According to writer and entrepreneur Stewart Brand, “Once a new technology rolls over you, if you're not part of the steamroller, you're part of the road.” And, since few fields see technological advancement at a more rapid rate than medicine, physicians must have a platform to dispense new knowledge, store data on discoveries, and confer on the latest innovations happening in their fields around the world to keep from being “part of the road.”
Luckily, there is an organization poised to help ophthalmologists and other eyecare professionals do just this. The Digital Ophthalmic Society (DOS) is leveraging digital technologies to gather and share information with the ultimate goal of improving patient outcomes.
I recently interviewed Eric Rosenberg, DO, MSE, a co-founder of the DOS and practicing cornea, cataract, and refractive surgeon with SightMD in New York.
In your words, what is the mission of the Digital Ophthalmic Society?
Rosenberg: It's a thought engine around novel digital solutions with clinical integration at the heart of it. It was important to bring in elements from all areas of digital medicine, telehealth, telemedicine, artificial intelligence, machine learning, neural networks, and server standardization, as well as the routine digitally backed equipment we use in-office such as biometers, OCTs, visual fields, and file databases. Lastly, digital visualization in the OR was a missing link for quite some time. Once matured, all the pieces came together, so now we can create a unified system that helps our patients.
What was your impetus for founding the society?
Rosenberg: While everyone was coming out with their own solutions for individual niche problems, nothing was being developed that was cross-collaborative and interoperable. We are getting so far into the development of individual technologies that the chance of taking a step back and being able to start collaborating may be fleeting rapidly. I thought it was really important that physicians, engineers, scientists, and industry all be on the same page about where we're going and how we need those pieces to dovetail.
Why is sharing data so important within the field of ophthalmology?
Rosenberg: We're now in an era where we can accumulate big data and leverage it to help us understand pathologies and patient outcomes. We've never been able to do that before.
“For that to happen, we will need to not be so myopic, appreciate the full spectrum of data collection, provide standardization protocols, and ultimately open databases for large aggregate studies.”
How can ophthalmologists best utilize DOS’s resources?
Rosenberg: The Digital Ophthalmic Society is quite multifaceted, however, one of its major pillars is centered around education. When considering the next generation and future ophthalmologists, I've already emphasized that it is important to not lose the forest for the trees—and appreciating everyone's perspective is unbelievably important.
At this year's ASCRS 2023 we will be hosting a first-ever subspecialty day of its kind: “Digital Day.” If you are interested in this facet of ophthalmology, we strongly encourage you to attend and participate. Resources available range from networking opportunities, to project alignments, to pure educational programs discussing how some of these technologies will be integrated into our day-to-day lives.
We have aligned with the American Society of Cataract and Refractive Surgery due to their longstanding commitment to ophthalmology, traditionally progressive outlook, and aligned mission statements to materialize our vision for the future of ophthalmology. With quarterly metaverse meetings, the digital subspecialty day at ASCRS, and several other educational modalities—we recommend interested participants or future leaders check out the Digital Ophthalmic Society website for how to best get involved.
Are there any recent innovations in the field that you are particularly excited about and why?
Rosenberg: I'm excited about two major things in the pipeline:
The first one is interoperability. Let me explain: I think a lot of hesitation surrounding adopting new technology remains centered around the learning and interfacing of new technologies. While many features of these systems provide crucial data to the clinician, it requires active involvement and frequently, manual logistics add time, aggravation, and inefficiencies to clinical workflow. Electronic medical records (EMR) are a great example of this concept. While EMR still has the potential to revolutionize the healthcare system, the unrolling of the platform was a flop.
Unfortunately, solutions centered around a 1:1 carbon copy of transitioning from old to new. While new technologies unfold, it remains important to consider how implementation may be leveraged to enhance patient care and promote change instead of copying how it was done in the past.
With that said, interoperability has the potential to put some of these concerns to rest. What if platforms were developed to communicate with each other, with in-office machines, AI algorithms predicted and analyzed changes in relevant studies and/or alerted technicians about what needs to be done for the patient based on learned behavior and standards of care? What if EMR was a backend tool that recorded information for posterity, and the clinician didn't need to interact with it actively or the various platforms/dicom servers, allowing them to reference relevant material and interact only with the patient?
“Interoperability is going to be very, very big for the field and allow us to return our focus to where it belongs—the physician-patient interaction.”
The second one is something I'm personally very excited about: the Metaverse and Web3. The utility of telehealth and telemedicine was brought to the forefront during COVID and no doubt is going to be paramount going into the future, where at the moment, there will not be enough providers to meet the patient demands. I believe it's going to be a very unique frontier, and how that interplays with medicine is going to be very interesting.
While patient-facing medical storefronts are currently in the very early stages of building, and outcomes have yet to be realized, I can tell you that meetings, discussions, and conferences will all start taking place in an engaging three-dimensional virtual environment where knowledge transfer can occur at levels that parallel, and in some instances, exceed in-real-life settings. Couple that with saving $500-1000 on a plane ticket plus hotel accommodations, to just throw on a virtual reality headset and you’re there!
What do you feel is the greatest challenge currently facing ophthalmologists?
Rosenberg: Ironically, the advent of technology— and we need it to be its own solution.
When I was chief resident, I used to tell my residents that you need to know how every piece of equipment works in your office and in your OR. You're the one using it; you need to know the basic features of how it works, where the menus are, what all the data output means, and how it relates to your patient care.
I strongly encouraged all my ophthalmology residents to read all the user manuals because it's ultimately not the technician's responsibility to triage problems or understand the values, it's yours. That becomes increasingly challenging as the technologies advance, and the solutions become a little bit more evasive. Therefore, I think it's our job to find solutions that simplify things once again.
By harnessing artificial intelligence and neural networks to process some of that information, we can leverage larger data sets to provide strong and accurate results to the clinician, thereby facilitating the adoption of more technologies as they advance.
In 10 years, looking back, where do you hope DOS will be?
Rosenberg: I sincerely hope DOS stays exactly where it is – at the junction between medicine, doctors, scientists, and engineers. I also think it resides in a uniquely good home with the American Society of Cataract and Refractive Surgery. ASCRS has been a foundation for a lot of us anterior segment surgeons; and with great leaders, meetings, and missions, they have always been advancing and pioneering the field.
While I am extremely excited about our partnership, I think many other meetings and societies appreciate the value of the DOS as well. For example, we will be hosting a session shortly at the 2023 European Society of Cataract and Refractive Surgeons moderated by the current ESCRS president Oliver Findl. Similarly, we have begun conversations with several other anterior and posterior segment societies about integrating and developing.
How can an individual join the Digital Ophthalmic Society?
Rosenberg: You can join us at digitalophthalmicsociety.com. The first 180 days are free; after that, there is a nominal membership fee. We are very inclusive of engineers, engineering students, scientists, physicists, MBAs, industry members, media companies, physicians, residents, and fellows—we want it to be all-encompassing because good ideas will come from everywhere.
People have their own uphill battles that aren't traditionally recognized, and to solve problems, we need to identify and classify them accurately. Identifying new problems can frequently lead to some very novel solutions.
What does membership to the DOS include?
Rosenberg: Of course, you gain access to the website and first dibs on any of our Digital Ophthalmic Society meetings in the metaverse. At these meetings, you learn firsthand about what new and innovative technologies are on their horizon, what it's going to mean for you, what it's going to mean for your patients, and how you can implement and mold the future. Each meeting hosts world-leading experts from all aspects of digital ophthalmology..
Joining also gives you access to a forum where you can ask your own questions. I wanted it to be very interactive; it was just recently built, and I hoped that people would feel free and open to ask the questions, even if it's been asked 15,000 times before, ultimately because it's new to them.
The last thing membership provides is access to policy. One of the facets of DOS will be setting policy as it relates to standardization and digitization. How should we do things—from the industry standpoint, the physician standpoint, or the engineering standpoint? We need to clearly define what we're expecting as clinicians and front-line providers.
Any final thoughts for our readers?
Rosenberg: I'd like them just to check out the Digital Ophthalmic Society—even if they're 2 years from retirement and not technologically inclined or have been writing code for decades. Ophthalmology is always on the bleeding edge of technology; the scale of innovation and ingenuity really knows no bounds.
“And, as technology continues to advance, so will the Digital Ophthalmic Society.”
With each new member comes new ideas, research, data, studies, experience, and insight, which when nurtured and encouraged, will further the field and most importantly patient care.
