Eyeworld

EW FEATURE 45 EyeWorld looks at how innovations in software technology have changed the profession "S oftware is eating the world," Netscape co- founder Marc Andreessen wrote in an essay published in The Wall Street Journal in August. He was refer- ring to how software has been trans- forming major industries from books to music to recruiting—think Amazon, iTunes, and LinkedIn. Software is in everything, from the exploration of oil and gas that fuels our cars and homes, to the navigation functions in our vehicles, to our everyday financial transac- tions in stores. In Mr. Andreessen's view, healthcare and education are "next up for fundamental software- based transformation." Indeed, in ophthalmology, it is clear that a software revolution has taken root. Software is not only re- sponsible for the vastly improved functionality of technology from di- agnostics to treatment to treatment monitoring, it has also changed the way ophthalmologists interact with each other, learn from each other, and how they communicate with patients. Driven by software "More and more of what we do is driven by computers. More of it is integrated such that we have tests that give us input on how to address a specific problem, and we didn't use to have that," said Stephen G. Slade, M.D., director, Laser Center of Houston. He continued, "Now we have much better ways to measure aberra- tions and treat them, measure to- pography of the cornea and treat it, measure astigmatism and treat it, and determine exactly what intraoc- ular lens to put in." Describing the sophistication of today's software-based technology, Stephen S. Lane, M.D., clinical pro- fessor of ophthalmology, University of Minnesota, Minneapolis, said that IOL power calculation is not neces- sarily only based on the physical measurements in the eye, but also on past results in patients with similar measurements and what results were achieved with a certain power lens. "Today's technology can suggest a treatment, it can guide and moni- tor the treatment, and then it can track results," Dr. Slade said. Software has also provided sur- geons with customization capabili- ties, said Mark J. Forchette, president and CEO, OptiMedica, Santa Clara, Calif. "We see it in phaco systems with custom parameter settings that physicians can work with, and they can make the system really efficient and usable," he said. Cataract surgeons are not the only ones noticing software's influ- ence in their practice. Glaucoma ex- pert Nathan M. Radcliffe, M.D., assistant professor of ophthalmol- ogy, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, said software solutions are providing a lot of new value in a way that's backward compatible. He explained, "Backward com- patibility is the method of taking old data that was collected 5 or even 10 years ago and being able to use it in a meaningful manner today." A problem highlighted by the development of the Fourier domain optical coherence tomography (OCT) is the fact that all of the OCT data previously collected by a time domain system would now be basi- cally useless, he said. The Humphrey visual field analysis package (Carl Zeiss Meditec, Dublin, Calif.) has made data col- lected years before available and available for very powerful analyses, Dr. Radcliffe said. Carl Zeiss Meditec has continu- ally upgraded its software without any changes to the hardware perimeter and because of this, physi- cians can now perform a trend-based analysis of visual field performance over time. They can determine not just whether their glaucoma patients are progressing, but the rate at which they're progressing, he said. The development of new tools for analyzing fundus photographs has also been great for his practice, Dr. Radcliffe said. Instead of deter- mining a patient's stability by com- paring photos taken today to photos taken 5 years ago in a traditional side-by-side manner, new software systems automatically align photos taken several years apart and allow practitioners to flip back and forth between the photos; the human brain is able to detect very small February 2011 November 2011 Innovation in ophthalmology by Enette Ngoei EyeWorld Contributing Editor The software revolution in ophthalmology OptiMedica's Catalys Precision Laser System for cataract surgery Source: OptiMedica AT A GLANCE • Software is not only responsible for the vastly improved functionality of technology from diagnostics to treatment to treatment monitoring, but has also changed the way ophthalmologists are interacting with each other, learning from each other, and how they communicate with patients • More and more of what we do is driven by computers. More of it is integrated such that we have tests that give us input on how to address a specific problem, and we didn't use to have that • The [new fundus photography analysis] programs not only enhance the ability to detect glaucoma, but their low cost means this type of analysis could be applied in third-world countries • Doctors will have a clearer under- standing of how the patients are doing, and they are going to do better surgery because of the refinement that will be possible with this software continued on page 46

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