Should this doctor be threatened by smartphone ophthalmoscopy?

For decades, physicians and other health professionals have opened their offices with the assumption that everyone will need to see the doctor eventually. Why? Because that’s where you go if you have a health problem and need to get checked out.

As a retina specialist, I assumed that years of training, working with special hand-held lenses, would offer me a diagnostic skill set that very few people in the world have mastered.

By artfully focusing lenses roughly 5 cm from the back of the eye, I am able to view a person’s retina to diagnose problems such as diabetes, macular degeneration and retinal detachments- all potentially blinding conditions.

With that skill, certainly, my job was safe. My profession was irreplaceable. Was I wrong?

Though digital photography of the retina had improved greatly — to the point where you don’t even need your pupils dilated — you still had to go to an eye doctor’s office to get the scan.

However, with the advent of smartphone ophthalmoscopy, there was the potential of having your retina imaged without necessarily having to see an eye doctor.

In the last year alone, several start-ups have developed ways to image the retina and beam that image directly to their mobile device. It may be an attachment lens to the phone or carefully aligning a 20 diopter lens co-axial to the camera.

From there, the HIPAA compliant image can be remotely sent to an eye doctor or perhaps a reading center that may be able to interpret the retinal image with hopes to triage the patient appropriately.

I’m told there are even companies creating software that can recognize ocular pathology and will triage based on pre-programmed algorithm.

This is already starting to happen in the screening examinations for premature babies where a blinding condition known as retinopathy of prematurity can occur.

In rural or third world countries where resources may be less abundant, the ability to perform retinal screening examinations simply through a smartphone could reduce barriers that have limited access to healthcare.

There are limitations to smartphone ophthalmoscopy including difficulty to image the peripheral retina where retinal tears and detachments occur most frequently. But central vision-threatening conditions like macular degeneration and diabetic retinopathy could be captured routinely.

Placed into strategic points of triage like the emergency department or urgent care facilities, primary care offices, or even a foreign medical mission, smartphone ophthalmoscopy could enable access like never before.

So, will I lose my job? Suffice it is to say, there will always be patients that need to be treated for their retinal disease, and they’ll hopefully make it into my office.

Smartphone ophthalmoscopy may help identify those who need to get there earlier.

Robert Wong is a retina specialist who blogs at 36th and Hamilton.

Image credit: Shutterstock.com

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