Issue: June 25, 2020
Source/Disclosures
Disclosures: Melles reports the project has been funded by various nongovernmental grants; patents pending.
June 19, 2020
4 min read
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Portable e-device would allow at-home ophthalmic examination

COVID-19 crisis accelerates research on home-based telehealth technologies.

Issue: June 25, 2020
Source/Disclosures
Disclosures: Melles reports the project has been funded by various nongovernmental grants; patents pending.
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An electronic device that enables patients to perform a slit lamp examination by themselves at home could provide constant monitoring and more frequent data points, optimizing follow-up care, according to one specialist.

“We are selecting the anatomical, functional and subjective parameters to establish a threshold and filter out the ‘normal’ eyes. Deviation from normal data will indicate that the patient needs to come in for a visit. Unlike most other e-devices, which aim at detecting signs of a pathology, our device incorporates as many ophthalmic parameters as possible to detect the normal,” Gerrit Melles, MD, PhD, said in an interview with Ocular Surgery News.

Normal eyes clog the system, he said, meaning that many consultations may be performed to exclude pathology. For example, the vast majority of surgeries today are, fortunately, uneventful, but as a consequence, a corresponding number of postoperative check-ups are done “in vain,” simply because it is considered protocol, he said. If regular monitoring could be done effectively from home by the patients themselves, time, money, travel, health care resources and carbon emissions would be saved, while allowing more time for patients who really need care.

Gerrit Melles, MD, PhD
Gerrit Melles

“Under the present circumstances of COVID-19, we even more understand the value of home-based technologies for patient examination. Many of our patients are older adults who are at a higher risk when attracting the virus. If they could stay at home and have a method for self-imaging, it would be much safer for them, while fewer clinical visits would also be safer for doctors and other health care personnel,” Melles said.

Other potential applications could be for people living or traveling in remote areas, for patients at an intensive care unit, for crew members on ships and even for astronauts in space.

A wealth of data

“The key thing is to incorporate as many ophthalmic parameters as possible and to process them and send them over. Artificial intelligence algorithms would analyze the data, and there is a potential to add systemic parameters as well, such as blood pressure and blood glucose,” Melles said. “As soon as a significant deviation from normal is detected, the software will signal that there is a reason to call the patient.”

If compared with current practice, a further advantage could be the collection of a larger number of data points, that is, more information on how the clinical picture evolves in the time between visits.

“If after surgery you see a patient at 1 month, 3 months and 6 months, you now have three measurements, but in between there may be much more than we know that is happening. Some of this information could give us new insights on how to improve eye care,” Melles said.

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Patients with chronic disease could examine their own eyes every week, every day or, if necessary, every hour, collecting more data than any conventional medical system would ever be able to collect, he said.

Evolving prototypes

The current prototype of this remote slit lamp consists of a goggles-shaped unit that covers the eyes, nose and forehead area from temple to temple and still incorporates a smartphone frontally. However, in the next prototype now in development, the mobile phone will be held separately and plugged in for reading and processing the data.

“There are different types and sizes of mobiles. They change rapidly over time, and having the two units connected rather than incorporated will be far more practical,” Melles said.

Posteriorly, inside the head unit, there is a concave mirror on which the reflected image of the patient’s eye is used as a target for fixation.

“This is to enable patients to self-focus on the device. If you see an image of your own eye, you will instinctively try to focus,” Melles said.

Behind the mirror, a slit lamp camera examines the eye. The current prototype combines visual acuity and slit lamp information, and “we are now testing the unit for the fundus examination and intraocular pressure measurements, which should all be incorporated into the system,” he said.

“We are trying different cameras and comparing the information we get through the portable device with the clinical information we get using the standard technology. In this way, we are progressively improving the system. With visual acuity, for instance, the validation was more difficult than we thought,” Melles said. “From this project, I have learned more about optics than in the past decades.”

The information is then processed by AI smartphone technology.

“Eventually, we want to combine anatomical, functional and subjective parameters and make the system tell us if a specific case falls below the ‘normal’ threshold,” he said.

Clinical trials are currently performed at the Netherlands Institute for Innovative Surgery in Rotterdam, and the next phase will be to give the device to patients to use at home. Prototype design and development are performed by Frank Talke, PhD, and his team of engineers at the Center for Magnetic Recording Research at UC San Diego.

“Home-based systems, telehealth and AI may have a role to play in ophthalmology medicine, and the current COVID-19 crisis could be accelerating this transformation,” Melles said. “These new e-technologies and digital solutions may still be in their infancy, and from what I have seen today with using a prototype e-device, one might foresee an amazing, progressive growth in the next 10 years.”

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