Technology for Access – Insights on the utility of IAPB Eye Health Technology Guide – A Q and A with Datuk Dr. Nor Fariza binti Ngah

1. Please describe a little about your interest in technology for eye health and why you think the Guide for Eye Health Technology is useful for your organization? 

Technology for eye health is evolving very fast and dynamic. A lot of new ideas and innovation emerged especially in the field of Artificial Intelligence, machine learning, new devices/ equipment and many more. Being a Medical Retina Consultant, I have observed and been engaged in screening activities as well as managing the complications of diseases such as Diabetes and Diabetic retinopathy/maculopathy. This is one of the key reasons for my interest in eye health technology as I can see potential in incorporating it into my services. 

New technology is necessary in order to develop quicker, safer, and more timely screening tool that can reduce or shorten the waiting time and the screening time while being affordable and accessible to all patients. 

To develop a new technology is not easy and requires expertise, knowledge, and the ability to simultaneously apply to the population of interest. Guidance and understanding on the eye health technologies must be made available for references to the newcomers in the field. I found it incredibly helpful to refer to the documents, particularly when I was approached for new projects. 

2.Have you used the Guide? Please describe how you have used the guide and how it was helpful. 

Yes, I have used the guide to gain more information regarding the technology access framework as well as the technology readiness scale. I have also shared the information with my research team for them to read and use it as a guide when conducting or considering any technological research or innovation. 

3. Can you think of an example of an Eye Health Technology that really stands out as having created a big impact in the way services are delivered or increased uptake of eye care services? Please describe the technology and why you think it was able to have such an impact.  

For me, the most impactful usage of technology that my team has created was the online training for Diabetic Retinopathy Screening Workshop. We have been utilizing it since 2022.   

Previously, our DR Screening workshops were organized physically by a team of Ophthalmologists, Optometrists, and paramedic staff. Attendees were either a group of Medical Officers / Paramedic personnel or those involved with diabetic retinopathy screening activities using fundus camera to capture images. This method is very time consuming, and for 1.5 days, the effectiveness of the sessions was never certain.  

Considering this concern, my team which consist of Ophthalmologists, Endocrinologists, Optometrist, and Paramedic have decided to create an online module for the similar workshop. We call it DRS-e-module. With the assistance of a local sponsor, we were able to do the startup planning, including the recording of each session and establish the platform for those who wished to acquire knowledge about DRS as well as part of compulsory session for the post basic trainee’s syllabus, for first year masters in Ophthalmology and those doing external paper in Ophthalmology.  

We completed and launched the DRS e-module just in time during the pandemic Covid-19 in 2022. Regardless of limitation in conducting physical session, continuous medical education still needs to be provided. With the innovation offered, the target group can go online and enjoy the sessions at their own leisure at home.  

The advantages of this eye health technology (online training) are: 

• Easy access for everyone- they can use their own computer/ smart phone to listen to the lectures and given 2 weeks to complete including performing the test. 
• Affordable- at minimal cost- basically for us to maintain the cost for the website. 
• More participants can join the session- unlimited pax per session. 

• Not interrupting with services as they can join the session at anytime and anywhere. 

Upon completion of the online training session, those who successfully complete the sessions and achieve a passing score of at least 80% will be awarded a certificate. For those who are going for the DR grader, a clinic attachment will be arranged, and they will sit for a grader’s test, after which they will be given credentialing and privilege certificate by the state Health Department. 

The National program for DR screening makes this technology impactful. Those involved directly with diabetic care will have a clear understanding of their responsibility to refer the patients for DR screening. On the other hand, those involved in the screening process must be knowledgeable and capable to grade the good/ acceptable image of the retina. 

The e-module DRScreening website is https://www.drsmodule.org.my/ and we have more than 1100 participants from all categories registered with the system.               

4. What challenges have you faced when introducing new technology into eye care services? Do you think the Guide will be useful to help identify challenges earlier and increase the likelihood of sustained use of the technology? 

 Challenges 

• The primary challenge lies in the general acceptance of the new technologies, be they equipment-related, new innovations or new drugs.  
• The second is the need for financial support, as the process of creating new things often requires significant investment.  

• Furthermore, expertise is yet another challenge that we need to take into account when looking at this matter. We, as clinicians, can have many great ideas, but to implement, to design and to think beyond our capacity and capability is very challenging. Nonetheless, once it happened, it is certainly worth it. 

 Utility of the guide to help identify challenges and increase the likelihood of sustained use of the technology 

• This guide can provide valuable assistance, especially for beginners, in determining the necessary requirements and evaluating the potential impact and benefits of the technology to a larger group of population, or just for a certain user.  
• With this guide, we can also make plans for financial support, including guidance on identifying and applying for grants, assessing their availability, and exploring potential industry support opportunities. 

5. What advice would you give to eyecare provider organizations or governments in adopting and implementing technology for eye care services? 

In order to adopt or integrate the new technology in eye care services, one must consider several key factors. These include the capacity to yield high impact at low cost, the ability to reach the entire population regardless of location, user-friendliness, as well as considerations of efficiency and safety.   

6. How can the IAPB eye health technology guide help when implementing technology into eye care services? 

This IAPB Eye health technology guide can be valuable resource for inventors, innovators, and researchers in the field of eye care. It provides a comprehensive overview of the essential technologies that are relevant to their respective areas of focus. By leveraging new technologies or improving existing ones, it may be possible to enhance the quality and accessibility of eye care services. This guideline may not be complete or detail, but it offers an excellent reference specifically for eye care.  

7. What current or future developments in technology do you see as having the most potential for improving eye health services? 

It is widely acknowledged that ophthalmology is a discipline that depends extensively on various gadgets and instruments. These include the use of slit lamp biomicroscope with handheld lenses for diagnosis, as well as diagnostic tool such as Optical Coherent Tomography (OCT), fundus fluorescein angiogram (FFA), Indocyanine Green Angiography (ICGA), perimetry, automated visual field and many more to aid in the diagnosis, monitoring and decision making for the management of the cases. All of this will have images and with the inclusion of images in this context enables the development and implementation of Artificial Intelligence (AI), Machine Learning (ML), and Deep Learning (DL) to enhance the efficiency and accuracy of algorithm, thereby facilitating the process of diagnosis and management planning.    

AI has demonstrated significant practicality in the field of eye disease both presently and in the years to come. It possesses huge potential for further development, particularly in the realm of multimodal imaging, to create the most optimal, easily accessible cost-effective, user-friendly, and accurate technology for specific eye care needs.