Stephane Wolf, Novartis Global Head Digital Health Solutions, Ophthalmology on:

How innovation in Digital Therapeutics and Solutions will help save peoples’ sight

By Teresa Murray, freelance writer for Healthtech & Giant Health Conference Team Writer 

Imagine for a moment an elderly person living quite a long way from a health structure,
getting into a car or a bus, and making their way there. Now, imagine that same person trying
to do that same thing with a big black blog right smack in the middle of their field of vision.
That’s what having Wet Macular Degeneration is like. To keep from going blind, people
suffering from this condition need to get themselves to their clinic for monitoring and
treatment on a regular basis.

No easy feat with the big black blob.

This makes sufferers dependent on someone else, which let’s face it, no-one likes. But, also
not everyone has someone to help. So, as Stephane Wolf, Global Head Digital Health
Solutions, Ophthalmology at Novartis explains, the problem is that the person doesn’t go as
often as they should to monitor their condition, or for treatment. Worse still, they simply don’t
go at all.

When patients don’t go enough or receive timely treatment, their condition gets progressively
worse and tragically too many end up losing their vision because of non-adherence. An
avoidable outcome.

The figures that Stephane relates are concerning. Non-adherence to treatment is the case for
over 40% of patients diagnosed with this condition just in the first year. This does not include
the thousands, or even hundreds of thousands, that remain undiagnosed. For a condition
where early detection and ongoing treatment are critical, low adherence and high defaulter
rates can mean going blind.

This is a real-world problem that Stephane and his team at Novartis plan to fix.

Stephane sees innovation in digital devices as a game changer for people with this condition.
And other conditions too. For too long, Stephane says, ophthalmology lagged behind other
chronic conditions in the development of digital therapeutics and solutions.

But, it is catching up fast, because as Stephane says, nothing is more precious for most of us
than our ability to see and perceive.

In the case of wet aged-related Macular Degeneration, digital therapeutics means taking the
diagnostic device out of the specialist’s consultancy room and putting it in the hands of the
patient to do the monitoring themselves at home using a smart device. This device will take a
scan of the back of the retina and with simplicity for patient use at the forefront of design, it
will signal either green, orange or red. This way the person knows if, and when, they should go
to the clinic for confirmation of treatment.

Medical grade vision testing has already been launched to monitor patients’ vision remotely
and detect when the patient may need to have additional treatment. Novartis launched
Odysight in France, Spain and the US in collaboration with Tilak Healthcare.

Deploying this simple to use technology is not however a simple technological feat. Apart from
making it portable, to get an accurate reading it is necessary to equip the device with
mechanisms that control for false readings generated through improper use by the person, like
holding the smartphone too close to their eyes. The software also needs capacity to adapt
automatically to the huge range of lighting conditions in homes to produce accurate visual
acuity testing.

Designing solutions for home monitoring is almost more complex than for clinic settings. Not
only do they have to provide accurate metrics despite being in the uncontrolled and varied
environments of homes, they must also be self-operated by patients who often have co-
morbid conditions. And, of course they must also be affordable.

Quite a challenge!

But Stephane says not only is this possible, it’s feasible and it’s happening. The barrier he
explains is not so much the optometric devices, but the interpretation of the image, a problem
that ultimately AI will resolve.

Stephane is all about immersion in the world of the patient’s journey and reality, and
passionate about leveraging digital and non-digital solutions that improve patient outcomes at
scale and solve problems. After all, he says, what is the point in developing the best drug
therapies or the best medical devices in the world if diagnosis is too late, absent even, and
adherence or default rates so low that impact is substantially lowered.

For Stephane, addressing adherence rates is key, and from his perspective, adherence and
compliance to treatments don’t cross over well from the world of clinical trials to the real
worlds of patients. Clinical trials have to eliminate too much of what makes the world real, and
patient behaviour and attitudes in clinical trials conditions are not really representative of
everyday life, especially when it comes to treatment compliance.

Digital solutions on the other hand provide key capacities to leverage useful real world
evidence. Using real world realities to design improvements across the patient’s journey, to
improve diagnostic and monitoring capabilities, and boost treatment adherence, is in
Stephane’s view what really matters.

And everyone along the continuum of care benefits.

Importantly, digital therapeutics and digital solutions in Stephane’s experience can enhance
the patient’s experience of treatments and devices. A great example is the story he tells of
Amblyopia, or commonly known as lazy eye. This condition, caused by a physical defect
causing one eye to not see well produces an almost exclusive reliance by the brain on the good
eye and so impedes the forming of 3 D images of what the brain is seeing.

Being able to see in 3D is fundamental to many activities. Stephane gives the example of sports
but it affects many. Once surgery corrects the physical problem, then it is necessary to
address the imbalance problem caused by the brain’s habit in only processing from the good
eye. Currently, to do this a patch must be worn over the good eye for 6 or 7 hours per day. The
aim of the patch is to retrain the brain to see with the previously lazy eye.

However, understandably, this is an example of a treatment protocol that is extremely
uncomfortable for the patch-wearer because at the beginning they can barely even see. So, as Stephane explains, unfortunately a high percentage of patients do not complete the recovery treatment and consequently don’t ever fully regain their full vision capacity.

Another real-world problem.

Enter Digital Therapeutics and gaming! Yes, gaming!

Stephane explains how Novartis is partnering with Ubisoft to develop technology that will
essentially do away with the patch. Instead, the person’s brain will retrain while playing an
entertaining video game for an hour or watching a movie. The technology will do the re-
balancing while the person engages with the game or movie by requiring a progressive use of
both eyes.

https://www.novartis.com/news/media-releases/novartis-acquires-amblyotech-pursuing-
novel-digital-therapy-children-and-adult-patients-lazy-eye

Like the patch but fun!

This technology is easy to use and does not carry the same social stigma as wearing a patch as
well as allowing the person to see. So, as Stephane reiterates, by improving the patient
experience, you improve the outcomes. Digital therapeutics combined with gaming design can
provide more engaging patient experiences.

Stephane envisages scenarios like these where digital therapeutics will move into the realms of
treatment, moving steadfastly beyond the pill. Of course, he does not see digital therapeutics
replacing drug therapy but rather occupying spaces where they can bring about better impact
at scale. Improving early detection, monitoring and diagnostic capacities at scale will in
Stephane’s view be made possible with advances in artificial intelligence, particularly with AI
capacity to process images.

The example that Stephane gives for this takes us back to image capturing for conditions such
as diabetic retinopathy, a common long term side effect from diabetes. Diagnosis is today
dependent on a specialist’s interpretation of the fundus picture. It is not possible for a GP to
do it. This dependence on a specialist translates into long waiting lists and late diagnosis or
under diagnosis. AI capacities, capable of screening and diagnosing faster and more
consistently by using increased automation will be a game changer for health care in the near
future in Stephane’s view.

In the case of diabetic retinopathy, this is already a reality.

This means that it feasible for a technician or GP to diagnose a patient as long as they have the
appropriate equipment. The diagnostic work is done automatically and is immediate.

Imagine just how many more conditions and patients could benefit from such technologies
Stephane says.

Maybe, he dreams, there will even be a day where advances in prevention and monitoring will
result in people not even becoming sick in the first place, or at least much less frequently.
Combine this with better early detection for exponentially more people means better
prognosis producing reduced rates of global disease and knock on benefits in quality of life and
productivity. Again, everybody wins.

Stephane and Novartis are firm believers in cultivating partnerships, fully aware that it is
impossible for pharma to control or own every innovation being conceived or developed.
Pharma does however occupy multiple, privileged spaces and spheres of influence. Because of
this Stephane sees that it can play a critical role in helping physicians to see digital solutions as
an opportunity to improve their quality of care and increase patient numbers, rather than as
an existential threat to their roles.

Not only this but by pharma being key players in more complex ecosystems and through
partnerships, digital innovation solutions can be driven forward faster to resolve real world
problems in healthcare and most of to all help patients.

And this dream is quickly becoming a reality.

Stephane Wolf is a panellist at this year’s Giant Health Conference and will be participating in the panel discussion: A Pharma Perspective: Deploying DTx through Partnerships on 30th Nov 2021 after the Welcome Address on the Main Stage.

Don’t miss it!