to read N8 (approxi- mately 20/50) or smaller text." This was a statistically significant improvement (p<0.01). Likewise, quality of life assessed by the reading ability subscale score on the modi- fied VF-14 improved from 2.0 to 4.4 (p<0.01). "The iPad is an effective low vision aid," Dr. Gupta concluded. Mobile eye exam One key limitation of screening for eye disease is the relative non-porta- bility of the equipment necessary for a comprehensive ophthalmological examination. A free app downloadable to both Apple and Android smartphones is changing this. Called the Eye Handbook, this multifaceted app provides clinicians with the tools necessary to assess near visual acuity, color vision, contrast sensitivity, nystagmus (using a virtual OKN drum), fluorescein staining of the ocular surface (using a blue light for illumination), and fusion (using the Worth 4-dot test), among other tasks. The app provides basic patient education on a host of ocular condi- tions, and also offers representations o f the visual consequences of eye diseases—for instance, it depicts diplopia, metamorphopsia, and floaters from the affected patient's perspective. While this app may be useful for screenings conducted by healthcare providers, there is no built-in inter- pretation platform, rendering it not useful for lay person self-screening. Clinical impact Technology is changing the world, and as evidenced by the tools described above, advances in tech- nology have the potential to change the way we identify people at risk of vision loss and blindness. These applications and web- based services have obvious and direct clinical relevance and preview what can happen in the technology space with minimal investment. From a public health standpoint, investment in screening using tools and concepts like those described above may be more cost effective than developing the next round of me-too drugs or advanced imaging technologies that can spot a single water molecule under the macula or detect the loss of a single nerve fiber layer axon. OB Editors' note: Dr. Ianchulev has financial interests with KeepYourSight Foundation, Transcend Medical (Menlo Park, Calif.), and Tullis Health Investors (Stamford, Conn.). Dr. Gupta has no financial interests related to this article. Contact information Gupta: shailesh.gupta@jax.ufl.edu Ianchulev: tianchul@yahoo.com March 2014 • Ophthalmology Business 7 There's an app (or a website) for that 02-19_OB March 2104_Layout 1 2/19/14 11:07 AM Page 7

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