APTOS-APOIS Updates: At-Home

APTOS-APOIS Updates

At-Home Monitoring and Patient-Centered AI by Sam McCommon

Nobody looks forward to a crisis. The turmoil, instability and anxiety experienced while living through one makes them, well, let’s just say “un-fun.”

But history has shown that crises inevitably birth societal advances, often technologically. The long-running crisis of the Comanche Wars in Texas popularized Samuel Colt’s revolver, and led to the much-romanticized vision of the gunslinging Wild West. The First World War drastically accelerated the development of avionics, automobiles and factory efficiency; the Second World War resulted in jet engines, rockets, space programs and nuclear physics. That these advances stemmed from mass human suffering is perhaps one of the greatest paradoxes of our species.

The COVID-19 crisis we’ve been going through for the last year, as of this writing, is fortunately nowhere near the magnitude as those mentioned above. But it’s profoundly accelerated extant trends — and there have been few buzzwords more popular in the medical world than telemedicine.

That’s a good thing, really, but it’s not entirely understood yet. To help understand it, the Asia-Pacific Teleophthalmology Society (APTOS) regularly holds webinars to discuss advances in telemedicine, featuring true leaders in the field. Their most recent webinar (an APTOS-APOIS joint event) centered around advances in at-home monitoring and artificial intelligence (AI) solutions.

We don’t have a crystal ball, but we feel comfortable guessing that the advances currently taking place are here to stay. Though their development seems inevitable, it may well have taken much longer sans pandemic to kick that development into high gear. There’s that old cliché about necessity being the mother of invention — and so far, no one has seen fit to disprove it.

At home diabetic r e t inopat hy , glaucoma and visu a l acu ity tes t in g are the way of the future.

At-home monitoring solutions: Tech tools to test

Professor Gavin Tan is a senior consultant at the Retina Center at Singapore National Eye Centre (SNEC) and plays a crucial role in the SNEC Ocular Reading Center as well, which provides image grading for Singapore’s national diabetic screening program.

As Dr. Tan pointed out, telemedicine isn’t a new concept at all — we’re just getting better at it. It’s not even a disruptive process, either, as it follows essentially the same pattern physicians are used to: collect patient data, interpret the data, and then provide care for the patient.

Newer, better imaging tools developed over the last couple of decades make certain home screening processes truly viable for the first time, and allow much greater efficiency in clinics. It’s currently best suited for diabetic retinopathy. Remote imaging sent to an asynchronous grader to later be assessed by an ophthalmologist saves time, reduces office crowding, and

can even prevent unnecessary visits altogether.

Remote imaging isn’t the best way forward in all cases, of course. Dr. Tan pointed out that he finds it to be most useful in more stable patients, as well as in those who don’t require injections. At least for now, anti-VEGF patients, for example, still have to be within arm’s reach.

When comparing athome ultrawide field OCT imaging with traditional slit lamp examinations, Dr.

Tan noticed very little difference. At-home imaging techniques were also used for glaucoma, which were then sent to ophthalmologists — after which medications were mailed directly to the patient. No visits needed.

One major upside Dr. Tan noted is that patient satisfaction with this program was upward of 90%. Furthermore, physicians who might traditionally see 20 patients in an afternoon could “see” nearly three times that many by examining remote images.

Dr. Tan is also piloting a new at-home visual acuity (VA) self-check app for patients to use. The app encourages a patient to get the image as stable as possible, but even then there can be mistakes. Odds are these kinks will be worked out in the near future.

One neat upshot from these athome checking apps is when they’re more fully developed, they’ll be able to seamlessly integrate with electronic medical records. Eventually, patients may be able to do a thorough at-home VA test. We’re not quite there yet, but with the blistering pace technology moves, it may be soon.

Patient-centered AI

The second speaker is a true heavyhitter: Dr. Michael D. Abramoff from the University of Iowa and founder of Digital Diagnostics. Digital Diagnostics was the first company in any field of medicine to get FDA approval for autonomous AI diagnostic tools. Just for reference, Dr. Abramoff holds 17 patents and has 31,000 medical citations under his belt. So, when he speaks, we listen.

Autonomous AI diagnostics for diabetic retinopathy (DR) are here already — they’re not science fiction. They were approved by the FDA in 2018 and, since then in the United States, check-up points can be found in grocery stores and other diabetic point-of-care locations. Just recently, Medicare has begun to cover these checkups at a rate of around $55. That’s a huge step forward.

Autonomous AI means there’s no human oversight, which means lightning-quick diagnoses as well as easy integration with electronic medical records and automated billing. But it also means that legal liability falls on the creator of the AI. As opposed to assistive AI, which is merely a tool assisting a clinician, autonomous AI requires no human oversight.

Making algorithms that can detect DR are fairly straightforward, noted Dr. Abramoff. What’s difficult is implementing them. For example, it took eight years for their AI to clear FDA approval. In addition to that, there are lots of other questions to answer — to the point where you’re almost entering sci-fi visionary Isaac Asimov’s territory.

For one thing, Dr. Abramoff wanted to prevent a potential backlash against AI, so had to deeply consider the ethics behind its use — in terms of data, bias, patient understanding and more. He specifically cited “inappropriate” gene therapy in the early 2000’s which cost lives and set the field back decades — as well as the multibillion dollar scandal of Theranos — as events that make people wary of tech in medicine. He’s got a point.

So, rather than disrupting the industry with AI like, say, Uber did to taxis, his company decided to work within the existing medical framework and focus strongly on ethics. For now, he cites three main ethical focuses for his AI: Do no harm, maintain patient autonomy and maintain justice.

That’s a good start, and we’re very glad someone with a solid ethical founding is leading the charge in medical AI. Nobody wants Skynet in their future.

Would a robot gunslinger have ethics in its programming?

Editor’s Note:

The joint Asia-Pacific Teleophthalmology Society-AsiaPacific Ocular Imaging Society (APTOS-APOIS) webinar was streamed live on February 19. Reporting for this story took place during the event.