Zachary M Bodnar1, Ronald Schuchard2, David Myung1, Michelle E Tarver2, Mark S Blumenkranz1, Natalie A Afshari3, Mark S Humayun4, Christie Morse5, Ken Nischal6, Michael X Repka7, Derek Sprunger5, Michael Trese7, Malvina B Eydelman2. 1. Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California. 2. Center for Devices and Radiological Health, Division of Ophthalmic and ENT Devices, US Food and Drug Administration, Silver Spring, Maryland. 3. Cornea and Refractive Surgery, FDA Committee,American Society of Cataract and Refractive Surgery, Fairfax, Virginia. 4. American Society of Retinal Specialists, Chicago, Illinois. 5. American Association for Pediatric Ophthalmology and Strabismus, San Francisco, California. 6. Section on Ophthalmology, American Academy of Pediatrics, Itasca, Illinois. 7. American Academy of Ophthalmology, San Francisco, California.
Abstract
IMPORTANCE: The US Food and Drug Administration's medical device regulatory pathway was initially conceived with hardware devices in mind. The emerging market for ophthalmic digital devices necessitates an evolution of this paradigm. OBJECTIVES: To facilitate innovation in ophthalmic digital health with attention to safety and effectiveness. EVIDENCE REVIEW: This article presents a summary of the presentations, discussions, and literature review that occurred during a joint Ophthalmic Digital Health workshop of the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, the American Society of Cataract and Refractive Surgery, the American Society of Retina Specialists, the Byers Eye Institute at Stanford and the US Food and Drug Administration. FINDINGS: Criterion standards and expert graders are critically important in the evaluation of automated systems and telemedicine platforms. Training at all levels is important for the safe and effective operation of digital health devices. The risks associated with automation are substantially increased in rapidly progressive diseases. Cybersecurity and patient privacy warrant meticulous attention. CONCLUSIONS AND RELEVANCE: With appropriate attention to safety and effectiveness, digital health technology could improve screening and treatment of ophthalmic diseases and improve access to care.
IMPORTANCE: The US Food and Drug Administration's medical device regulatory pathway was initially conceived with hardware devices in mind. The emerging market for ophthalmic digital devices necessitates an evolution of this paradigm. OBJECTIVES: To facilitate innovation in ophthalmic digital health with attention to safety and effectiveness. EVIDENCE REVIEW: This article presents a summary of the presentations, discussions, and literature review that occurred during a joint Ophthalmic Digital Health workshop of the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, the American Society of Cataract and Refractive Surgery, the American Society of Retina Specialists, the Byers Eye Institute at Stanford and the US Food and Drug Administration. FINDINGS: Criterion standards and expert graders are critically important in the evaluation of automated systems and telemedicine platforms. Training at all levels is important for the safe and effective operation of digital health devices. The risks associated with automation are substantially increased in rapidly progressive diseases. Cybersecurity and patient privacy warrant meticulous attention. CONCLUSIONS AND RELEVANCE: With appropriate attention to safety and effectiveness, digital health technology could improve screening and treatment of ophthalmic diseases and improve access to care.