EyeMDs facing opportunities, challenges for glaucoma innovation

San Francisco-Ophthalmologists must change the way they use data in order to meet the mounting challenges facing their profession, said Paul P. Lee, MD, JD, in the Drs. Henry and Frederick Sutro Memorial Lecture at the 4th Annual Glaucoma 360 New Horizons Forum. “We know there are certain mega-trends out there that we have to deal with,” said Dr. Lee, who is professor and chairman, Department of Ophthalmology, and director, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor. Dr. Lee, who has written extensively on glaucoma and eye-care delivery, identified multiple challenges for ophthalmologists: shifting demographics, a changing workforce, and pressure to improve the quality of care in the face of costs. An aging and growing population will need more eye care, he said. At the same time, the population is becoming more diverse. “The ethnic makeup of the United States is changing, and changing very quickly,” Dr. Lee said. “California is already a state where there is not a majority by ethnicity, and the same will soon be true of the rest of the country.” NEXT: Page 2 + EXCLUSIVE VIDEO OF DR. LEE This diversity can offer an opportunity to ophthalmologists who understand the data about the needs of subgroups, he said. Along with demographic changes in the population as a whole are coming changes in the eye-care workforce, Dr. Lee said. He cited a report by the American Academy of Ophthalmology study finding that the United States will face a shortage of ophthalmologists and a surplus of optometrists in the future. In addition, he said, there are generational differences in the approaches that practitioners bring to their work. In an exclusive interview with Ophthalmology Times, Paul P. Lee, MD, JD, discusses his Sutro Memorial Lecture at Glaucoma 360. The health-care system is changing as well, Dr. Lee said. He outlined four alternative scenarios for the future based on an analysis by the Robert Wood Johnson Foundation (RWJF). On one extreme, we could move into “health if you can get it.” In this disorganized system of growing desperation, “people who have money get really great care,” Dr. Lee said. “People on the bottom are trying to figure out what they can do to survive.” The second possible scenario-which Dr. Lee called the “conventional pathway”- is “slow reform, better health.” In this scenario, health care is gradually becoming more centralized and big data is starting to play a role. As an example, he cited a drive by the Centers for Medicare and Medicaid Services to pay providers by quality or value of care. As part of this initiative, it expects to pay half of providers through accountable-care organizations and bundled payments by the end of 2018. The third scenario is “big data, big health gains.” This scenario entails a focus on prevention and social determinants of health, personalization of care, health education, prediction of health states, stem cell transplants, widespread use of bio-monitoring, integration of health systems leveraging big data clouds, and community-centered health homes. The fourth scenario laid out by the RWJF is a “culture of health” in which optimal health care is delivered equitably, efficiently, and economically. To realize this ideal future will call for rapid innovation, Dr. Lee said. Already the dissemination of medical discoveries is speeding up, he said, pointing out that it took 264 years to implement the knowledge that citrus fruits could prevent scurvy. Today, it takes 15 to 17 years for a confirmed evidence-based therapy to penetrate to the marketplace, he said. This process can be accelerated. “It won’t be 15 years or 17 years in the future,” he said. To speed up this process will require structural changes, Dr. Lee said. For example, setting protocols that allow patients to send photographs of their eyes to their ophthalmologists could help determine when they need to be seen. “We know that telemedicine does improve access to care,” he said. Another promising innovation is a device patients can use at home to monitor their own neovascularization, he said. “Home monitoring, if we have things that work, would be very helpful for what we do,” he said. Dr. Lee praised the use of algorithms that can predict the course of a patient’s illness. His own institution has started to use geospacial information mapping. As a first step, researchers there have created a map of strabismus for the United States. “We can tell you which states are underdiagnosed by the Medicare system,” he said. Such a map for glaucoma might overlay glaucoma diagnoses with a variety of risk factors, even including the location of grocery stores and neighborhood crime statistics. “If you’re not in a safe neighborhood, you can’t go out for a walk, so you’re not going to get your exercise,” Dr. Lee said. As a final point, he called on practitioners to make room for “the genius in the garage.” “It’s going to take someone who challenges the existing orthodoxy to really make things better,” he said.