OPHTHALMIC OPERATING ROOM MICROSCOPE IS USED BY EYE DOCTORS I.E., OPHTHALMOLOGISTS WHO ARE SPECIALISTS IN EYE AND VISION CARE. OPHTHALMOLOGISTS ARE TRAINED TO DIAGNOSE AND TREAT DISEASES, PERFORM EYE TESTS, PRESCRIBE MEDICATION, AND PERFORM EYE SURGERIES. A POSITIVE ASSOCIATION BETWEEN OPHTHALMOLOGIST DENSITY AND INCOME I.E., AN AVERAGE 76.2 PER MILLION POPULATION IN HIGH INCOME COUNTRIES AND A MEAN 3.7 IN LOW-INCOME COUNTRIES HAS BEEN REPORTED. HOWEVER, THE CORRELATION BETWEEN BLINDNESS AND OPHTHALMOLOGISTS WAS INVERSE. MOST COUNTRIES REPORTED A POSITIVE 60.3% GROWTH IN NUMBER OF OPHTHALMOLOGISTS.
WITH THE INCREASE OF GERIATRIC POPULATION, THERE IS A TREMENDOUS INCREASE IN THE NUMBER OF OPHTHALMIC PATIENTS. TO ACCOMMODATE THIS, INCREASE THE NUMBER OF OPHTHALMOLOGISTS AND OPHTHALMIC DEVICES ARE ON THE RISE ALL AROUND THE WORLD. THERE IS STILL A HUGE GAP BETWEEN TREATMENT AVAILABILITY BETWEEN HIGH INCOME AND LOW-INCOME COUNTRIES. IN 2017, ZEISS MEDITECH ESTIMATED AN INCREASE OF 55% EYE PATIENTS IN THE COMING YEARS. ALSO, GREATER THAN 25 MILLION CATARACT SURGERIES ARE PERFORMED IN A YEAR GLOBALLY. ADDITIONALLY, WITH 9.3% OF THE WORLD POPULATION HAVING DIABETES IN 2019, IT IS ESTIMATED THAT >75% OF THEM WILL DEVELOP OF DIABETES RETINOPATHY.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
AS SHOWN IN FIG 1. ?E UNDERLYING TECHNOLOGIES ARE SEEN
AS A BLACK BOX TO THE USERS AND THEY ARE RESPONSIBLE FOR
FACILITATING PROCESSES OF EACH PROPOSED SERVICE
.......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...........
....................................... ................................
EDUCATION AND PRACTICE FUNDAMENTALS
" INTRODUCTION TO THE PRACTICE OF TELEMEDICINE
JOHN CRAIG* AND VICTOR PATTERSON*
W
?
DEPARTMENT OF NEUROLOGY, ROYAL VICTORIA HOSPITAL, BELFAST, UK;
W
CENTRE FOR ONLINE HEALTH, UNIVERSITY OF QUEENSLAND, BRISBANE,
AUSTRALIA
SUMMARY
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE AND THE EXCHANGE OF HEALTH-CARE INFORMATION ACROSS DISTANCES. IT IS NOT
A TECHNOLOGY OR A SEPARATE OR NEW BRANCH OF MEDICINE. TELEMEDICINE EPISODES MAY BE CLASSI?ED ON THE BASIS OF:
(1) THE INTERACTION BETWEEN THE CLIENT AND THE EXPERT (I.E. REALTIME OR PRERECORDED), AND (2) THE TYPE OF
INFORMATION BEING TRANSMITTED (E.G. TEXT, AUDIO, VIDEO). MUCH OF THE TELEMEDICINE WHICH IS NOW PRACTISED IS
PERFORMED IN INDUSTRIALIZED COUNTRIES, SUCH AS THE USA, BUT THERE IS INCREASING INTEREST IN THE USE OF TELEMEDICINE
IN DEVELOPING COUNTRIES. THERE ARE BASICALLY TWO CONDITIONS UNDER WHICH TELEMEDICINE SHOULD BE CONSIDERED:
(1) WHEN THERE IS NO ALTERNATIVE (E.G. IN EMERGENCIES IN REMOTE ENVIRONMENTS), AND (2) WHEN IT IS BETTER THAN
EXISTING CONVENTIONAL SERVICES (E.G. TELERADIOLOGY FOR RURAL HOSPITALS). FOR EXAMPLE, TELEMEDICINE CAN BE EXPECTED
TO IMPROVE EQUITY OF ACCESS TO HEALTH CARE, THE QUALITY OF THAT CARE, AND THE EF?CIENCY BY WHICH IT IS DELIVERED.
RESEARCH IN TELEMEDICINE INCREASED STEADILY IN THE LATE 1990S, ALTHOUGH THE QUALITY OF THE RESEARCH COULD BE
IMPROVED-THERE HAVE BEEN FEW RANDOMIZED CONTROLLED TRIALS TO DATE.
INTRODUCTION
ONE OF THE GREAT CHALLENGES FACING HUMANKIND IN THE
21ST CENTURY IS TO MAKE HIGH-QUALITY HEALTH CARE AVAILABLE
TO ALL. SUCH A VISION HAS BEEN EXPRESSED BY THE WORLD
HEALTH ORGANIZATION (WHO) IN ITS HEALTH-FOR-ALL STRATEGY
IN THE 21ST CENTURY.
1
REALIZING THIS VISION WILL BE DIF?CULT,
PERHAPS IMPOSSIBLE, BECAUSE OF THE BURDENS IMPOSED ON
A GROWING WORLD POPULATION BY OLD AND NEW DISEASES,
RISING EXPECTATIONS FOR HEALTH, AND SOCIOECONOMIC
CONDITIONS THAT HAVE, IF ANYTHING, INCREASED DISPARITIES IN
HEALTH STATUS BETWEEN AND WITHIN COUNTRIES.
TRADITIONALLY, PART OF THE DIF?CULTY IN ACHIEVING
EQUITABLE ACCESS TO HEALTH CARE HAS BEEN THAT THE
PROVIDER AND THE RECIPIENT MUST BE PRESENT IN THE SAME
PLACE AND AT THE SAME TIME. RECENT ADVANCES IN
INFORMATION AND COMMUNICATION TECHNOLOGIES,
HOWEVER, HAVE CREATED UNPRECEDENTED OPPORTUNITIES FOR
OVERCOMING THIS BY INCREASING THE NUMBER OF WAYS THAT
HEALTH CARE CAN BE DELIVERED. THIS APPLIES BOTH TO
DEVELOPING COUNTRIES WITH WEAK OR UNSTABLE ECONOMIES
AND TO INDUSTRIALIZED COUNTRIES. THE POSSIBILITIES FOR
USING INFORMATION AND COMMUNICATION TECHNOLOGIES TO
IMPROVE HEALTH-CARE DELIVERY ( HEALTH TELEMATICS ) ARE
INCREASINGLY BEING RECOGNIZED. THE WHO HAS STATED THAT
WITH REGARD TO ITS HEALTH-FOR-ALL STRATEGY IT RECOMMENDS
THAT THE WHO AND ITS MEMBER STATES SHOULD:
INTEGRATE THE APPROPRIATE USE OF HEALTH TELEMATICS IN
THE OVERALL POLICY AND STRATEGY FOR THE ATTAINMENT OF
HEALTH FOR ALL IN THE 21ST CENTURY, THUS FUL?LLING THE
VISION OF A WORLD IN WHICH THE BENE?TS OF SCIENCE,
TECHNOLOGY AND PUBLIC HEALTH DEVELOPMENT ARE MADE
EQUITABLY AVAILABLE TO ALL PEOPLE EVERYWHERE.
2
SUCH A COMMITMENT TO IMPROVE HEALTH-CARE DELIVERY,
BY UTILIZING INFORMATION AND TELECOMMUNICATIONS
TECHNOLOGIES, IS ALSO BEING CONSIDERED BY THOSE WITH THE
?NANCIAL MEANS TO DO SO, FOR EXAMPLE, THE PARTICIPANTS
IN VARIOUS EUROPEAN COMMISSION PROJECTS. AT THE
NATIONAL AND SUBNATIONAL LEVEL, THERE IS ALSO EVIDENCE OF
GOVERNMENTAL INTEREST IN THE BENE?TS THAT THESE
TECHNOLOGIES MIGHT BRING TO HEALTH CARE. FOR EXAMPLE,
IN THE UK, INFORMATION TECHNOLOGY INCLUDING
TELEMEDICINE IS AT THE HEART OF THE GOVERNMENT S
STRATEGY TO MODERNIZE AND IMPROVE THE NHS.
3
TELEMEDICINE, THE AREA WHERE MEDICINE AND INFOR-
MATION AND TELECOMMUNICATIONS TECHNOLOGY MEET, IS
PROBABLY THE PART OF THIS REVOLUTION THAT COULD HAVE THE
GREATEST IMPACT ON HEALTHCARE DELIVERY
OPHTHALMIC OPERATING ROOM MICROSCOPES ARE DESIGNED FOR SURGICAL PROCEDURES. EYES ARE AN EXTREMELY DELICATE ORGAN AND SO THESE DEVICES NEED TO BE ABLE TO MONITOR PROGRESS AT MICRO-LEVEL. OPHTHALMIC MICROSCOPES PROVIDE A DETAILED AND HIGH CONTRAST IMAGING OF ALL REGIONS OF THE HUMAN EYE. AN APOCHROMATIC (APO) LENS WILL PROVIDE HIGH QUALITY IMAGING AT LOWER LIGHT INTENSITIES. OTHER MICROSCOPES PROVIDE MULTIPLE LIGHTING OPTIONS AND CAN SWITCH BETWEEN XENON AND HALOGEN BULBS.
BASED ON TYPES, THE OPHTHALMIC OPERATING ROOM MICROSCOPE MARKET IS FRAGMENTED INTO ON CASTERS, WALL MOUNT, TABLETOP AND CEILING MOUNTED. THE MODERN MICROSCOPE HAS A PRECISION MOTORIZED MECHANICS AS SUPPORTING STRUCTURE SO THE MICROSCOPE CAN BE BALANCED EASILY AND FLEXIBLY ADJUSTED TO THE RIGHT POSITION. THE FUNDAMENTAL TASK OF THE SUPPORTING STRUCTURE IS TO KEEP THE MICROSCOPE STABLE. VARIOUS CONTROLLING METHODS HAVE BEEN DEVELOPED FOR HANDS-FREE OPERATION REDUCING THE STRAIN ON SURGEONS DURING LONG SURGERY HOURS.
BASED ON APPLICATION, OPHTHALMIC OPERATING ROOM MICROSCOPE MARKET IS DIVIDED INTO CATARACT SURGERY, LASIK, KERATOPLASTY SURGERY, TRABECULECTOMY AND OTHER. ROUGHLY 9.2 MILLION AMERICANS GOT LASIK SURGERIES IN 2019 AND A TOTAL OF 40 MILLION LASIK SURGERIES HAVE BEEN PERFORMED FROM 1991 TO 2016. ADDITIONALLY, 1.7 MILLION INDIVIDUALS IN U.S. GOT A CATARACT SURGERY IN 2019 AND THIS NUMBER IS INCREASING EVERY YEAR. OTHER THAN THAT, TRABECULECTOMY IS A PROCEDURE USED TO TREAT GLAUCOMA BY LOWERING THE EYE PRESSURE. KERATOPLASTY ON THE OTHER HAND, IS THE REPLACEMENT THE NATURAL CORNEA BY SURGERY.
BASED ON END-USER, THE OPHTHALMIC OPERATING ROOM MICROSCOPE MARKET IS DIVIDED INTO HOSPITALS, AMBULATORY SURGICAL CENTERS, OPHTHALMOLOGY CLINICS AND OTHERS. AMBULATORY SURGICAL CENTERS ARE FORECASTED TO RISE BY THE HIGHEST RATE IN THE FORECASTED PERIOD. THE KEY FACTOR OF THIS IS THE RISE IN SURGICAL COSTS. INSURERS RECOMMEND PATIENTS TO UNDERGO SURGERIES AT AMBULATORY SURGICAL CENTERS (ASCS) RATHER THAN OUTPATIENT DEPARTMENTS IN HOSPITALS.
FOR A BETTER UNDERSTANDING OF THE MARKET ADOPTION OF THE OPHTHALMIC OPERATING ROOM MICROSCOPE MARKET, THE MARKET IS ANALYSED BASED ON ITS WORLDWIDE PRESENCE IN THE COUNTRIES SUCH AS NORTH AMERICA (UNITED STATES, CANADA, AND REST OF NORTH AMERICA), EUROPE (GERMANY, FRANCE, ITALY, SPAIN, UNITED KINGDOM AND -REST OF EUROPE), ASIA-PACIFIC (CHINA, JAPAN, INDIA, AUSTRALIA, AND REST OF APAC), AND REST OF WORLD. NORTH AMERICA CONSTITUTES A MAJOR MARKET FOR THE OPHTHALMIC OPERATING ROOM MICROSCOPE INDUSTRY AND GENERATED MAXIMUM REVENUE IN 2020 OWING TO THE INCREASING NUMBER OF CHRONIC DISEASES, AND RISING HEALTHCARE SPENDING IN THE REGION.
SOME OF THE MAJOR PLAYERS OPERATING IN THE MARKET INCLUDE ALCON (NOVARTIS AG), JOHNSON & JOHNSON LIMITED, CARL ZEISS MEDITEC AG, INAMI & CO., LTD., TAKAGI SEIKO CO., LTD., DANAHER CORPORATION (LEICA MICROSYSTEMS), TOPCON CORPORATION, KARL KAPS GMBH & CO.KG, METALL ZUG GROUP (HAAG-STREIT HOLDING), SEILER INSTRUMENT INC. SEVERAL M&AS ALONG WITH PARTNERSHIPS HAVE BEEN UNDERTAKEN BY THESE PLAYERS TO DEVELOP OPHTHALMIC OPERATING ROOM MICROSCOPE MARKET.
OPHTHALMIC OPERATING ROOM MICROSCOPE MARKET WAS VALUED US$ 483.5 MILLION IN 2020 AND IS EXPECTED TO GROW AT A CAGR OF 5.9% TO REACH A MARKET VALUATION OF US$ 722.1 MILLION BY THE YEAR 2027F. THE MARKET IS EXPECTED TO WITNESS A BOOST ON INCREASING PATIENT POOL AND HIGHER CHRONIC ILLNESSES ARE AUGMENTING THE NEED FOR EYE TREATMENTS SUCH AS DIABETIC RETINOPATHY GLOBALLY. THE INVESTMENTS RAISED BY THESE INDUSTRIES ARE INCREASING THE NUMBER OF OPHTHALMOLOGISTS AVAILABLE WORLDWIDE.
