Centervue is making some really amazing cameras, the Eidon and the new Compass are by far the easiest fundus cameras to use on the market and give great images. Matching this process with Centervue's cameras would be useful and help eliminate a lot of the artifacts you have to deal with. ( It looks like most of these images were taken with Zeiss, probably the FF450 and the Visucam, and Topcon TRC 50 series cameras. You can tell by the masking markers on the images)
My company (unifiedimaging.com), does cloud based image management for ophthalmology (we also upgrade old fundus cameras).
We are actually working on a diabetic screening program with a few local clinics and have been playing around with the idea of using an automated grading system. We currently have over 100,000 images and the number is growing every day. The images are all stored separately from the PHI, so we'd love to help contribute to training sets if anyone is interested.
In this case, that is not true at all. I worked for a large retina group for 6 years and now consult for several different retina and general ophthalmology practices, so I'm a little biased, but I've also been lucky enough to see these new drugs through various stages.
First of all, Doctors are the ones buying the drug, and they have to keep enough inventory on hand to treat the patients that need it until the next delivery day. The introduction of these higher priced biologics has had a huge affect on the way practices (especially smaller ones) have to manage their inventory. The last practice I worked for was buying between $1.2 and $1.8 millon worth of lucentis, a few hundred grand worth of Eyelea and a boatload Avastin every month. If anything goes wrong during the reimbursement process and the practice isn't paid as expected, it can be devastating. When the use of these drugs started ramping up, there were definitely a few scary payroll periods for us. Putting the right inventory management procedures in place significantly helps this problem, but there's definitely some stress knowing you're on the hook for over 2mil each month.
Genentech's rebate and Regeneron's extended payment terms are efforts to alleviate some of this stress on providers while ensuring they are keeping enough stock on hand that they aren't having to bring patients back for a follow up visits just to order the drug. (some practices will see a patient, diagnosis, reschedule for follow up injection, then order the drug. This just wastes everyone's time)
Even more importantly though, as said elsewhere in the comments, these drugs are definitely not the same. A lot of us, even the docs, in the industry joked about the high price of Lucentis when it first came out and many doctors (though I'm not sure on the exact number, but I think I remember hearing 80% of anti-vegF injections were Avastin not lucentis) used avastin over lucentis specifically because of the price.
In the past few years however, this thinking has changed and it has very little to do with the reimbursement model. In the beginning, these drugs were simply awe inspiring. Before the availability of these drugs, a retina doc's approach to AMD was, "here's an amsler grid.. let me know if anything changes (it will), we'll see you in 6 months to asses how much more blind you've become. There are some vitamins you can take that might slow things down (barely), and oh yeah, there is this cold laser treatment we can try(PDT)that will just shut down that area and maybe prevent the spread. That treatment is going to require us to infuse you with a drug for 15 min, then shoot a laser in your eye for 83 seconds.. oh then after that, we are going to wrap you like a mummy because any form of UV is going to burn the shit out of you.. fun stuf"
Now all of a sudden here is a drug (Avastin) that takes half a second to inject, and not only preserves the vision that you have, but if we catch the leakage early, it can even dry it up and improve your vision! I was fortunate enough to work on some of the early trials and honestly the follow up visits were just breathtaking. NVAMD used to be a death sentence to vision.. now it's merely an inconvenience that can be overcome.
With that success came Lucentis (Avastin was being used totally off label) an FDA approved drug that was crazy expensive. Patient's couldn't afford it, no one really used it. Then medicare and some other insurances started having issues with off-label use and it actually became easier to get reimbursed for using Lucentis. The CATT trial started and some issues started being raised over whether or not Avastin was actually safe long term. Then there was the scare in Florida were a batch of Avastin from a compound pharmacy was contaminated and a ton of patients lost their sight to infections. So we started using Lucentis a little more frequently, just to see. While the Catt trial shows the two drugs are pretty equivalent.. in everyday practice, it's becoming more apparent that this is not the case. Some forms of AMD respond better to lucentis than Avastin. Diabetics with Macular Edema sometimes respond quicker to Lucentis (and even faster with Eylea!) It becomes more about finding the right drug for the individual patient than just choosing the cheapest option. Most doctors are not trying to screw their patients over, and have protocols in place for finding the best possible drug, and, in my experience at least, most of these protocols do consider the affordability to the patient as well as the effectiveness. (Personally, I think there are genetic variants of these diseases that determine the effectiveness of the drug, we just don't fully understand yet.. once we can more accurately test these variants and build trials around them, this will become more of a non-issue)
A few years ago, I would have totally agreed with this article, not anymore. The sad truth is profit drives innovation, it's a bitch developing new drugs, and their has to be enough of an incentive both financially and medically to encourage progress in that field. At the end of the day, the majority of the doctors out there just want was is going to be best for their patients and are continually re-evaluating their strategies to ensure that goal is met.
However, I hope this is sarcasm. 30 somethings that get suckered into the sungazing myth are some of the saddest patients.