Digital Health at the Byers Eye Institute
Digital health is an important element looking ahead into the future of medicine and ophthalmology, and has been a focus of major contributions from our faculty, fellows, residents, scholars, and students. Over the years, we pioneered new ways of doing ophthalmic telemedicine, implemented machine learning and artificial intelligence in ophthalmology, developed new devices such as smartphone-based visual acuity testers and ophthalmic cameras, and harnessed mobile devices to serve as visual field testers and quantify biometric data. Stanford faculty have also been at the forefront of education in digital health, through involvement in national and international conferences and workshops on the subject, mentorship roles in the Byers Biodesign Program, and regular participation in hackathons.
Dr. Darius Moshfeghi founded the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) program in 2005, and today it remains the oldest and largest telemedicine screening program for in-hospital screening of high-risk infants for treatment-warranted ROP (TW-ROP) in the United States. It is located at satellite neonatal intensive care units (NICUs) situated throughout Northern California and two other states. The goal of the SUNDROP initiative is to reduce blindness and poor visual outcomes from ROP by providing infants in rural and county hospitals with quaternary care. At each site, all infants meeting established criteria are screened using RetCam II images, which are subsequently sent to the Stanford University Byers Eye Institute reading centre for remote interpretation by an ROP specialist.
The advantage of this system is that they provide high level care without the travel time, which saves time for the hospital, physicians, and the patient’s family. Moshfeghi has worked with industry both in a consultative and creative-founder role to develop wide-angle imaging camera technology as well as deep learning classifier platforms for the identification of disease in healthy term newborn infants.
Below are Dr. Moshfeghi and Dr. Theodore Leng's report on the 6-year results of the SUNDROP initiative.
Dr. Moshfeghi and Dr. Leng Publications:
Dr. David Myung and Dr. Robert Chang developed a smartphone-based ophthalmic camera system that enables both anterior and posterior segment imaging of the eye. Paxos Scope is an FDA-registered Class II-exempt ophthalmic camera that is a universal smartphone adapter that converts any smartphone into an easy-to-use, compact ophthalmic camera. Originally funded as a project by the Spectrum/Biodesign program, the device costs a fraction of a typical tabletop retinal camera in an eye clinic, and yet the device is small and lightweight enough to fit in a white-coat pocket. The device has been tested in a variety of clinical settings which have been reported in recent publications, including as a diabetic screening tool, and in rural international settings in India and Nepal.
Dr. Myung and Dr. Chang in the Press:
In 2008, Dr. Blumenkranz and Dr. Palanker founded DigiSight Technologies with the intent to develop augmented reality glasses for patients with low vision. In 2010, they launched a new product line focused on home monitoring of vision to assist in early detection of clinically significant changes in vision between office visits and to help personalize drug treatment regimens for patients with macular disease . For this purpose, they developed an app called SightBook (now known as CheckUp), that can quickly measure visual acuity, contrast sensitivity, low light vision, and other visual functions using a smartphone. They also created a HIPAA-compliant medical database stored in the cloud, where patients’ data, including fundus images and OCT images could be stored, processed, and made available to designated physicians, with trend analysis and automatic alerts. Subsequently the ability to capture high quality fundus and anterior segment images using a specialized adapter for smartphones (Paxos Scope, developed by Dr. Myung and Dr. Chang) was added to further enhance the functionality of system, along with the ability for this cloud-based data to integrate with existing electronic heath records. This work helped create a new, more efficient, paradigm for ophthalmic healthcare by enabling patients to frequently provide data to their physicians from the comfort of their home, and also allowing for out of the office testing in other settings including remote underserved locations and the workplace or primary care practices to facilitate screening for other types of ophthalmic disease at early time points than are currently possible.
Dr. Zachary Bodnar is an app developer and retina fellow who was the inaugural fellow of the Ophthalmic Innovation Program.
Drs. Blumenkranz, Myung, Moshfeghi, and Bodnar spoke at the 2017 Ophthalmic Digital Health Workshop
Carolyn Pan, MD, has been teaching smartphone fundus photography at AAO:
Dr. Chang News & Events
Digital health device development and clinical validation work
· Robert Howard Next Step Award
Asian Pacific Teleophthalmology Society, Vice President
· APTOS main website
· APTOS Council
Medtech entrepreneurship education at Stanford and beyond
Beijing seminars: HealthTech Hackathon Seminar Beijing
Hong Kong seminars:
· Enabling Medical Care Outside the Hospital - DreamCatchers MedTech Hackathon HK 2017
· DreamCatchers MedTech Hackathon Hong Kong 2016
· Two weeks in China: Lessons on innovating abroad
· Stanford doctors use biodesign training to spark health innovation in Brazil
· Stanford’s first health hackathon brings health care innovators together