Technology has and will continue to have a key role in ophthalmic screening, according to Bobeck S. Modjtahedi, MD, in his talk at the Saturday symposium, “Using Technology to Solve the Biggest Problems in Ophthalmology” (Sym04).
Screening helps reduce vision loss, but barriers remain. While screening is critical for reducing the risk of vision loss associated with many ophthalmic conditions, including diabetic retinopathy (DR), glaucoma, and hydroxychloroquine (HCQ) toxicity, many clinicians don’t understand the importance of screening and screening guidelines. Other barriers include socioeconomic factors and lack of access to appointments.
Computerized screenings in children can lead to too many astigmatism referrals. While many schools and offices use the American Association for Pediatric Ophthalmology and Strabismus vision screening kits, others have been using computer- and app-based vision screening tests. The latter methods provide very fast results but also lead to overreferrals for nonamblyopic, symmetric astigmatism.
Automated DR reading improves detection. To improve DR detection, the DR screening system is now fully automated in the Kaiser Permanente system, where Dr. Modjtahedi practices and which treats 470,000 patients with diabetes each year. A centralized reading center model, involving fundus photos taken in local offices and reviewed by different physicians, has improved DR detection rates from 10.1% to 22.6%.
Alerts smooth the DR screening process. Kaiser patients’ medical records are regularly flagged if they have not had a DR screening within a certain time period. Images can be taken in the office even when the patient’s visit is for a different issue.
Automated HCQ toxicity referrals and follow-up visits can improve patient care. Often, patients who may have HCQ toxicity are underscreened. Automated referrals can help identify patients who are eligible for screening, and electronic communications and outreach programs can improve follow-up rates for patients with abnormal test results.
Technology will play a large role in ophthalmology screening. Dr. Modjtahedi concluded the presentation by saying, “Technology can play a central role in improving each step of ophthalmology screening,” and he identified patient-facing apps and improved risk-stratification models as potential areas for growth.
—Stephanie Leveene, ELS
Financial disclosures: Dr. Modjtahedi: Genentech: S; VoxelCloud: S.
Disclosure key: C = Consultant/Advisor; E = Employee; EE = Employee, executive role; EO = Owner of company; I = Independent contractor; L = Lecture fees/Speakers bureau; P = Patents/Royalty; PS = Equity/Stock holder, private corporation; S = Grant support; SO = Stock options, public or private corporation; US = Equity/Stock holder, public corporation For definitions of each category, see aao.org/eyenet/disclosures.
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