I love cataract surgery. I love the precision. I love helping patients achieve better vision. Once I am in the OR, I feel like I am in what psychologists call a “state of flow.” It’s wonderful.
However, for years I was frustrated with the process that led up to the surgery itself. My staff would have to go to each diagnostic machine and print out each patient’s results — usually a biometer, topographer and a macular optical coherence tomography. They would have to comb through the EMR to find the patient’s refraction and ocular surgery history then type the patient data into an IOL calculation program, which was labor intensive, boring and open to transcription errors. This would generate a printout of the IOL calculations. Then, they would compile a paper chart for each patient with all that information. If I wanted a toric IOL, I would have to open another computer program to calculate the toric power of the lens needed — another chance to make a transcription error and another waste of my valuable time.
Post-LASIK patient? You guessed it — another computer program, another manual re-entry of the same data. There had to be a better way, a way to make the planning as efficient and beautiful as the surgery itself.
This was the impetus to create Eyetelligence (Bausch + Lomb), which I will discuss below.
HOW EYETELLIGENCE WORKS
Eyetelligence is a cloud-based surgical planning software platform that works with all the leading diagnostic devices and EMRs.
Eyetelligence does not change your clinic’s workup routine. It requires almost no training for your staff, working instead silently in the background.
The first step for Eyetelligence is to monitor each and every diagnostic device in your clinic. As soon as a patient is scanned with your diagnostic device, that patient’s data is securely transferred to the Eyetelligence cloud. Data from the EMR also flows up into the Eyetelligence cloud.
The process to sync your diagnostic machines to your Eyetelligence is nearly effortless. We have built software that we call a “bridge.” The bridge looks for any new scans or data from any patient screened on the device. It then automatically brings that data into the Eyetelligence cloud and organizes for constructive use. It takes the B+L IT team about 5 minutes to set up the software on any device. After that, “set it and forget it.”
Think of each cataract patient as undergoing a journey. The first step of that journey is the pre-operative evaluation and diagnosis. Next comes diagnostics, followed by surgical planning. Then comes the surgery itself and later the post-operative care and outcomes. Eyetelligence follows, documents and organizes everything in that journey. Everything is HIPAA-secure, organized and can be accessed from any computer anywhere in the world at any time.
PROVIDES DATA EVEN BEFORE MEETING THE PATIENT
Eyetelligence even helps you before you meet the patient. Say your patient is put in front of a Pentacam AXL (OCULUS). Eyetelligence gathers and organizes the data, analyzes it and sends IOL recommendations to the surgeon’s phone app. Instead of the surgeon looking through 10 screens of data, Eyetelligence examines and analyzes the data instantly, showing the surgeon only the most critical, relevant data.
Before walking into the room with the patient, the surgeon can glance down at their phone and see, for instance, that there is a high amount of coma in the eye. Eyetelligence also alerts them that the astigmatism present is asymmetrical and may benefit more from a single arc astigmatic incision rather than a toric IOL. Many diagnostics just give a printout of the magnitude of astigmatism and its axis, so it is easy to miss this critical detail. Heading back to the room with the patient, the surgeon now knows that they should not waste time discussing a multifocal IOL due to the high coma and can focus the discussion on what types of lenses will work best for the patient.
Eyetelligence also recommends an IOL based on the measured corneal spherical aberration and an IOL’s spherical aberration correction, finding the match that brings the total eye spherical aberration to zero for optimized distance vision. Conversely, if the surgeon wants to increase the depth of field for an eye, Eyetelligence recommends the IOL with the best spherical aberration profile for that eye.
The Eyetelligence patient phone application collects lifestyle and vision preferences from the patient before the visit, allowing the practice to again expedite and tailor the cataract surgery discussion to the patient’s specific desires and needs.
AN IOL CALCULATOR WITHOUT THE GUESSWORK
The most powerful feature of Eyetelligence is the IOL calculator. Data for each eye from multiple diagnostic devices flows into the calculator. No staff time is wasted making printouts, and since there is no typing, there is no chance for transcription errors.
The surgeon can contrast and compare the data from multiple sources instantly and decide on what data should be used for the calculation. Also, the surgeon can choose their favorite formulas to calculate the IOL.
Additionally, this platform offers a powerful new option: the Eyetelligence advisor. You might have a formula that you like to use for long anterior-posterior (AP) axis myopic eyes. But what if the eye in question is unusual, such as a long AP axis length and a shallow anterior chamber, or a shallow anterior chamber and a thin AP diameter lens? Do you really know what formula will work best? Eyetelligence doesn’t want you to guess, so it comes to the rescue.
The Eyetelligence advisor looks at the unique physical measurements of an eye then compares them to a large database of successful cataract surgeries. Once it finds similar eyes in the database, Eyetelligence determines which IOL formula would produce the most accurate results for eyes with those physical features. It then displays the three most accurate formulas for that eye and their IOL power calculations (Figure 1).
MORE THAN JUST CATARACT PLANNING
Beyond cataract planning, the data from diagnostic instruments is invaluable for planning LASIK and implantable collamer lenses, so Eyetelligence offers features to help with this. It provides a surgical schedule as well as a surgeon-specific “task list” so the surgeon knows what upcoming cases for the next few weeks still need IOL planning.
In addition to assisting in calculating IOLs, Eyetelligence also assists with EVO Visian ICL (STAAR Surgical) calculations, LASIK calculations and IOL ordering.
It can save a typical clinic hours of time previously spent collecting data.
No more staff hunting down the surgeon with a stack of paper charts in hand for last-second calculations. It has built-in limbal relaxing incision and artificial intelligence nomograms for astigmatism management (Figure 2).
IMPROVEMENTS TO PATIENT SAFETY
Eyetelligence also reaches into the OR to improve patient safety. Every patient receives a QR code sticker to wear on their surgery day. Eyetelligence has separate phone apps for the surgeon and for the OR staff, both of which link back to the main cloud system. Using the app, the OR tech staff scans the QR code and then the barcode on the IOL box in the room. If the QR code matches the right patient, a green light appears. If the IOL make, model and power match what was calculated for the case, a second green light appears.
This timeout is far better than our current human-led timeouts. Technology never gets bored, never gets distracted, never gets complacent. This should forever eliminate “wrong eye, wrong lens, wrong patient” errors. Future additions of Eyetelligence will advise surgeons on what settings to use in their phaco machines for each individual eye based on diagnosis and comorbidities (Figure 3).
POST-SURGERY ASSISTANCE
After surgery, Eyetelligence continues to go to work. All post-operative data from future visits are ferried from the EMR into the Eyetelligence cloud. The data is then fed into a remarkable tool known as “liquid analytics,” which allow surgeons to look at all their cataract outcomes instantly. It makes looking at subgroups of patients easy and blazing fast. You simply use the mouse to choose a subgroup, such as patients with astigmatism between 1-4 diopters who received a particular brand of toric IOL. Instantly the data “flows,” showing just the results for that subgroup. See an outlier? Just highlight it on the graph and instantly Eyetelligence takes you to that patient’s chart so you can determine what went awry and how to improve it (Figure 4).
COMANAGEMENT ASSISTANCE
An optometric phone app is being developed as well. Imagine you have a busy cataract surgery day with 18 patients on the schedule and half of them are co-managed with ODs outside your clinic. Eyetelligence keeps you in constant contact with your referral sources.
Each IOL calculation can be shared with the referring OD via the phone app, so they know what lens type and strategy was chosen for their patient. On the OR day, the op note can be instantly shared again via the phone app so that the OD knows if any problems or complications arose.
Best of all, the OD can quickly indicate the UCVA and IOP of each patient into the app. The surgeon looks at their Eyetelligence phone app, where a list of all the post-op day 1 patients resides. If a patient name is in green, then the surgeon knows that the patient had a normal visual acuity and IOP. This means you know exactly how all your patients from the previous day are doing in a single glance. If a patient name appears in red, you know to call the OD and find out what the issue might be. No more hunting through EMRs, calling referring clinics or waiting days to get a faxed post-op note.
CONCLUSION
When I began creating and building Eyetelligence 6 years ago, I wanted to craft it into the tool I always needed in my own clinic. I wanted it to be device agnostic, able to work with the machines and EMRs ophthalmologists already had in their offices.
Eyetelligence is designed to make the surgeon and staff’s lives easier and more efficient. It is meant to be unobtrusive and intuitive to use. It should help avoid errors in IOL calculation and in the OR and offers new tools to examine your post-operative results.
Beyond this, new features and tools coming in the next 2 years will reshape how technology and artificial intelligence can become your true partner in clinic and in the OR. Innovative, never-before-seen approaches to harvesting data from analytics and diagnostics will be pushing you to ever better results. OM
