Ophthalmology has been an early adopter of blockchain architecture for managing research datasets and model testing. As a result, it provides secured data integrity and immutability, as well as automation in data consistency and a shared ledger promoting easier collaboration of artificial intelligence (AI) and big data analytics. The authors of the accompanying article have researched in great detail the extent of the adaptability of blockchain in the field of ophthalmology.[1] Blockchain technology has seen accelerated development and maturity over the past few years. A blockchain is a digital record of transactions that is distributed across a network of computers. Each block in the chain contains a record of multiple transactions, and once a block is added to the chain, it cannot be altered. This allows for the creation of a secure and transparent record of transactions that is resistant to tampering and revision. Blockchains are often associated with cryptocurrency, such as Bitcoin, but the technology has many other potential uses, including the secure and transparent tracking of supply chain data, the creation of secure and immutable voting systems, and the facilitation of secure and transparent record-keeping for a wide range of industries. The Flow of a Blockchain Transaction – A Step-By-Step Illustration A detailed flowchart that includes the steps involved in mining a new block to the blockchain is shown in Fig. 1. Below are the steps involved in a blockchain transaction:Figure 1: Flowchart showing the flow of blockchain transaction A user initiates a transaction. The transaction is broadcast to the network and verified by network nodes. The verified transaction is added to the candidate block. The candidate block is hashed, and the hash is compared to the difficulty target. If the hash is less than the target, the block is mined and added to the blockchain. If the hash is greater than the target, the mining process is repeated with a new cryptographic nonce. The updated blockchain is distributed to all nodes on the network. Usage of Blockchain Technology in Digital Ophthalmology – The New Now Several specific fields within ophthalmology could benefit from the use of blockchain technology. Clinical Trials Blockchain technology can be used to securely and transparently record and track the progress of clinical trials in ophthalmology, helping to ensure the integrity and reliability of the results. It is a possible solution for maintaining an extensive database for American Society of Cataract and Refractive Surgery (ASCRS) intraocular lens (IOL) power calculators, storing the preoperative and postoperative refractive surgery data, and academic applications, such as securing patients’ genomes, telemedicine platforms, AI, and managing the global myopia pandemic.[2–8] Electronic Health Records Blockchain technology can be used to create a secure and decentralized platform for storing and accessing electronic health records (EHRs), making it easier for ophthalmologists to access and share important patient information with other members of the healthcare team. Clinical Research This technology can be used to create a secure and transparent platform for storing and accessing clinical research data, thus making it easier for ophthalmologists to access and analyze the results of studies relevant to their work. Specifically, it benefits in assessing patient compliance with drugs and treatment. Supply Chain Management Blockchain technology tracks the movement of medical devices and supplies, such as contact lenses or ophthalmic medications, through the supply chain, thus helping to ensure that they are authentic and have been handled correctly. Medical Billing and Claims Processing It also streamlines and secures medical billing and claims processing, thus reducing errors and improving efficiency. Blockchain technology could also revolutionize international data collection of various private and government institutes aimed at better patient care and isolating epidemiological data. The prime examples include endophthalmitis, toxic anterior segment syndrome (TASS), and cataract surgical outcomes.[9] Current Relevance of Blockchain Technology in the TASS Epidemic – The Need of the Hour in India Currently, a TASS epidemic is sweeping across India. This has left several ophthalmic surgeons in the lurch, as it has created a glitch in their regular practice. Considering the scale of the issue and its widespread reporting, several WhatsApp groups were created to help get to the bottom of this conundrum. Additionally, Google forms were used to assimilate data for analysis by different national and regional ophthalmic societies. The All India Ophthalmological Society (AIOS) has released a list of batches of IOL presenting with TASS, which were shared by the members of the society. Also, the members are asked to report further incidents of adverse reactions of TASS following intraocular surgery through any of the following methods. Method 1 Through the Medical Device Adverse Event Reporting form (under the aegis of Materiovigilance Programme of India [MvPI], National Health Systems Resource Centre, National Institute of Health and Family Welfare (NIHFW) Campus, Baba Gangnath Marg, Munirka, New Delhi 110067) - Go to the link mentioned below to download the form - https://moseye.org/wp-content/uploads/2022/12/MDAEform.pdf - Fill the necessary details and the adverse events related to TASS - Duly filled Medical Device Adverse Event Reporting Form can be sent to Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Sector-23, Rajnagar, Ghaziabad - 20002 OR Email to [email protected] Method 2 Alternatively, you can download the adverse drug reactions (ADR) Pharmacovigilance Programme of India (PvPI) App to report the adverse events related to TASS electronically. - Open the app and select the tab of “Healthcare Professionals” - Fill the necessary details and the adverse events related to TASS electronically - Click the “Submit” button at the bottom of the form It is also proposed that members who have faced TASS recently may please take the AIOS-TASS survey, so that the office can compile a cumulative report for submission to authority. In this current scenario, blockchain implementation can prove as a saving grace in terms of data handling, considering its atypical and sensitive nature. At present, data handling is more centralized and can be exposed to mismanagement. If blockchain were to be adapted, it could provide more decentralized handling of data, thus safeguarding it from human error. Creating such a database paves the way for a digital ledger that is not controlled by a single organization or person. Every time new data or a “block” is added, it can be visualized across the entire network, giving people direct access to the data. In addition to being virtually incorruptible, it provides security in terms of server failure. As there is no single source of storage, the information stored in it is virtually safe. In this current situation, creating a blockchain dataset could establish an upscaled mode of interaction to bring about a solution to this problem.[10] TASS is an acute, sterile, and severe anterior segment inflammation following an anterior segment surgery, which usually occurs between 12 and 48 hours post-surgery. It is a multifactorial issue with a wide etiology. It can be due to issues related to the intraocular lens, balanced salt solution, ophthalmic viscosurgical devices, inadequate autoclaving protocols, or any and all instruments or drugs used intraocularly.[11] Hence, it is imperative to get accurate documentation regarding all the incident cases to create a holistic picture. Only then, can we arrive at the cause and formulate a solution. Blockchain Technology – The Novel Way Forward for Confidential Data Pooling Blockchain technology helps in collecting this data from all the institutions including private/solo practitioners and government hospitals, and sharing them confidentially with all the ophthalmologists across India and even all over the world.[12] Through this technology, patient data can be communicated for referral and also for early detection of any major outbreak. Also, this helps health researchers in acquiring broad and comprehensive data and facilitates the faster discovery of new drugs and treatments. Conclusion The implementation of blockchain technology in the ophthalmology field can revolutionize the network, ensuring transparent, large-volume, and efficient data sharing across digital platforms by maintaining integrity. This will also pave the way for future research for the development of newer protocols and algorithms for widespread TASS and management of other mass outbreaks. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.