eHealth – Digital Health, also for Eyes

The word "eHealth" covers all aspects of the application of digital technologies to the field of healthcare. It includes areas such as diagnostics, prognosis and the monitoring of illnesses as well as other fields, and can be broken down further into subject headings such as telemedicine, electronic patient files or apps on prescription. Professor Stephan Jonas is Head of the Chair of Digital Health at the Technical University of Munich and of the Institute for Medical Informatics at the Bonn University Hospital and stated in an interview: 

Apps which check our visual performance online have a preventive role to play as we all tend to under-estimate when the time for a professional eye test has come round again. Although a digital facility does not replace a professional vision test, it can represent a first step in the right direction thanks to its ease of use.

As smartphone ownership is now almost universal and has become a "maid of all work", it should not be a surprise that it can be used for the benefit of your own health. According to a recent study in Germany, 75% of smartphone users are already using health or fitness apps.¹ 63% of these say that they now know more about their body or state of health thanks to an app. Many apps function more as motivators, while others offer genuine medical value-added. Very few apps are certified as medical devices or even available on prescription in Germany.²

ZEISS is developing several apps for the ophthalmological sector; these apps are not medical devices but can be used by the man or woman in the street and assist them in learning more about their own state of health. One of these is the ZEISS Online Vision Screening. The app provides users with a quick and free indication of their current visual performance, from home or on the go - just by using their smartphone. Deteriorations can be identified faster and therefore action taken earlier, thanks to digitalization. A professional eye test, in-depth consultations and examinations for diagnosing potential health problems are then subsequently performed by an eye care professional.

When developing apps like the ZEISS Online Vision Screening, factors come into play which are different from those that are prevalent in the development of ophthalmological instruments as the apps are to be used by non-professionals. "People were key when answering important initial questions such as: How is the product to be structured, which tests make sense, how should the sequence of tests look, how should instructions be formulated and structured visually, and what do we learn from the experiences we could gather with the former, successful Online Vision Screening," stated Eric Nehrbass, Head of Online Business Solutions and leader of the team at ZEISS Vision Care which developed the app.

Nevertheless as much ophthalmological know-how as possible was incorporated into the app. "Even though no expert uses the app, we can still make use of certain tests which comply with international standards. For example, we use the Landolt C for visual acuity and contrast sensitivity. Color vision is tested using a standard clinical test in which figures are presented in confusion colors" says Nehrbass. However, the online tests cannot replace the extremely accurate professional eye test at the opticians.

Next to the apps which consumers can operate themselves, telemedicine also has a role to play in eye health. The video consultation is only the most basic example. “Many doctors and therapists resorted to teleconsultations during the pandemic; fundamentally speaking, these are a video call for professional purposes. By that I mean that the "analog" process of a visit to the doctor has been directly transferred into a digital dimension in exactly the same way that digitalization in hospitals has generally only changed paper files into digital documents. In essence, digitalization is a disruptive process which also challenges all existing procedures and structures to optimize processes and shape them around the user”, explained Professor Jonas.

How this could be solved, nicely shows the example of ZEISS VISU360: this platform can use remote access to link ophthalmological and optical experts with consumers and patients. With the help of telemedicine, technical staff can make it possible for patients to be examined, assessed and looked after by doctors and eye care professional in a totally different location. In this way, for example, specialists can open a second, remote practice in which they can care for patients digitally from a distance. Also problems of the demographic change can be addressed, i.e. older, less mobile people can still get an appointment with a specialist without having to travel long distances, without long waiting times and without possibly having to "master" the technology themselves from home. This innovative solution integrates all of the diagnostic data from devices and examinations, from retina screening and consultations through to refraction. 

No, a visit to the eye care professional cannot be replaced by digital means, just as there is no replacement for treatment by a qualified ophthalmologist or optician. But thanks to eHealth, some steps at specific positions are being digitalized - to the patient's benefit. As in all matters connected to digitalization, data protection is the topmost priority - and never more so than with sensitive data relating to health. In the case of some apps, the users have to take a long, hard look at security aspects, but other medical devices such as ZEISS VISU360 have undergone stringent checks and been certified for their ability to protect patients' data. The digitalization of health is a subject which, like many apps, is a long way from reaching the end-point of its development. It is quite certain that new doors and opportunities will continue to open up, particularly for consumers.

¹ Source: https://www.bitkom-research.de/system/files/document/Pr%C3%A4sentation_DigitalHealth2020.pdf // Population of 909 smartphone users over 16 years of age in Germany

² https://www.bfarm.de/SharedDocs/Pressemitteilungen/DE/2020/pm4-2020.html