Telemedicine, Technology, Optometry, and Ophthalmology: An Eye on the Future

01

DECEMBER 2020

TeleMedCo

My mom is legally blind, and as a result, I have been studying new technologies that are literally helping the blind to see.

Recently, I took my mom to an appointment with eSight. Her condition? Retinal detachment on the right and diminished vision on left.

eSight, along with a handful of similar companies and competitors, use Virtual Reality style lenses that enable legally blind individuals to see and live life more independently.

Many visual impairments degrade central vision while leaving peripheral vision intact; the headsets from eSight transmit images from a forward-facing camera to small internal screens — one for each eye — in a way that beams the video into the wearer’s peripheral vision. This changes the game for people with limited vision, including legal blindness.

And while eSight’s glasses won’t help people with total blindness, their solution does in fact work – as my mom witnessed.

The price?

$10,000.

Is restored eyesight priceless? Yes, until we figure out that much of the same functionality can be offered up through inexpensive VR glasses, some of which cost $5 or under.

Insurance doesn’t cover eSight. They consider the glasses an “assistive” technology similar to hearing aids.

ESight CEO Brian Mech said in a recent article that improvements might help insurers overcome their “short-sighted” decisions, arguing the insurance companies will pay less for this assistive technology compared to surgical procedures.

eSight’s product enables wearers to magnify the video feed sent through the headset from a front-facing camera up to 24 times, compared to just 14 times in earlier models. Hand control for adjusting brightness and contrast is a recent improvement, as is the higher definition camera embedded into the wearable.

ESight’s investor presentations and other communications claim 200 million people worldwide with visual acuity of 20/70 to 20/1200 can benefit from the product, including people macular degeneration, diabetic retinopathy, ocular albinism, Stargardt’s disease, optic nerve hypoplasia, and more rare conditions.

Given the high-ticket price, the company has sold only a few thousand headsets.

Is this innovation just too early, too untested, too expensive, or other?

There are competitors.

Companies working on high-tech glasses and related tools include Aira (an application built for Google Glass), Orcam, ThirdEye, NuEyes, Microsoft, and others – all with different technology approaches.

After visiting eSight in Boca Raton, Florida, my mom and I went shopping at a local variety store and found VR glasses for $5. I put my iPhone into the VR holder and magnified the image using the video magnifying lens!

Closely related to the innovation and evolution in wearables to assist the legally blind, we just advocate for the advancement of telemedicine for ophthalmology. It’s urgent. Why?

The population is growing, and aging, and the base of physicians practicing ophthalmology not keeping pace, we desperately need smarter ways to care for people. Given high definition cameras, higher-speed networks, the affordability of very high-end devices, and the development of software platforms that secure patient-doctor virtual visits, this seems like the ideal place for telemedicine to take off.

While the technologies that make telemedicine are truly “there’ the willingness of insurance carriers to reimburse physicians for its use have not kept pace with the innovations and new products coming out.

Smaller practices have a hard enough time keeping the day to day operations running and hesitate to set up a telemedicine practice and train their staff, particularly given the “newness” to patients and “slowness” of payors to adapt.

There are CPT codes for ophthalmic telemedicine is the remote diagnosis and treatment of patients by means of telecommunication technology. In 2011, two codes were added:

  • 92227   Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral
  • 92228   Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation, and report, unilateral or bilateral

The codes are subject to interpretation and the presence of retinal disease.

Medicare covers 92228 because this service is performed “… for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” A retinal disease justifies coverage.

Screening services are not covered in the absence of a statutory provision, for example, a mandate to test for glaucoma.

Telemedicine in ophthalmology has been used with some success for the screening of diabetes, glaucoma, and macular disease. Telemedicine also has been proven to detect pediatric retinal disease.

Approaching this issue with a clear understanding of the specific diseases where virtual examinations can add value makes the most sense for ophthalmic intervention.

Another great opportunity for those who practice eye healthcare is also the rapidly emerging category of wearables, like eSight and their competitors. Will smart glasses that enable the legally blind to see one day be prescribed by doctors?

The combination of things and software, people, care, and connected healthcare can bring enormous benefits to patients, including those in rural areas who have no access to care whatsoever. Ophthalmologists working with inventors are encouraged to learn more and play an active role in re-imaging the telemedicine ophthalmology future.

Dr. Miranda

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