The impact of glaucoma
Glaucoma is a progressive disease that leads to optic disc cupping and visual field loss due to retinal ganglion cell damage. It is known as the “silent thief of sight,” and represents the most common cause of irreversible blindness worldwide.
As of 2020, about 80 million people globally were living with this chronic condition.1 In the United States alone, more than 3 million people are living with glaucoma.1 Unfortunately, it is estimated that half of glaucoma patients remain undiagnosed.
Improve quality of life with Heru
Heru’s mission is to improve access to care and the quality of life for millions of patients with visual defects and disorders. Heru was born out of the University of Miami’s Bascom Palmer Eye Institute, where the company continues to make advancements in vision technology.
Heru’s technology is the culmination of over 10 years of clinical and scientific research and development. This effort is led by Heru’s founder and CEO, Mohamed Abou Shousha, MD, PhD, Associate Professor of Clinical Ophthalmology at the Bascom Palmer Eye Institute.
After years of feeling limited by options to help improve his patients’ lives, Dr. Abou Shousha became inspired. He and his team of leading physicians, scientists, and engineers set out to develop Heru’s wearable device, which leverages commercially available AR/VR head-mounted displays.
The Heru platform
With Heru’s autonomous, efficient, and accessible technology, providers can enhance the exam experience for millions of patients using state-of-the-art, wearable technology that enables the delivery of better care to more patients while impacting fewer resources.
Small and lightweight, the Heru platform is a portable solution that does not require a designated dark room, allowing providers to collect vital clinical data anytime during a patient's visit—with no dedicated or additional testing space required. Providers can transform the waiting room, use an existing pre-test space, or move it between practices—even tin remote locations.
Clinical equivalence
Heru’s patented re:Imagine™ threshold algorithm adapts and predicts an optimized full-threshold testing workflow without compromising clinical performance, ensuring continuity of care with clinical results comparable to the Humphrey perimeter.2
Increased speed and efficiency
Heru improves productivity with the patented Autoflow™, which minimizes the time between detecting and quantifying disease.
Unlike legacy technology that requires patients to fixate on a static location for uncomfortable lengths of time, Heru’s patented ActiveTrack™ real-time gaze tracking confirms the patient’s fixation is always appropriate. This improves data quality while keeping the patient engaged and focused throughout the exam. Reducing the need for fixation loss monitoring enhances clinic workflow and reduces repeat testing.
Improved patient experience
Patients, especially those with mobility challenges, may dread the conventional perimetry process. Heru’s virtual “personality” creates a relaxing, immersive, and enjoyable exam that teaches, encourages, and supports patients throughout the process.
How it works
In just three easy steps, Heru fits into a clinic’s existing workflow:
- Order the test.
Heru’s innovative cloud-based technology seamlessly integrates into practice workflow. - Patient takes the visual field test.
Patient uses Heru to take a visual field test that is fast and provides immediate results. - Results available in real-time.
Upon completion of the visual field, results are automatically sent to a web portal or EMR.
Safe, secure, and scalable patient data management
The double-encrypted patient database, redundantly held in the cloud, is always accessible and synchronized across multiple sites and devices.
Increase practice revenue while enhancing the patient experience
With 9 vision exams linked to 5 CPT codes, Heru delivers a simple solution to reimbursement for patient care.
- Visual Fields: CPT 92081 | 92082 | 92083
- Color Vision Testing: CPT 92283
- Dark Adaptation: CPT 92284
- Contrast Sensitivity
Heru in practice
Dr. Schweitzer is a glaucoma expert with Vance Thompson Vision, a large OD-MD practice in Sioux Falls, South Dakota. He says he spends about 50-60% of his day managing glaucoma and the rest working with anterior segment disease.
When asked how he became interested in using wearable devices in his glaucoma practice, Schweitzer acknowledged it can be difficult to shift from traditional approaches and try something new.
“We're so used to our standard automated perimetry. We know how to read that. We know how it works, and that's really what we grew up on,” he explained. “Then something like this comes along and you need to wrap your head around it. Once you do, you're going to see there are so many advantages to embracing new technology.”
Expanding optometry’s reach and improving workflow efficiency
Schweitzer said one of those advantages relates to cost, especially for colleagues who are interested in treating and managing glaucoma but are put off by the high price of visual field technology.
“The cost of entry with Heru is low, which makes it easier to adopt the new technology,” he said.
Noting that Heru’s AR/VR wearable headset has been demonstrated to strongly correlate with the gold standard in automated perimetry, Schweitzer believes this will help expand optometry's reach in managing patients with glaucoma.
And since it has such a small footprint and is portable, Heru eliminates bottlenecks seen in exam lanes and improves practice workflow.
“For someone like me who treats a lot of glaucoma on a daily basis, we have a few visual field machines in our practice, but that is the biggest bottleneck we run into,” he said. “Our visual field rooms get backed up, creating challenges for our doctors and technicians. We need something efficient and effective.”
Schweitzer said Heru’s wearable platform can provide that efficiency.
“Heru can help practices to be more efficient as patients can sit in the exam room or pre-test room and perform the test. A specific testing location within the clinic is not required, so patients don’t have to be shuttled from room to room.”
Schweitzer also noted that the device is simple and easy to use for both patients and providers.
“It's a little larger than a pair of glasses and wraps around your head very comfortably as the headband can be adjusted for a customized fit. Patients have remarked that the headset is lightweight and appreciated that the test could be performed while they sat comfortably in their chair."
He added that Heru technology is easy for technicians to use.
“Heru’s virtual onboard personality provides patients with instructions on how to perform the test and keeps them engaged throughout," Schweitzer said. "This frees up technicians to work up the next patient. The onboard personality isn’t necessarily needed though, as it is just such a simple technology to use.”
He further explained that lighting conditions aren’t an issue which is a tremendous benefit.
“You don't have to turn the lights down when using Heru. Testing can be performed in a fully lit room.”
Integrating into clinic workflow
As far as integrating Heru’s wearable platform into a clinic’s workflow, Schweitzer said that depends on how individual clinics are set up.
“In our clinic, we have three visual field machines and they're in specific rooms and they take up some space,” he explained. “I love my visual fields and I look at this as an adjunct to them. I don't think we'll ever stop using those, but the beauty of this is if your technician says, ‘Hey, we're backed up,’ I won't hesitate to utilize a technology like this.”
Schweitzer said when that’s the case, it’s a simple process. The technician sets the patient up and they take the test.
“The technician can even leave while the patient is taking the test if they want to,” he said. “The only challenge is that the test is finished so quickly. With Heru, their Fast Pattern Suprathreshold can be completed in as little as 40 seconds per eye. For the more in-depth Full Threshold exam, it can be as fast as 3.5 minutes. So, there's not an extended period of time that patients are undergoing the exam.”
As far as visual field reports, Schweitzer said they’re interpreted the same way as traditional visual field tests. “There is no learning curve for practitioners, as the Heru report mirrors the report you learned about in optometry school, including the helpful reliability indices and quantitative metrics like mean deviation and foveal threshold.”
Schweitzer noted that it’s also a bonus that the Heru platform comes with several other vision exams. “If you want to perform visual fields on your glaucoma suspect or patient, you can do that. You can also perform dark adaptation and contrast sensitivity if you manage AMD patients, or use color vision testing as part of a patient’s routine comprehensive eye exam."
With visual fields, if pathology is detected, Schweitzer said the Heru platform provides the ability for providers to order a Full Threshold 24-2 or a 10-2.
“With Heru, there is a variety of different fields that can be utilized on a daily basis with glaucoma patients,” he said.
He added that research indicates that the platform’s results strongly correlate with legacy diagnostic devices.
“As physicians, that makes us feel really good about utilizing this technology in clinical practice,” Schweitzer said.
As far as selecting the “ideal candidate” for this type of technology, he believes it would be a good fit across the board.
“It’s really ideal for any type of patient you need a visual field for. Especially those with mobility issues, dread the conventional perimetry process, or had trouble when using legacy diagnostic equipment,” he explained.
The patient experience: new technology that enhances care and delivers a wow factor
When it comes to the patient experience, Schweitzer reinforced that it’s critical to remember the importance of providing exceptional customer service and investing in new technology that focuses on the patient experience.
“Having that wow factor is a big deal,” he said. “When you have technology like this in your practice, patients comment on it, they're interested in it. So, I think it’s a good practice builder, as well.”
Schweitzer also addressed practice revenue.
“You're able to bill for these types of technologies because there are CPT codes that are formulated around them,” he said. The visual field tests available on the Heru platform, as well as dark adaptation and Farnsworth D-15 extended color vision exam, are billable to insurance.
When asked how Heru compares to other wearable technologies on the market, Schweitzer said, “they all have their positives,” but with Heru, “patient comfort is huge and it’s just such a small footprint. I've had a chance to utilize a few of the other types out there and patients love the comfort of the Heru platform.”
As far as how the Heru platform is being used in his practice, Schweitzer said they are currently applying it to research involving more advanced glaucoma and plan to implement it in their clinic to relieve bottlenecks in the workflow.
“We envision using the technology on a new patient that comes in, let's say for a cataract evaluation, whom I happen to identify as a glaucoma suspect. In that case we can do to do the visual field right away,” he explained. “Rather than moving the patient to another room or asking them to come back for a separate appointment, the technician will come in and perform it with the Heru wearable device, so we’ll have a test very quickly. If needed, they can then return for a full glaucoma evaluation.”
He added that it will also be helpful to optimize workflow for their glaucoma patients too.
“We may have multiple glaucoma follow-ups or glaucoma evaluations scheduled, which means the visual field machines can get backed up,” Schweitzer said. “This will allow us to put a patient in a pretesting room or an exam room and perform the visual exam there. I believe Heru can greatly benefit our workflow and efficiency.”
References
- Prevalence of Open-Angle Glaucoma Among Adults in the United States. Arch Ophthalmol. 2004;122(4):532. doi:10.1001/ archopht.122.4.532.
- Goldbach, et al. Visual field measurements using Heru Visual Field Multi-platform application downloaded on two different commercially available augmented reality devices. ARVO Annual Meeting Abstract. June, 2021.
