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Special Communication
June 6, 2019

Evaluating New Ophthalmic Digital Devices for Safety and Effectiveness in the Context of Rapid Technological Development

Author Affiliations
  • 1Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
  • 2Center for Devices and Radiological Health, Division of Ophthalmic and ENT Devices, US Food and Drug Administration, Silver Spring, Maryland
  • 3Cornea and Refractive Surgery, FDA Committee,American Society of Cataract and Refractive Surgery, Fairfax, Virginia
  • 4American Society of Retinal Specialists, Chicago, Illinois
  • 5American Association for Pediatric Ophthalmology and Strabismus, San Francisco, California
  • 6Section on Ophthalmology, American Academy of Pediatrics, Itasca, Illinois
  • 7American Academy of Ophthalmology, San Francisco, California
JAMA Ophthalmol. Published online June 6, 2019. doi:10.1001/jamaophthalmol.2019.1576
Key Points

Question  How could ophthalmic digital devices be evaluated for safety and effectiveness to streamline innovation?

Findings  This Special Communication from a workshop on ophthalmic digital devices comprising regulators, health care practitioners, researchers, medical device firms, mobile application developers, patients, and other stakeholders concluded that because of the risks associated with automation are substantially increased in rapidly progressive diseases, 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, and to promote cybersecurity and protect patient privacy.

Meaning  With appropriate validation against criterion standards, physician oversight, and robust cybersecurity protocols, digital health technology could improve screening and treatment of ophthalmic diseases and improve access to care.

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.

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