Adopting new technology without sacrificing the training space

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Floor space is often a limiting factor when optometrists make important decisions about adding technology to their practice. We strive to equip ourselves to provide the best possible care for patients, and this often involves weighing the impact of various devices on office layout and patient flow.

Eye care professionals need to do the right thing for the patient. We build patient trust and work hard to maintain it. If a patient has a condition that we cannot diagnose with confidence and we do not have the means to perform the necessary additional testing, we will only refer the patient for testing or refer them to a specialist for care.

Then it may turn out that the issue may have been resolved in our office. This would save the patient the hassle of traveling to a new office and meeting new staff.

As the pace of technology development continues to accelerate, more devices become available that we can adopt. The good news is that devices in general are decreasing in size.

I’ve been in the industry for over 25 years and I remember my training with Zeiss’ first Humphrey Field Analyzer (HFA) with a large bowl 5 feet long and 5 feet wide. While still significant, current HFA devices are significantly smaller (see Figure 1). Figure 1). Lasers also required a large room. They are now generally portable and can be moved from office to office.

The launch of wearables takes this size reduction trend to a new level. In my application, I use the Heru headset with visual field (see fig. figure 2), contrast sensitivity and color vision examinations.

The platform is passed through a headset that can be hung on the wall. It creates its own dark environment, so there is no need for a special dark room. This means that the addition of this powerful technology has no impact on floor space.


portability

The portability of new diagnostic technology, such as the Heru headset with multiple vision diagnostic exams, is incredibly valuable to eye care professionals as testing can be performed on a patient anywhere in the practice.

As we navigate the COVID-19 pandemic, this gives clinicians the flexibility needed to avoid moving a patient from room to room. Technology comes to the patient, who can be in a clean room with the door closed.

Another important factor is that the patient does not contaminate an additional test chamber. When a room becomes dirty, it is closed until it is cleaned. This requires a more thorough, time-consuming cleanup than was done prior to the arrival of COVID-19, and test rooms can become bottlenecks.

As apps struggled to keep running smoothly between the new distance and cleanliness requirements, one step was often to take a more problem-focused approach to exams.

Providers will ask if an exam really needs to be done during the visit or if it is possible to skip bringing the patient to a testing room.

In our practice, we relocated equipment, anticipating tests that patients tended to need at the same time, and trying to put these devices in the same room.

In this setting, the ability to bring instruments into the patient’s exam room is invaluable. It facilitates performing a wider range of screening and testing and reduces the need to limit oneself to a reactive approach.

If the patient has a family history of glaucoma, I can have my technician run a rapid field of vision using the Heru headset. Also, if a patient mentions a headache and I want to rule out neurological factors, I can quickly do an ad hoc scan.

Better use of resources

Waiting rooms often represent underutilized space in a practice. With the introduction of wearable devices that make up its own testing environment, the waiting room can become a testing ground. This also applies to the expansion area, which is sometimes not just a testing station but also a treatment area.

In small applications, for example, meibography can be performed in the dilatation area. If appropriate for flow, meibomian gland therapy can also be followed at the same location using a portable or fixed camera system.

TearCare (Visual Sciences) is a wearable eyelid technology that provides heat therapy that practitioners can use on patients in the dilatation area or examination room (see Fig. figure 3). Manual expression of the meibomian glands can also be done in the exam room using a slit lamp.

Staff availability is a limited resource in all applications, but not square meters. Wearable devices such as the Heru headset allow technicians to carry out valuable practical activities while in the room with the patient. In the past, visual field testing required a dark room and the technician was sitting in the dark and unable to multitask.

With the Heru headset platform, patients can wear the headset and their environment is sealed (see Figure 1). Figure 4). The platform features a virtual guide that guides patients through tests, and real-time gaze tracking within the platform confirms that patient fixation is always appropriate.

Patient-focused testing allows the technician to complete other tasks, such as updating records, entering medication into the system, or ordering contact lenses.
While the technician should still be in the room, they can still perform additional activities.

multifunctionality

Another trend is multifunctionality. A wide variety of diagnostic exams combined in 1 device.

Optical coherence tomography (OCT) devices contain cameras, which makes it possible to capture images of the retina and OCT. New OCT devices can also take both anterior and posterior segment images with wide-angle imaging. Other combinations include infrared auto-diffraction devices with camera or meibography capabilities.

For glaucoma diagnosis and monitoring, the Ocular Response Analyzer G3 (Reichert) measures both corneal hysteresis and corneal compensated IOP, giving a more complete predictor of glaucoma progression than IOP alone or IOP combined with corneal thickness (see Table of Materials). Figure 5 for a similar device). FAT1 (Falck Medical) measures ocular profusion in addition to IOP, ocular pulse amplitude, and pulsatile force of the central retinal artery.

Versatility meets wearability. The Heru platform offers suprathreshold and full-threshold visual fields, contrast sensitivity testing and color vision scanning (both Ishihara and Farnsworth D-15 extended color vision tests). The company has also added a new “fast model” above-threshold visual field test that takes just 20 seconds.

When I first started using the Heru for visual field testing, I used the platform on a patient with known glaucoma and had an HFA visual field done the same day. This showed me how consistent the results and outputs were. The digital platform has been shown to have a strong correlation with the gold standard HFA.one

I like the platform’s ability to test for contrast sensitivity because some patients come in with vision problems at night. This is usually related to the low macular pigment density, which I measured on the palm of the patient’s palm with the Pharmanex BioPhotonic scanner (Figure 6).

This is another device that can be moved. I work quite a bit with nutraceuticals, so if I detect a problem with contrast sensitivity and the BioPhotonic scanner, I can start patients on the nutraceutical and then see if their contrast sensitivity and skin carotenoid levels change.

In addition, there are now lenses that help with color vision problems. I can use the Heru platform for color vision screening to identify patients who might benefit.

These VR platforms aren’t just for the younger patient population. Heru’s device has been clinically tested on patients aged 15 to 95, and I’ve found the tests to be so intuitive that just about anyone, at any age, can complete them.

Two of the first patients I tested with the platform, in their 60s or 70s, said they thoroughly enjoyed the interaction.

a promising outlook

The future looks bright for wearables. I imagine a scenario where the patient comes into the waiting room and a technician comes out with a wearable diagnostic device and has the patient sit down without being moved into the exam room.

A number of screening tests may be performed on the patient, including visual acuity, color vision, pupil assessment, and rapid-scan visual field. While these are uploaded to the system, the technician returns and performs an OCT scan or photograph of the patient’s optic nerve.

When the technician sits in the room with a patient, they have an overview of preliminary data that can be shared when the doctor enters the exam room.

The faster and more efficient the scans and diagnoses, the more realistic it is to apply them to patients without vision problems. Early detection of progressive eye conditions allows optometrists to effectively treat the disease.

Wearable diagnostic platforms and multifunctional devices facilitate a more efficient application workflow and enable even those with a small footprint to have a wide range of devices with increased diagnostic capabilities.

Reference

1. Rethinking glaucoma management using Heru’s wearable diagnostics: re:Vive Visual Field. heru. August 1, 2021. Retrieved March 10, 2022. www.seeheru.com/rethinking-glaucoma-management-using-wearable-diagnostics-from-heru-revive-visual-field

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