A couple of weeks ago I got the chance to visit Las Vegas to attend the Annual Conference of the American Academy of Ophthalmology (the “Eye MD Association”) a huge event that gathered 18,000 industry Professionals from around the world (a 12% increase over last year).

Here’s a quick round up of some of the interesting mHealth related developments I picked up on during my visit to the conference sessions, 300+ scientific papers and 500+ exhibitors:

My personal ‘star of the show’

The highlight for me was a paper titled “Phoneography and Teleconsultation Training in the Deployed Environment” presented by Dennis J Curtis OD MAJ from Womack Army Medical Centre and Erin S Seefeldt MD MAJ from Madigan Army Medical Centre (who was on hand to answer my odd questions and share some incredible insights into the project):

Essentially an Ophthalmologist & Optometrist team employed by the US Military are teaching Primary Care Physicians and Nurses who are working in remote and isolated military bases across the Middle East on how to conduct a quality external eye exam and record it with their smartphone for remote evaluation.

This is similar to how my Veterinarian friends have been working for years and I really hope that the military publishing details of the success of this program will help drive wider awareness of the potential because whenever talking with the leading eye clinics they all moan on about security issues (the military also has these) and the cost to them of the low quality of the Patient referrals that they’re sent by GPs because there is not just a lack of skill/knowledge in Primary Care centres but because everyone feels pressure to just make an emergency referral as they can’t afford to take any chance because of the medicolegal implications.

The US Military has shown that you can safely use the smartphones we all have in our pockets to put the expertise of Consultant Ophthalmologists into Primary Care centres in war effected regions. Government healthcare providers and Ophthalmology referral centres should be doing everything they can to set up such specialist services like this to support their front line Primary Care Professionals.

When trying to coach innovation to executives at big organisations it’s a cliche to challenge them to try and think ‘what would you sell if you could no longer sell <BLANK>?’ where the blank is whatever happens to be the best selling/most profitable product that their company produces. Perhaps for Healthcare Organisations we need coaches to challenge them to ask ‘How would the Military do this?’.

Scientific Paper Highlights

The ‘Delay in the diagnosis of Retinoblastoma revisited in the UK’ paper from the Moorfield Eye Hospital in London was very interesting as it in many ways charts how advances in the quality of camera phones and the adoption of social media are in effect upscaling Parents capacity to notice Leukocora – by as much as 50%!

A closer look at the table there showing that Emergency Room referral is almost as common as  GP referral reveals the increased need for us to do everything we can to up-skill and make NHS GPs more accessible. I wonder how the data would compare with what’s being seen in Dublin’s Royal Victoria Eye & Ear Hospital as perhaps this has been skewed by the increasing GP waiting times and diminishing consult times offered in the NHS?

Medical tech futurists have got great media mileage out of talking up how the stethoscope is being replaced by GE’s V-Scan handheld/pocketable ultrasound devices but this paper by the Department of Ophthalmology at the Byers Eye institute at Stanford University School of Medicine found that a mobile app can not only enable visual acuity tests to be self administered (saving time for Emergency Department staff) but they can offer an accurate representation of the visual acuity recorded and used by ophthalmologists in emergent ophthalmologic care.

If you’re unfamiliar with the how we traditionally measure Visual Acuity with a Snellen Chart watch this video as it will give you a feel for the sort of complexity that a Emergency Room Nurse or Doctor faces every time they need to run this test with immovable walls and never ending time constraints and pressure to process more Patients with less resources:

Exhibition Floor highlights

I noticed Welch Allyn generated the most buzz on the Exhibition Floor with their new iExaminer accessory for the iPhone 6S Plus. The iExaminer accessory/app makes an interesting medical device mHealth case study as it comes from a market leader founded in 1915 (it’s now part of the $1.5B/year HillRom group) that employs 2,5000 staff. The £50 selling price means the sales margins are incredibly low on the iExaminer Adapter (the cradle accessory that you need to attach to a Welch Allyn PanOptic before it will work with your iPhone) and lack of revenue has no doubt been behind the slow pace of evolution (the device is still only compatible with the old iPhone 4 and 4S models). On the upside for Ophthalmologists this means they can leave their old iPhone in the device and don’t need to be swapping in and out the personal phone they carry when working.

For medical device companies looking for a northern light a good company to emulate is Alivecor (who have shown how to evolve a mHealth device while staying compatible with the rapidly evolving mobile phone market). Hopefully the new iPhone 6 Plus case will be on the market before the year is out (a very nice mHealthy way for Welch Allyn to mark their 100 years in business!) and I can’t see anyone wanting to replace that powerful big retina screened 12 megapixel package in a hurry!

The booth of the Hangzhou Mocular Medical Technology company from China also had a calculator that will have used up it’s batteries as delegates were striking deals in a frenzy while I was there picking up a couple of samples to trial.

Their business was focused on providing Ophthalmologists with a low cost mobile phone based way to update their analogue slit lamps.

It was noticeably a lot busier than the booths that were selling Digital Slit Lamps and not hard to see why with most delegates I saw already wielding an iPhone 6 and presumably having a reliable analogue slit lamp that it could be used to upgrade.

San Francisco based DigiSight Technologies were demoing their Paxos Checkup (that replaces their successful SightBook app) and Paxos Scope Apps. The Checkup app offers Patients access to vision tests on their mobile phone and enables them to share the results of these (via the secure DigiSight Network platform) with their Ophthalmology team. In an UCLA study published last year in the Journal of Diabetes Science and Technology the SightBook app was shown to be popular with Patients at risk of diabetic retinopathy and this is an area I think that lots of Diabetes Apps will need to partner with DigiSight to expand into.

On the main stage they also launched their new universally designed ‘Paxos Scope’ smartphone accessory with a focus on remote low resource care environments and partnerships with the American Society of Cataract and Refractive Surgery and the Himalayan Cataract Project to deploy the technology/services in Nepal.

 

Google Glass

Google should’ve sent their Google Glass team (I checked and there was no one from Google registered as an attendee!) as there were some really smart Ophthalmologists showcasing tech that they should be thinking about (if not incorporating).

This “Assessment of the Kinematic Features of Spontaneous Blinks in Patients with Parkinson Disease” paper helps you imagine the potential for neurological disease/medication monitoring/Clinical Research applications that could open up if the next edition of Google Glass had an upgraded camera pointing at the wearers eye.

Stopping to read about UCL’s work with the Argus II retinal prosthesis System was interesting as I’ve heard a lot of technologists suggesting that there’s scope to use Smart Glasses with such a system. The published researcher I talked with was of the feeling that the resolution on the brain electrode cluster is in need of attention before there will be positive progress made in this direction.

“A novel compact wireless high resolution eye and head tracking technique” shared info on the opportunity that opens up when you can spectacle frame mount a low cost compact non-contact high resolution eye tracker to aid diagnosis and follow up of ocular movement disorders. This tech had been lifted straight out of a desktop mouse casing!

There’s huge potential using smart glasses to add superhuman senses and there are few people who can benefit from this as much as surgeons. I can’t wait to see custom loupes integrated with advanced capabilities like video recording, InfraRed cameras, etc. A company to watch in this space is Designs for Vision:

Had some interesting conversations with delegates by the booth of the Ophthalmic Photographers Society that have started to get me thinking in a completely different way about cameras…

Diabetes

I learnt a lot from the booth of Retinal Screenings who are behind a program to boost Diabetic Eye Exams in Primary Care. Be sure to visit their website for more.

There were also some interesting papers that relate to the new Diabetes module that I’m launching next week at the mHealth Symposium I’m running at the International Diabetes Federation’s World Diabetes Congress in Vancouver.

Smartphone based Tele-ophthalmology screening for diabetic eye disease was a very interesting proof of concept:

A Medical University of Vienna paper reported on the correlation of retinal neurodegeneration measures and early signs of retinal and systemic neurodegeneration in diabetes.

A paper reporting on the effectiveness of telemedicine for identifying diabetic retinopathy cases compared the effectiveness in identifying diabetic retinopathy through referral using telemedicine based retinal imaging in Diabetes Centres with that of the conventional referral system in which every diabetic Patient at risk is referred for eye exams ad concluded that targeted referral using telemedicine was more effective.

It was interesting finding that body weight loss may be a risk factor for Glaucomatous Disease (something that will become a lot more interesting as ocular perfusion pressure becomes easier to add to Primary Care/Pharmacy screening programmes):

Social Media and Ophthalmologists 

The only medical profession that I know getting as much love from their clients are the best small animal Veterinarians but I couldn’t help but see a lot of missed opportunities that the AAO had to help build awareness of the profession. When you consider the benefits of this for the health of society (eg. more powerful public health messaging and increased awareness of eye health) it feels like a great shame not to be capitalising on this.

A short film maker could’ve made an incredible video that would’ve gone viral around the world if they were just stood by this social media wall with a camera to record the story/background to some of the powerful scrawled quotes I read on there. I hope the AAO retain these boards perhaps in their offices?

I also see social media being really important for the recruitment of quality Doctors into the field. Ophthalmology wasn’t even on my radar at Med School but I can imagine initiatives like the AAO Young Ophthalmologist (AAOYO) program will help greatly with this. The content was interesting and quite fun so it was a bit odd that the audience was so reserved (delegates were mostly sat around the back of the room and were slow to volunteer to answer questions etc).

Technology

I was quite disappointed with the poor turn out for the Technology Pavilion and I hope that the AAO will find partners that they can collaborate with to fill the obvious skills gap eg. along the lines of the effort we’re doing with the IDF for their World Diabetes Congress next week in Vancouver.

There’s enormous scope to build on the tech pavilion and make it more interesting to delegates.

It felt to me that the majority of the delegates tech interest seemed to currently be limited to just getting their clinic website up and search engine optimised:

Which was a bit disappointing as although it’s clearly key to business there’s so much that can be done with Patient education and from making proactive investments in social media eg. I wish I had applied to provide an intro to mHealth talk covering ways to use your mobile safely, getting started with social media, etc, etc.

I think the AAO also need to focus on modernisation of their own processes. Fresh from the Dublin WebSummit the opportunities were very obvious to me but I also noticed it was a minority of the delegates who could be seen lugging about both of these giant paper weights.

The upside of just committing to invest in the event app instead of these immediately-out-of-date tombs should be easy to envision when you have a conference centre with free high speed wifi and so many of the keynote speakers were taking the effort to tailor their talks based on realtime audience feedback eg. could you imagine how much easier it would’ve been to offer interactivity like this and even drilling down into the data after sessions are finished etc.

Perhaps the AAO should reach out to the gifting team at Apple – an AOO branded iPad would be a nice thing to receive and it could feature AAO donation app, exclusive member directory/networking, IT training, educational content, etc. If the Times newspaper can do it for a £5/week it can’t be beyond the reach of an organisation charging member subscription rates of $925/year (which is reasonable compared to what a GP here in Europe pays for the membership of RCGP etc).

A great take away message from David W Park II MD, CEO of the AAO, on the need for a strategic rebranding of the American Academy of Ophthalmology in order to bring a greater focus to its mission:

“Think of the value associated with the Apple Logo and the emotional response it engenders. That’s the impact we’re trying to achieve for your academy and on behalf of our Profession…   …protecting sight, empowering lives“.

Did you notice anything mHealth related that I missed?