Technology and artificial intelligence could significantly increase access to glaucoma care.
Image credit: Dmitrii Kotin – adobe.stock.com
Advances in mobile technology and artificial intelligence (AI) have opened the door to providing ophthalmology care to ever-growing patient populations, including those in underserved or vulnerable populations, according to a session at the annual meeting of the American Academy of Ophthalmology in 2024, held in Chicago.
The focus of the session, which was co-sponsored by Prevent Blindness, was on glaucoma, given its easily undetected nature and potential to cause blindness. Eve J. Higginbotham, MD, of the University of Pennsylvania, noted that there is an urgent need to address barriers to accessing glaucoma care, both nationally and internationally. The discussion highlighted the expected increase in the number of visual impairments, especially in areas with limited resources.
“Even if you have access, even if you have insurance, disparities persist,” Higginbotham said. “Income inequality is actually related to the degree of visual impairment you see by state, as well as health literacy, distance to an eye care provider, and whether or not there is an eye care provider within a facility that you can access.”
The presentation underscored the importance of increasing the medical workforce to meet rising demand, at a time when a significant shortage of eye care professionals is expected. To this end, technology could play a crucial role in overcoming this challenge in healthcare delivery. Emerging technologies, such as telemedicine and improved patient triage systems, were highlighted as essential tools to expand access to glaucoma care.
“Technology as a tool to expand access… patient triage can be improved, we can do more telemedicine, and both methods of accessing visual acuity, visual field and intraocular pressure,” Higginbotham said. “Going forward, multiple factors are needed to address the workforce shortages we predict.”
In her presentation, Lisa Hark, PhD, of Columbia University, highlighted findings from the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT), funded by the CDC, as a way to improve the detection and management of glaucoma in underserved communities of New Zealand to radically change. York city. The study, officially launched in 2021 due to a COVID-19 delay, focused on improving access to eye care by incorporating telemedicine and community engagement directly into housing developments, significantly increasing participation among residents.
“We’re bringing eye care to where people live, not in their apartments, but in the common areas in the buildings,” Hark said. “We are improving access to eye care and its use. The consensus was that poor follow-up after eye exams was a major problem, and we wanted to address this need by bringing eye care into the community where people live.”
The study findings showed that 78% of participants failed these initial screenings, underscoring the need to reach this population. At a later date, after this initial screening was completed, an optometrist was deployed to the housing facility for follow-up examinations, with an 83% attendance rate for follow-up examinations. When intervention was needed, the follow-up rate with navigator support for planning was 71.8%, compared to 36.3% without the navigator.
A cost analysis found that costs per individual were relatively low: $180.88 per screen and $273.64 per detected case of eye disease, of which there were 468 cases. The costs associated with taking in-office exams were $24.25 in the intervention group for those with a navigator, which was $8.78 less than those without the navigator.
When it comes to expanding glaucoma screening even further, Barbara Marie Wirostko, MD, of the University of Utah, said, “Telemedicine is beautifully set up for this.” Wirostko highlighted a possible shift in ophthalmology from a reactive to a proactive approach. Thanks to advances in telehealth and teleophthalmology, care can now be delivered remotely, allowing for early detection and intervention.
For example, Wirostko highlighted the UK’s widespread screening of more than 1.7 million people with diabetes using fundus photography, which took place in 2011. This study demonstrated the effectiveness of digital innovations in expanding reach and improving patient outcomes , she noted.
Wirostko also pointed to the growing role of satellite clinics and home monitoring devices in the treatment of glaucoma, reducing barriers posed by travel and economic restrictions. These innovations not only increase efficiency, but are also cost-effective, she said, citing a 2012 study that found telemedicine assessments were cheaper than traditional office visits.
“Digital innovation and AI have certainly changed this. We can also have equipment for home use so that the equipment is sent home. You can also have equipment in the satellite office,” she said. “But the other thing is that it really helps patients with the travel costs, greenhouse gases, lost wages and healthcare providers having to take time off work to drive patients for hours just for a pressure check.”
With the affordability, access and ease of interpretation that technology brings, the opportunities for improving global access continue to expand. Nicolas Jaccard, BS, PhD, an employee of Orbis International, presented the steps his company has taken with its AI in Africa and Asia, primarily in the area of diabetic retinopathy and now moving toward glaucoma.
“We conducted a study that showed that non-medical evaluators who spent five hours on this course were able to match the performance of local experts in glaucoma detection,” says Jaccard. “Just five hours of this course was enough for non-medical graders to detect glaucoma.”
By automating the interpretation of retinal images, the platform provides immediate referral recommendations, which has been shown to significantly improve patient compliance, Jaccard said. Called Cybersight AI, the platform is designed to work within existing retinopathy screening programs and allows healthcare providers to implement broad screening for glaucoma, ensuring more patients receive timely interventions.
“AI is the technology that we need to ensure is used safely and efficiently,” said Jaccard. “Our goal is to ensure that AI agrees with experts as well as experts agree with each other, which is how we measure success in this area.”
As the program continues to develop, continued data collection and monitoring will be essential to refine the technology and validate its impact on diverse populations; However, this approach underlines the potential of AI to not only improve glaucoma management but also revolutionize patient care in resource-limited settings.
In addressing the pressing issue of glaucoma care in resource-poor countries, Anil K Mandal, MD, of the LV Prasad Eye Institute in India, emphasized the critical need for a comprehensive and integrated approach to eye health. Glaucoma remains the third leading cause of blindness worldwide, with more than 90% of primary open-angle glaucoma cases going undiagnosed in countries like India, he said.
The lecture underlined the importance of establishing a permanent infrastructure, training healthcare professionals at all levels and deploying innovative technologies for screening and referral processes. “The delivery system established and implemented over a period of three decades at the LV Prasad Eye Institute can be replicated in several other low-resource countries,” Mandal said.
The proposed model involves a pyramidal approach to eye care delivery, integrating training programs for volunteers and establishing vision centers equipped with modern diagnostic tools. This system has proven its success, targeting populations of up to 1.5 million people and providing essential services from primary to tertiary care. By utilizing telemedicine and remote consultations, the initiative ensures timely diagnosis and treatment, ultimately improving patient outcomes in rural areas.
