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Digital transformation of ophthalmology takes root in Australia

Happier staff, more time, and a safer, more enjoyable patient experience might sound like an eyecare utopia, however, the digital transformation of ophthalmology means many of these concepts already exist in several Australian eye clinics.

Sydney ophthalmologist Dr Peter Sumich can recall a time when the surgeon and patient were satisfied to simply complete a cataract surgery without complication. Today, patients expect this as a given, and are placing greater demands on their eye doctor to provide a refractive outcome optimised to their lifestyle.

For Sumich, this means there is greater need to closely inspect each data point for the patient work up, along with an expectation to have the patient actively involved in the IOL selection and planning of their surgery. 

This trend means the traditional method at Hunter Street Eye Specialists – where staff collate volumes of data from print-outs and USB sticks to build a surgical plan – is no longer efficient and effective. 

But, much of the redundant, manual work in Sumich’s practice has been eliminated after investing in ZEISS EQ Workplace, a cataract surgery planning solution developed by ZEISS which allows him to have biometry, other vital scans and a calculation platform all on a single display, with minimal manual data entry. 

“With cataract and refractive surgery we are trying to pull together huge volumes of diagnostic data to make important and integrated decisions about refractive targets, lens choices and excimer laser strategies. As diagnostic technology has evolved, this has become an inconvenient clutter of data print outs fanned out across my desk and harried staff producing the gold,” Sumich explains. 

“Because I am obsessive about biometry and like it available during the patient consult, this involved a lot of staff time scanning, entering data, correlating and producing a diagnostic array of clumsy paperwork.

“The ZEISS EQ Workplace has been a real game changer. In one digital display, I now have topography, biometry, wavefront aberrometry, OCT and a calculation platform to formulate a surgery plan. I don’t like becoming dependent on an ecosystem, however someone at ZEISS has clearly been listening to what surgeons want.”

Sumich is the first to admit he is slow to change his habits, unless convinced otherwise. This shift towards digitalised workflows has seen IT infrastructure and support become a significant area of investment and focus for the practice. 

“The saving on staff time has been tremendous. Frankly they love it as much as me. The biometry data from the IOLMaster is automatically populated into the networked – EQ Workplace, eliminating risks of transcription errors and making paper redundant,” he says.

“Topography, aberrometry and Hill RTC (still manual) are dragged and dropped into the additional data panels. ZEISS EQ Workplace includes the Barrett TK toric software which is my base formula and if needed I can manually add integrated Ks. All the other common formulas are there, although the Kane is notably absent.”

Patient data captured during the cataract work-up phase is pre-populated into the system, removing the need for manual data input.

To use EQ Workplace to its full extent, the surgical plans can be stored on the cloud ensuring the surgeon can access them from the mobile device at multiple sites, including at the operating theatre. The patient’s work-up data in the cloud can link with ZEISS Callisto eye, a computer-assisted cataract surgery system.

“Now patients are demanding the highest-level refractive outcome from surgery – expectations have risen to an extent that you have to look at everything very closely,” Sumich explains.

“EQ Workplace allows me to present patients many options on how this can be achieved. At one sitting we’re able to discuss all options, and they leave with a good idea of what’s going to be done. 

“Being able to draw on that data on the spot means we can spend time talking about their lifestyle, clinical outcome and what’s important, rather than wasting time sorting through paper.

“It’s also helped patients better understand the complexity of what we are doing. It gets them on board as active decision makers and you’re able to provide worked examples to show how some approaches may vary to others.”

Efficient, more effective clinics  

EQ Workplace is an example of how ZEISS is helping lead the digital transformation taking place in ophthalmology. It is achieving this through integrated workflows where devices talk to one another and comprehensive data management solutions. 

By connecting devices, data and applications, the company has created an ecosystem helping eye doctors optimise the clinical management of their patients. Each ZEISS ophthalmic workflow can be broken into four distinct areas: 1. Assess & educate, 2. Plan, 3. Treat, 4. Check. 

ZEISS has developed ‘workflows’ for several eye diseases. The company’s flagship Cataract Workflow (pictured) connects each point of the patient journey.

In the case of the Cataract Workflow, this could involve ZEISS IOLMaster biometry and the ZEISS Eyeguide Patient App (Assess & educate), ZEISS EQ Workplace and ZEISS Digital Ordering Platform (Plan), ZEISS OPMI Lumera 700 ophthalmic microscope, ZEISS Quatera 700 phaco system and the aspheric monofocal intraocular lens ZEISS CT Lucia 621  (Treat), and then a ZEISS slit lamp (Check). 

According to ZEISS, the benefits derived from increasing developments in digital technologies are not limited to improvements in the treatment of cataracts. Significant advances in how huge volumes of data can be managed and analysed have created opportunities across the entire ophthalmological space.

In a recent expert interview about digital technology in ophthalmology, Mr Euan S. Thomson, PhD, president of ophthalmic devices & head of digital business unit at Carl Zeiss Meditec, says ophthalmology is an amazing environment where the eye is the window to the identification of so many different conditions. 

“However, this is hard to do if you don’t embed tools like artificial intelligence into the environment. When you do it opens up many possibilities for patient management,” he says.

“There can be a huge number of variables associated with a patient and the more variables, the more data points you need to draw conclusions. However, the number of patients that a physician can see during their entire career may not be enough to collect the needed data points to interpret some of those nuanced variables. If you aggregate the data and bring the data together on one platform you can then learn collectively.” 

As this digital transformation accelerates, the ANZ market has recently seen the previously mentioned ZEISS Eyeguide Patient App being trialled. This app supports patients in their treatment journey allowing them to refer to information relevant to their upcoming cataract surgery, in turn, helping to reduce patient counselling time. The virtual coach tool also includes features such as pre- and post-operative checklists or eye drop notifications to improve compliance and overall experience.

Also in the pipeline, ZEISS has developed the Surgery Optimizer App that leverages artificial intelligence in surgical videos to enable surgical performance tracking, improvement and standardisation of surgical techniques.

ZEISS views the next 24 months “as an exciting time” as these product launches will see adoption of digital technologies gain further momentum among Australian and New Zealand surgeons.  

More reading

Digital integration saves hospital time and money

Eliminating inefficiencies and never-events in cataract surgery

Bringing telehealth and artificial intelligence into real-world ophthalmology practice

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