Attendees entering the 100% Optical trade show
Several common themes emerged across the equipment on offer at this year’s 100% Optical show. From small start-ups to multinational giants, most manufacturers and distributors had a stake in some form of artificial intelligence driven technology. A rising trend was noted in portable instrumentation and enthusiasm for dry eye gadgets showed few signs of waning. eye machine optometrist
Artificial intelligence (AI) has accelerated developments in optometric equipment at a pace unparalleled, at least in my memory. From talking to the equipment manufacturers, I understand few aspects of the patient journey lie untouched by AI.
My first AI experience at 100% Optical was with the Topcon backed Toku, an AI-powered retinal screening software that uses retinal imaging to estimate your biological age and risk of systemic disease.
Professor John Marshall discussed Toku in his presentation on the future of AI and precision medicine in optometry
I was informed that a biological age of five or more years than your actual age was associated with an increased risk of cardiovascular disease. The middle of a busy trade show floor is not the ideal place to find out about impending death but, fortunately, my fundus images were a picture of health.
Buoyed by the outcomes, I turned to my friend to ask how she had fared. It turned out she had fibbed to the technician about her real age, knocking off a few years, but the machine had managed to catch her out.
Next up was a series of companies, including Altris AI and Retina AI, that are making waves in AI-powered retinal optical coherence tomography analysis, and several AI-powered fundus photo analysers from companies including OphtAI by Virtual Care and EyeCheckup.
Key points to look out for with such AI driven systems is the range of conditions they cover (which seem to vary greatly); whether they detect, diagnose and grade the conditions; the research studies that have been undertaken, including how they fare against eye care professionals’ (ECPs) diagnoses, time taken for analysis, and also compatibility with existing practice systems and instrumentation.
‘Vendor neutral’, was a term I heard multiple times, meaning a platform that works irrespective of the machine with which the image was taken. It is worth mentioning that some companies are at great pains to emphasise AI will complement rather than replace the ECP’s role because decision-making still lies with the clinician.
Remote testing, self-testing, and telehealth have all been in the works for many years, but the Covid-19 pandemic catalysed developments in this area. Potential benefits include the ability to access care more easily, monitoring in-between formal eye exams, and a reduced need to travel.
If the instruments can demonstrate their validity and reliability, and professional rules and regulations allow, this is yet another way in which our field could change and adapt to changing demographics. Among the types of equipment on offer was remote visual field screening. The Eyeonic is a cloud based, AI-powered screener.
Users undertake the test on a tablet or computer and results are interpreted by the optometrist. Using a slightly different approach, Virtual Care offers the Oculera VR visual field analyser, a CE certified and Class IIa medical device, which allows a range of visual field-testing paradigms including full threshold and Esterman. Ibisvision has gone further and developed a remote eye examination.
The online platform hosts a suite of 11 online eye exams, among which visual fields and online refraction are also offered. Capturing all the main key trends of the conference (portable, remote and AI), was Olleyes with the virtual reality platform VisuALL. Olleyes uses virtual reality headsets to deliver tests, with a gamified approach for paediatric patients. Another perk of some of these newer pieces of kit is their ability to test in different languages.
Companies involved in the field of remote care or self-testing have begun publishing research showing how outcomes from their devices compare with more conventional gold standard approaches. Not all companies are looking to replace the gold standard, but instead some suggest offering self-testing or remote care as an adjunct to regular eye exams.
As professional guidance is adapted to accommodate these new technologies, a clear distinction will need to be made about where they are appropriate as actual replacements and where they can complement more conventional approaches.
A marked trend towards portable or handheld instruments was evident across many equipment manufacturers and distributors. The motivation underlying these developments was not always made explicit, but drivers may include a desire to save practice space or provide a more comfortable experience for patients who find conventional approaches to testing uncomfortable (for example, young children).
Additionally, given recent evidence showing that the proportion of our lives spent in ill health is increasing, a rise in demand for domiciliary eye care services may be one of the reasons why we are seeing a move towards portable pieces of equipment.
Birmingham Optical and Occuity showcased the Occuity AX1 Axiometer, which is a handheld, portable device to measure axial length.
This will be a welcome addition to the toolkit of ECPs engaging in myopia management. A similar looking instrument, also available via Birmingham Optical, was a portable, non-contact pachymeter, the Occuity PM1. Perhaps not a tool commonly found across practices, but given the interest in extended roles for optometrists, perhaps one to consider.
Other opportunities to downsize focused on fundus cameras: WiFi enabled, handheld or portable or just small. These cameras form part of the product portfolios of many companies and include the Visuscot 100 handheld camera from Zeiss, which comes complete with carry case; the Luna Handheld retinal camera distributed by Frost Optical; and the Optomed Aurora IQ and iCare DRSplus from Mainline.
But the giant of the mini machine world, with perhaps the widest array of portable instruments on offer, was Sunkingdom Medical Instruments. Among its many portable offerings was an electrophysiology testing device.
A divergent approach to marketing seems to be emerging in the world of dry eye with some ECPs leaning towards a more medically focused approach and others appealing to the aesthetics market. Whatever your preference, there were plenty of dry eye diagnostic and treatment related instruments on offer at the ExCel.
EssilorLuxottica ran promotions on the IDRA diagnostic device, which measures lipid layer thickness, meibography, non-invasive break up time and much more, and, for those wishing to provide treatment, there was the Tearstim, an intense regulated pulsed light-based device (IRPL).
Frost Optical is one of the distributors of MeiboVue, a smartphone-based meibographer (another portable device). Grafton Optical launched the DEA Dry Eye Analyser from Moptim, which can be desktop-based or handheld. Among its many functions, the device allows tear meniscus height measurement, meibography and interferometry.
Continuing the portable theme, The Body Doctor is a distributor for the NuLids system, a handheld device for addressing meibomian gland dysfunction or blepharitis related concerns.
For me, the true winners at the show were the classic products. Iconic designs that have withstood scrutiny by generations of ECPs: the Oculus Trial Frames, the Haag Streit B900 series of slit lamps; the Henson visual fields analysers and so on. There is something admirable about the way these test room stalwarts have managed to retain their places in an ever-expanding field.
I was also pleased to revisit approaches that, for some, may have been consigned to history. For example, Heine were exhibiting a headset binocular indirect ophthalmoscope (BIO) which, in case you had not already heard, no longer requires a heavy power pack but instead incorporates a lightweight lithium polymer battery. Perhaps it is time to give the headset BIO another chance?
This year’s show saw the welcome addition of the ophthalmology education stream, which was accompanied by ophthalmology-related exhibits that covered everything from medical lasers through to surgical microscopes. Although much of the content may fall outside an optometrist’s immediate domain, the opportunity to network with other professionals and get better acquainted with details of surgical procedures seemed to be well received by attendees.
Based on conversations with attendees at this year’s 100% Optical show, there was a palpable sense of both excitement and trepidation about the innovative technologies on offer. Our work lives are changing at a pace some of us may not have anticipated, but these new toolkits will likely make us more efficient and adaptable at managing the changing needs of patients.
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