Eyeworld

P RACTICE MANAGEMENT 128 | EYEWORLD | DECEMBER 2020 by Liz Hillman Editorial Co-Director About the sources Ranya Habash, MD Medical Director of Technology Innovation Bascom Palmer Eye Institute Miami, Florida Michael Singer, MD Director of Clinical Research Medical Center Ophthalmology Associates San Antonio, Texas Michael Freeman, JD Founder and CEO Ocutrx Irvine, California Relevant disclosures Habash: Microsoft Singer: Verana Health Freeman: Ocutrx began hybrid visits and drive-thru IOP checks, there is still the need for truly remote moni- toring. iCare HOME (iCare) is one option that Dr. Habash mentioned, which performs hand- held tonometry and is covered by insurance as a remote monitoring device. Dr. Habash also brought up Injectsense, which is creating an injectable smart sensor that can continuously monitor IOP. It recently received an FDA Break- through Device Program designation. "I think this is really exciting. … This is a missing piece of the puzzle," she said. Triggerfish (Sensimed) has been approved since 2016, but it has been used more for re- search purposes rather than being adopted for the wider patient base. With remote monitoring devices like these, Dr. Habash said, physicians can access a pa- tient's data without the necessity of an in-per- son exam. Physicians get reimbursement for monitoring the data/alerts sent from the device and another fee for discussion held with the patient to go over results. This is a monthly reoccurring payment. Another simple monitoring tool Dr. Habash uses is an Amsler grid. She screenshares an Amsler grid from her phone or computer during telehealth visits with patients, so patients don't need to download an app. She also mentioned ForeseeHome (Notal Vision), an AMD home monitoring program that sends an alert to doc- tors if the patient shows a statistically signifi- cant difference in a digital tracing. "It's a more subtle way to look for changes in the Amsler grid, with a connected device using Internet of Things (IoT) alerting," Dr. Habash said. Remote visual field testing is another tool Dr. Habash thinks will be adopted as a result of the telemedicine push. Several companies are working on technology for this. One challenge practices have been discussing is how to keep the in-office visual field machine clean. "If the visual field test can be taken on a wearable device like the Microsoft HoloLens or any virtual reality headset, sanitizing becomes much simpler, and you don't have to worry about masks causing an inferior visual field defect," Dr. Habash said. Pandemic pushes remote monitoring and testing T he COVID-19 pandemic and the early shutdown of non-essential medical vis- its propelled innovation on the front of home monitoring, diagnostics, and treatment. Some systems are available now, some in the works, and some still on oph- thalmologists' wish list. Though in-person clinic visits returned to "normal" several months ago, Ranya Habash, MD, said in September that telehealth visits still comprise almost 30% of the practice at Bascom Palmer Eye Institute. For many around the coun- try, telehealth in some capacity is also here to stay even post-pandemic. As MarketScope put it in a July article announcing its 2020 Diagnostic Equipment Market Report: Increasing demand for telehealth and mobile applications due to the COVID-19 pandemic has led manufacturers to scramble to add functionality and accessibility to existing devices and protection apparatuses or create new devices. Regulatory bodies and reimbursement organizations have relaxed rules to enable lower barriers for practices implementing these products and services, giving a rare path forward to a telehealth business model that struggled to find its footing in the past. Historically, the ophthalmic diagnostic equipment market has been one of the most dynamic spaces within ophthalmology, with several new devices and features added every year. This was never more true than during the early stages of the pandemic, as physi- cians struggled to manage chronic patients while many countries were in various states of lockdown. "People have found that telehealth makes sense. It will only grow with further advances in digital health technology," Dr. Habash said. For telemedicine to become even more successful in the very image-reliant specialty of ophthalmology, there are technologies needed to expand this option. Regular IOP monitoring is one of the most obvious examples. Even though glaucoma services pivoted during the shutdown and many

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