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Tech Culture | Jul/Aug '16

Cataract Surgery App on Tap

Coming soon to an OR near you.

In May 2016, Bausch + Lomb and IBM announced they were teaming up to develop an app for cataract surgeons. The app, which will be available for iPhone and iPad devices, is being designed to help cataract surgeons streamline their workflow by delivering patient information, clinical insights, and IOL options on a single digital platform. With the app, cataract surgeons would be freed from consulting patient data and preop notes via printouts and, instead, could plan surgical interventions and view all necessary information on their mobile devices or display screens in the OR.

Intrigued by potential of this innovative digital solution, I took the opportunity to speak with Andy Chang, Senior Vice President and General Manager, US Surgical, Bausch + Lomb, to learn more about his pivotal role in the creation of this app and both its short- and long-term capabilities.

Gary: This project at Bausch + Lomb is being undertaken in conjunction with Apple and IBM. So, we have a titan in ophthalmology and two titans in personal computing and data management coming together—that is really exciting. Andy, tell us about this new project.

Andy: About 3 years ago, we started off on this growth and development path. Part of this was to make sure that we filled up the products to a point that we found very robust within cataract, refractive, and retina. We are doing that through acquisitions and internal development.

Additionally, we made huge leaps and bounds with investments within the IOL space and equipment, which led us to this app and to reaching out to Apple. We were embarking on a huge phaco project and a huge laser project, which, independently, were giants on their own. However, we knew that all of these products had to speak to each other, work together, and make life easier for ophthalmologists. We hear time and time again that ophthalmologists are not looking for another device that will make a procedure longer or more complicated. So, I thought, how do we do this in a way that is more meaningful to hit refractive targets?

I came up with this idea to reach out to Apple. I figured, might as well go for the top dog and emailed Tim Cook. I told him we were about to embark on this investment and that ophthalmology was lacking in terms of digital innovation. If you think about what Silicon Valley is to our consumer products, it is absolutely missing within ophthalmology. When you cross that invisible line to the clinic or the OR, all of a sudden, you are back to printing a ton of pages and taping papers to the microscope.

Gary: I take it you heard back from Tim?

Andy: He actually sent my email to Special Projects group member Myoung Cha. He then let me know and put on a call. We had his team on and then invited the IBM team because, within Apple, they don’t want to deal with data. IBM, however, is heavy into patient data, data protection, Watson, predictive analytics, and so on. We realized that if we could put those two together, and with our know-how within optics, design, and equipment, then we have the triad, the good core group of people to make this thing work.

The work of Warren Hill, MD, taught us that for the vast majority of surgeons who miss a refractive outcome, it has nothing to do with their surgical technique or tools. It is all within the logistics—they made an incorrect power calculation or the wrong lens choice. So, we thought, how do we do this in a way that enables everyday surgeons to make the best choice possible while also making that process easier? That is how we came to phase one of development.

Gary: It is hard for physicians who have ideas or inventions to get up the food chain at a company like Apple or IBM to say, “Hey guys, I’ve got an idea. Will you listen?” I want to congratulate you for taking on that task, which really is something physicians need.

At a recent conference, I heard a speaker say that the average Little League coach knows more about the statistics and batting averages of his or her starting lineup for summer baseball than the average surgeon knows about his or her A-constant for each lens or his or her predictive results for various procedures. At first, I thought, “No, we’re better than that.” Then I started thinking more about it and realized that we don’t really have a great system in place for analytics, for follow-up, or for data mining in our clinic. It takes time, and it takes effort.

In the last issue of MillennialEYE, I discussed how ophthalmologists have so many boxes that plug in. There is one box for topography, one for biometry, one for OCT, etc., and then other devices for keratometry and refractions. But, at the end of the day, we don’t have a system that can collate all of those data. So, as creatures of habit and creatures of efficiency, we just look at the Lenstar (Haag-Streit) or IOLMaster (Carl Zeiss Meditec) or whatever printout we have available and, in doing so, maybe end up with results that could be better. So much can be learned from getting the data that we have right now and putting cautions or parameters around them to say, does this look consistent and reliable?

I am exited that there is an initiative moving in this direction, and I think we will see a technological revolution in ophthalmology if we can get this going right. Can you tell us about what you are doing in phase one and then what phase two might look like?

Andy: What we love about this partnership is that we have Apple forging ahead with all of its technologies and constantly adding more functionality that we can tap into. Then, on the other end, IBM is forging ahead with its various experiences in diabetes, in oncology, with the Cleveland Clinic, and so on. The infrastructure is there, and as these companies improve, we are dovetailing right off of them. That is the beauty of it.

There are multiple other facets of patient education components that can come into play when we are ready. But the very first thing we need to nail down, the minimal viable product, is how to make surgeons’ lives easier. If we can free up an FTE or make their weekend or evening time better, then we have accomplished something. And they obviously have to nail the desired results and make that process easier for the patient journey. That’s phase one.

Phase two involves integrating other technologies. Now, we can venture into OR efficiencies and everything else that is in the art of the possible. One surgeon asked me if it would be possible to talk to Siri and ask for topography in the OR. I said, absolutely. Telemetry, to fingerprinting ID, to scanning—that is just the surface of what we can do. However, we know we have to hit that mark in the very beginning to say we have accomplished something that no other company can because we have Apple and IBM behind us.

Gary: Do you envision this to be an app for surgeons or a plug-in for EHR or a technology suite?

Andy: Initially we will go forward with an app on iOS devices, and then we can start venturing into a broader audience or broader tools if we need to. Remember, the goal is mobility and making it easier so that you don’t have to bring all of your charts home because all of that information is on your mobile device, which can also be brought into the OR. Then you have all your equipment talking to the mobile device throughout the patient journey.

This is really the widest gap when we look at all the different technology. Yes, we can make new lens material and do different things with phaco (which we’re still pursuing in a very vigorous way). However, there is this other avenue that we realized was completely missing that we can pursue to help the community today.

Gary: To be honest, I never really thought that EHR was going to solve anything. I figured that it would take a simple system that has worked for a long time and make it more complex. And it has done that. But I always thought that the silver lining—if there was one—was that we would be able to mine data much more efficiently.

There are some efficiencies with EHR; however, the last missing piece is that, often, that “data” is just a PDF or a JPEG image. It is not smart data, where you are able to query or do a search to say, “On average, how many times are my K readings from this device within a 0.25 D or 0.50 D than this other device?” EHR is just not set up to do it this way.

It sounds like we need a conduit, like what you are talking about, that can be connected to our different devices, perhaps to our EHR, and maybe even to a video camera in the OR so that we can record our cases. It is unbelievable the amount of data that we are going to be able gather from that. Then we are going to be able to start drawing meaningful conclusions.

I would bet there are a lot of people who have suggestions for this project that they would like to share. Is there a forum or a way that surgeons can suggest ideas, as you get your arms around this concept?

Andy: At this point, I would love to hear feedback directly via email. This is a fresh frontier that we are venturing into. At first, we questioned whether people would take to the idea. But people are really excited because we’re making it more efficient. We’re not just selling another huge box to say, you need to do this to succeed. Those are all tools that play a part, but you first must nail down the logistics. That is where we want to get people, and then we can all move on to the next step.

Gary: The more bright minds that are thinking about how to meaningfully move the ball forward to develop a tool that will help our devices talk to each other and help us analyze information and ultimately make better choices for our patients—that is a win in every category.

Gary Wörtz, MD | Section Editor
Gary Wörtz, MD
  • Cataract and refractive surgeon at Commonwealth Eye Surgery in Lexington, Kentucky
  • Founder and Chief Medical Officer of Omega Ophthalmics
  • drwortz@omegalens.com; Twitter @GaryWortz