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Li F, Wang D, Yang Z, Zhang Y, Jiang J, Liu X, Kong K, Zhou F, Tham CC, Medeiros F, Han Y, Grzybowski A, Zangwill LM, Lam DSC, Zhang X. The AI Revolution in Glaucoma: Bridging Challenges with Opportunities. Prog Retin Eye Res 2024:101291. [PMID: 39186968 DOI: 10.1016/j.preteyeres.2024.101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
Recent advancements in artificial intelligence (AI) herald transformative potentials for reshaping glaucoma clinical management, improving screening efficacy, sharpening diagnosis precision, and refining the detection of disease progression. However, incorporating AI into healthcare usages faces significant hurdles in terms of developing algorithms and putting them into practice. When creating algorithms, issues arise due to the intensive effort required to label data, inconsistent diagnostic standards, and a lack of thorough testing, which often limits the algorithms' widespread applicability. Additionally, the "black box" nature of AI algorithms may cause doctors to be wary or skeptical. When it comes to using these tools, challenges include dealing with lower-quality images in real situations and the systems' limited ability to work well with diverse ethnic groups and different diagnostic equipment. Looking ahead, new developments aim to protect data privacy through federated learning paradigms, improving algorithm generalizability by diversifying input data modalities, and augmenting datasets with synthetic imagery. The integration of smartphones appears promising for using AI algorithms in both clinical and non-clinical settings. Furthermore, bringing in large language models (LLMs) to act as interactive tool in medicine may signify a significant change in how healthcare will be delivered in the future. By navigating through these challenges and leveraging on these as opportunities, the field of glaucoma AI will not only have improved algorithmic accuracy and optimized data integration but also a paradigmatic shift towards enhanced clinical acceptance and a transformative improvement in glaucoma care.
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Affiliation(s)
- Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Deming Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Zefeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Yinhang Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Jiaxuan Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Xiaoyi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Kangjie Kong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Fengqi Zhou
- Ophthalmology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Felipe Medeiros
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Ying Han
- University of California, San Francisco, Department of Ophthalmology, San Francisco, CA, USA; The Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, California, USA.
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA.
| | - Dennis S C Lam
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China.
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
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Chan VTT, Ran AR, Wagner SK, Hui HYH, Hu X, Ko H, Fekrat S, Wang Y, Lee CS, Young AL, Tham CC, Tham YC, Keane PA, Milea D, Chen C, Wong TY, Mok VCT, Cheung CY. Value Proposition of Retinal Imaging in Alzheimer's Disease Screening: A Review of Eight Evolving Trends. Prog Retin Eye Res 2024:101290. [PMID: 39173942 DOI: 10.1016/j.preteyeres.2024.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/24/2024]
Abstract
Alzheimer's disease (AD) is the leading cause of dementia worldwide. Current diagnostic modalities of AD generally focus on detecting the presence of amyloid β and tau protein in the brain (for example, positron emission tomography [PET] and cerebrospinal fluid testing), but these are limited by their high cost, invasiveness, and lack of expertise. Retinal imaging exhibits potential in AD screening and risk stratification, as the retina provides a platform for the optical visualization of the central nervous system in vivo, with vascular and neuronal changes that mirror brain pathology. Given the paradigm shift brought by advances in artificial intelligence and the emergence of disease-modifying therapies, this article aims to summarize and review the current literature to highlight 8 trends in an evolving landscape regarding the role and potential value of retinal imaging in AD screening.
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Affiliation(s)
- Victor T T Chan
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siegfried K Wagner
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Herbert Y H Hui
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaoyan Hu
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Ko
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR China; Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR China
| | - Sharon Fekrat
- Departments of Ophthalmology and Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yaxing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital University of Medical Science, Beijing, China
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yih Chung Tham
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pearse A Keane
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dan Milea
- Singapore National Eye Centre, Singapore
| | - Christopher Chen
- Memory Aging & Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR China; Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China.
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Jørgensen EP, Muttuvelu DV, Peto T, Natarajan S, Davies J, Keane PA, Ehlers LH. Implementing teleophthalmology services to improve cost-effectiveness of the national eye care system. Eye (Lond) 2024:10.1038/s41433-024-03156-4. [PMID: 38834842 DOI: 10.1038/s41433-024-03156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/02/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND PURPOSE Optometrist-assisted and teleophthalmology-enabled referral pathway (OTRP) for community optometry referrals has the potential to improve the capacity and efficiency of eye care delivery systems through risk stratification and limiting the number of improved referrals. This study investigates the expected future costs and benefits of implementing OTRP under various possible organizational set-ups relevant to a Danish context. METHODS A decision-analytic model (decision tree) with a one-year time horizon was constructed to portray alternative future patient referral pathways for people examined in optometry stores for suspected ocular posterior segment eye disease. The main outcomes were total healthcare costs per patient, average waiting time from eye examination in store until the start of treatment or end of referral pathway, and quality-adjusted life-years (QALY) gained. The economic evaluation compares the general ophthalmologist referral pathway (GO-RP) with a potential reimbursement model for the optometrist-assisted teleophthalmology referral pathways (R-OTRP) and a procurement model for the optometrist-assisted teleophthalmology referral pathways (P-OTRP). RESULTS The cost per individual with suspected ocular posterior segment eye disease was estimated to be £116 for GO-RP and £75 and £94 for P-OTRP and R-OTRP respectively. The average waiting time for diagnosis or end of referral pathway was 25 weeks for GO-RP and 5.8 and 5.7 for P-OTPR and R-OTPR respectively. QALY gain was 0.15 for P-OTRP/R-OTRP compared to 0.06 for GO-RP. CONCLUSION OTRP is effective in reducing unnecessary referrals and waiting times, increasing patients' HRQoL, and decreasing the costs of diagnosing individuals with suspected ocular posterior segment eye disease.
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Affiliation(s)
- E P Jørgensen
- Nordic Institute of Health Economics, Aarhus, Denmark
| | - D V Muttuvelu
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- 2mitØje ApS, Aarhus, Denmark
| | - T Peto
- Queen's University Belfast, Belfast, UK
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - S Natarajan
- Aditya Jyot Eye Hospital Pvt Ltd, Mumbai, Maharashtra, India
| | - J Davies
- Global Business School for Health, University College London, London, UK
| | - P A Keane
- University College London, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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Patel D, Abdi S, Carmichael J, Balaskas K, Blandford A. What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians. BMJ Open 2024; 14:e078161. [PMID: 38803257 PMCID: PMC11129051 DOI: 10.1136/bmjopen-2023-078161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/17/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Implementing teleophthalmology into the optometric referral pathway may ease the current pressures on hospital eye services caused by over-referrals from some optometrists. This study aimed to understand the practical implications of implementing teleophthalmology by analysing lived experiences and perceptions of teleophthalmology in the optometric referral pathway for suspected retinal conditions. DESIGN Qualitative in-depth interview study SETTING: Fourteen primary care optometry practices and four secondary care hospital eye services from four NHS Foundation Trusts across the UK. PARTICIPANTS We interviewed 41 participants: patients (17), optometrists (18), and ophthalmologists (6) who were involved in the HERMES study. Through thematic analysis, we collated and present their experiences of implementing teleophthalmology. RESULTS All participants interviewed were positive towards teleophthalmology as it could enable efficiencies in the referral pathway and improve feedback and communication between patients and healthcare professionals. Concerns included setup costs for optometrists and anxieties from patients about not seeing an ophthalmologist face to face. However, reducing unnecessary visits and increasing the availability of resources and capacity were seen as significant benefits. CONCLUSIONS Overall, we report positive experiences of implementing teleophthalmology into the optometric referral pathway for suspected retinal conditions. Successful implementation will require appropriate investment to set up and integrate new technology and remunerate services, and continued evaluation to ensure timely feedback to patients and between healthcare professionals is received. TRIAL REGISTRATION NUMBER ISRCTN18106677.
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Affiliation(s)
- Dilisha Patel
- UCL Interaction Centre, University College London, London, UK
| | - Sarah Abdi
- UCL Interaction Centre, University College London, London, UK
| | - Josie Carmichael
- UCL Interaction Centre, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ann Blandford
- UCL Interaction Centre, University College London, London, UK
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Azzolini C, Premi E, Donati S, Falco A, Torreggiani A, Sicurello F, Baj A, Azzi L, Orro A, Porta G, Azzolini G, Sorrentino M, Melillo P, Testa F, Simonelli F, Giardina G, Paolucci U. Ten Years of Experience With a Telemedicine Platform Dedicated to Health Care Personnel: Implementation Report. JMIR Med Inform 2024; 12:e42847. [PMID: 38277199 PMCID: PMC10858419 DOI: 10.2196/42847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 07/13/2023] [Accepted: 11/29/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Telemedicine, a term that encompasses several applications and tasks, generally involves the remote management and treatment of patients by physicians. It is known as transversal telemedicine when practiced among health care professionals (HCPs). OBJECTIVE We describe the experience of implementing our telemedicine Eumeda platform for HCPs over the last 10 years. METHODS A web-based informatics platform was developed that had continuously updated hypertext created using advanced technology and the following features: security, data insertion, dedicated software for image analysis, and the ability to export data for statistical surveys. Customizable files called "modules" were designed and built for different fields of medicine, mainly in the ophthalmology subspecialty. Each module was used by HCPs with different authorization profiles. IMPLEMENTATION (RESULTS) Twelve representative modules for different projects are presented in this manuscript. These modules evolved over time, with varying degrees of interconnectivity, including the participation of a number of centers in 19 cities across Italy. The number of HCP operators involved in each single module ranged from 6 to 114 (average 21.8, SD 28.5). Data related to 2574 participants were inserted across all the modules. The average percentage of completed text/image fields in the 12 modules was 65.7%. All modules were evaluated in terms of access, acceptability, and medical efficacy. In their final evaluation, the participants judged the modules to be useful and efficient for clinical use. CONCLUSIONS Our results demonstrate the usefulness of the telemedicine platform for HCPs in terms of improved knowledge in medicine, patient care, scientific research, teaching, and the choice of therapies. It would be useful to start similar projects across various health care fields, considering that in the near future medicine as we know it will completely change.
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Affiliation(s)
- Claudio Azzolini
- Advisory Council of e-Health and Telemedicine, University of Insubria of Varese-Como, Varese, Italy
- TM95 Srl, Milan, Italy
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
| | - Elias Premi
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Department of Life Sciences and Biotechnologies, University of Insubria, Varese-Como, Italy
| | - Simone Donati
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Andrea Falco
- TM95 Srl, Milan, Italy
- Alfa Design Studio, Milan, Italy
| | | | - Francesco Sicurello
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Andreina Baj
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Lorenzo Azzi
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Alessandro Orro
- TM95 Srl, Milan, Italy
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Giovanni Porta
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | | | | | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Veeramani P, Pilar Martin-Gutierrez M, Agorogiannis E, Hamilton R, Griggs T, Nicholson L, Heng LZ. Efficacy and Safety outcomes of a novel model to assess new medical retina referrals in a high-volume medical retina virtual clinic. Eye (Lond) 2024; 38:168-172. [PMID: 37491441 PMCID: PMC10764806 DOI: 10.1038/s41433-023-02653-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/12/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Ophthalmology outpatient attendances have significantly increased recently with rising pressure from backlogs arising from the pandemic. Medical retina digital surveillance clinics for stable follow-up appointments are well established. We present a model for assessing new referrals and evaluating clinical outcomes and long-term sustainability in a complex high-volume medical retina service. METHODS Suitable routine new patient referrals were identified from electronic referrals and referred to this new pathway. Structured history, visual acuities, and intraocular pressures were recorded, and widefield colour fundus and optical coherence tomography imaging were performed at a imaging hub for asynchronous consultant-led review. RESULTS 1458 patients were invited to attend over four months, with a 13.2% did-not-attend (DNA) rate. Common diagnoses included stable diabetic retinopathy (19.9%), early age-related macular degeneration (6.7%), central serous retinopathy (8.8%), and retinal vein occlusion (6.3%). 7 patients (0.05%) required urgent same-day review. 61 (5.0%) required urgent face-to-face (F2F) assessment within two weeks. A total of 727 (59.0%) were either discharged or remained in the virtual pathway following their first visit. CONCLUSION This study encourages the use of a digital model that efficiently assesses suitable newly referred medical retina patients in both complex and local eye unit settings. This decreased the need for F2F clinics and resources. Further patient satisfaction surveys for digital services are currently being evaluated to guide long-term sustainability of this model.
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Affiliation(s)
- P Veeramani
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - E Agorogiannis
- Manchester Royal Eye Hospital Manchester, Manchester, UK
| | - R Hamilton
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - T Griggs
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - L Nicholson
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - L Z Heng
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
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Than J, Sim PY, Muttuvelu D, Ferraz D, Koh V, Kang S, Huemer J. Teleophthalmology and retina: a review of current tools, pathways and services. Int J Retina Vitreous 2023; 9:76. [PMID: 38053188 DOI: 10.1186/s40942-023-00502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/02/2023] [Indexed: 12/07/2023] Open
Abstract
Telemedicine, the use of telecommunication and information technology to deliver healthcare remotely, has evolved beyond recognition since its inception in the 1970s. Advances in telecommunication infrastructure, the advent of the Internet, exponential growth in computing power and associated computer-aided diagnosis, and medical imaging developments have created an environment where telemedicine is more accessible and capable than ever before, particularly in the field of ophthalmology. Ever-increasing global demand for ophthalmic services due to population growth and ageing together with insufficient supply of ophthalmologists requires new models of healthcare provision integrating telemedicine to meet present day challenges, with the recent COVID-19 pandemic providing the catalyst for the widespread adoption and acceptance of teleophthalmology. In this review we discuss the history, present and future application of telemedicine within the field of ophthalmology, and specifically retinal disease. We consider the strengths and limitations of teleophthalmology, its role in screening, community and hospital management of retinal disease, patient and clinician attitudes, and barriers to its adoption.
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Affiliation(s)
- Jonathan Than
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Peng Y Sim
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Danson Muttuvelu
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- MitØje ApS/Danske Speciallaeger Aps, Aarhus, Denmark
| | - Daniel Ferraz
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
- Institute of Ophthalmology, University College London, London, UK
| | - Victor Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Josef Huemer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK.
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
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Gillam M, Younus O, Loo SP, Connolly J, Cauchi P, Gregory M, Drummond S, Chadha V. Is an image-based eyelid management service safe and effective? Eye (Lond) 2023; 37:3643-3647. [PMID: 37225825 PMCID: PMC10206336 DOI: 10.1038/s41433-023-02572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic created a requirement for reduced patient contact and reduced capacity in clinics. We previously published results of an Image-Based Eyelid Lesion Management Service (IBELMS) which was found non-inferior to traditional face-to-face clinic at diagnosing lesions and identifying eyelid malignancies. We now present first-year safety and efficacy data from this service. METHODS Data were collected retrospectively on all patients seen in NHS Greater Glasgow and Clyde eyelid photography clinics from 30th September 2020 to 29th September 2021, including referral source and diagnosis, time to clinic review, treatment and patient outcomes. RESULTS 808 patients were included in the study. Chalazion was the most common diagnoses recorded (38.4%). There was a statistically significant decrease in mean time from referral to appointment time between the first 4 months and last 4 months of the service (93 days to 22 days, p ≤ 0.0001). 266 (33%) of patients were discharged following photographs, 45 (6%) were discharged for non-attendance and 371 (46%) were booked for a minor procedure. 13 biopsy-confirmed malignant lesions were identified; only 3 had been referred as suspected malignancy. 23 patients out of 330 with at least 6 months follow up (7%) were re-referred within 6 months of treatment or discharge; however, none of them with a missed periocular malignancy. DISCUSSION Eyelid photography clinics effectively reduce patient waiting times and maximise clinic capacity. They accurately identify eyelid lesions including malignancies with a low re-referral rate. We propose that an image-based service for eyelid lesions is a safe and effective way of managing such patients.
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Affiliation(s)
- Matthew Gillam
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
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Ong AY, Naughton A, Hornby S, Shwe-Tin A. Impact of an email advice service on filtering and refining ophthalmology referrals in England. Int Ophthalmol 2023; 43:4019-4025. [PMID: 37420128 DOI: 10.1007/s10792-023-02806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE The growing capacity-demand imbalance has necessitated the accelerated digital transformation of eye care services. The role of Oxford Eye Hospital's (OEH) email advice service has become even more relevant in the post-Covid era. We sought to evaluate its impact on referrals to secondary care. METHODS The consultant-led OEH email advice service primarily targets primary eye care personnel (optometrists and GPs) requiring clinical advice on patient referral. Emails received between September and November 2020 were analysed for demographic data, contents, characteristics, and outcomes. Thematic analysis was performed. A user feedback survey was conducted. RESULTS A total of 828 emails were received over the 3-month study period (mean 9.1/day). They were predominantly from optometrists (77.9%) and general practitioners (16.1%). Of the 81.0% (671) relating to clinical advice, over half (54.8%) included images from a variety of modalities, and following review, over half (55.5%) were deemed suitable for management in the community, while 36.5% were referred directly to appropriate subspecialty clinics. Only 8.1% required urgent assessment in eye casualty. Thematic analysis showed that this service was most useful for retinal lesions, optical coherence tomography abnormalities, and borderline abnormal optic discs. No adverse events were identified. User feedback was very positive. CONCLUSION A secure email advice service is a safe and low-maintenance modality that provides direct and efficient two-way communication between primary and secondary eye care professionals. It allows rapid response to clinical queries, referral filtering and refinement, and streamlining of patient referral pathways. Users (predominantly optometrists) were overwhelmingly positive about its usefulness in clinical practice.
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Affiliation(s)
- Ariel Yuhan Ong
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
| | - Aoife Naughton
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Stella Hornby
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Audrey Shwe-Tin
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
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Carmichael J, Abdi S, Balaskas K, Costanza E, Blandford A. The effectiveness of interventions for optometric referrals into the hospital eye service: A review. Ophthalmic Physiol Opt 2023; 43:1510-1523. [PMID: 37632154 PMCID: PMC10947293 DOI: 10.1111/opo.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE Ophthalmic services are currently under considerable stress; in the UK, ophthalmology departments have the highest number of outpatient appointments of any department within the National Health Service. Recognising the need for intervention, several approaches have been trialled to tackle the high numbers of false-positive referrals initiated in primary care and seen face to face within the hospital eye service (HES). In this mixed-methods narrative synthesis, we explored interventions based on their clinical impact, cost and acceptability to determine whether they are clinically effective, safe and sustainable. A systematic literature search of PubMed, MEDLINE and CINAHL, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), was used to identify appropriate studies published between December 2001 and December 2022. RECENT FINDINGS A total of 55 studies were reviewed. Four main interventions were assessed, where two studies covered more than one type: training and guidelines (n = 8), referral filtering schemes (n = 32), asynchronous teleophthalmology (n = 13) and synchronous teleophthalmology (n = 5). All four approaches demonstrated effectiveness for reducing false-positive referrals to the HES. There was sufficient evidence for stakeholder acceptance and cost-effectiveness of referral filtering schemes; however, cost comparisons involved assumptions. Referral filtering and asynchronous teleophthalmology reported moderate levels of false-negative cases (2%-20%), defined as discharged patients requiring HES monitoring. SUMMARY The effectiveness of interventions varied depending on which outcome and stakeholder was considered. More studies are required to explore stakeholder opinions around all interventions. In order to maximise clinical safety, it may be appropriate to combine more than one approach, such as referral filtering schemes with virtual review of discharged patients to assess the rate of false-negative cases. The implementation of a successful intervention is more complex than a 'one-size-fits-all' approach and there is potential space for newer types of interventions, such as artificial intelligence clinical support systems within the referral pathway.
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Affiliation(s)
- Josie Carmichael
- University College London Interaction Centre (UCLIC), UCLLondonUK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCLInstitute of OphthalmologyLondonUK
| | - Sarah Abdi
- University College London Interaction Centre (UCLIC), UCLLondonUK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCLInstitute of OphthalmologyLondonUK
| | - Enrico Costanza
- University College London Interaction Centre (UCLIC), UCLLondonUK
| | - Ann Blandford
- University College London Interaction Centre (UCLIC), UCLLondonUK
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11
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Carmichael J, Abdi S, Balaskas K, Costanza E, Blandford A. Assessment of optometrists' referral accuracy and contributing factors: A review. Ophthalmic Physiol Opt 2023; 43:1255-1277. [PMID: 37395045 PMCID: PMC10946769 DOI: 10.1111/opo.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False-positive referrals from primary care are one of the main factors contributing to the oversubscription of hospital eye services (HESs). We reviewed the accuracy of referrals originating from primary care optometrists and contributing factors, such as condition type and years since registration. RECENT FINDINGS Of the 31 studies included in the review, 22 were retrospective analyses of referrals and appointments at the HES. Eight were prospective studies, and one used online clinical vignettes. Seven assessed the accuracy of referrals for all ocular conditions. The remaining studies focused on glaucoma (n = 11), cataracts (n = 7), emergency conditions (n = 4), neovascular age-related macular degeneration (n = 1) and paediatric binocular vision (n = 1). The diagnostic agreement for suspected emergency ocular conditions was the lowest, with only 21.1% of referrals considered to require urgent attention in one study. For glaucoma, the first-visit discharge rate was high (16.7%-48%). Optometrist referral accuracy was overall 18.6% higher than General Medical Practitioners'; however, the two mainly referred different ocular conditions. Female optometrists made more false-positive referrals than males (p = 0.008). The proportion of false positives decreased by 6.2% per year since registration (p < 0.001). SUMMARY There was significant variation in referral accuracy across different ocular conditions, partly due to differences when defining accurate referrals. Optometrists working in primary care are generally more limited in their resources than the HES. Thus, choosing the cautious option of referral when they are unsure could be in the patients' best interests. The possible effect of increased use of advanced imaging on referrals requires evaluation. Although interventions such as refinement schemes have been put in place, these vary across regions, and their approaches such as virtual referral triaging may reduce unnecessary HES face-to-face appointments and promote communication between primary and secondary care.
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Affiliation(s)
- Josie Carmichael
- University College London Interaction Centre (UCLIC), UCLLondonUK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCLInstitute of OphthalmologyLondonUK
| | - Sarah Abdi
- University College London Interaction Centre (UCLIC), UCLLondonUK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCLInstitute of OphthalmologyLondonUK
| | - Enrico Costanza
- University College London Interaction Centre (UCLIC), UCLLondonUK
| | - Ann Blandford
- University College London Interaction Centre (UCLIC), UCLLondonUK
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12
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Faes L, Maloca PM, Hatz K, Wolfensberger TJ, Munk MR, Sim DA, Bachmann LM, Schmid MK. Transforming ophthalmology in the digital century-new care models with added value for patients. Eye (Lond) 2023; 37:2172-2175. [PMID: 36460858 PMCID: PMC9735073 DOI: 10.1038/s41433-022-02313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
Ophthalmology faces many challenges in providing effective and meaningful eye care to an ever-increasing group of people. Even health systems that have so far been able to cope with the quantitative patient increase, due to their funding and the availability of highly qualified professionals, and improvements in practice routine efficiency, will be pushed to their limits. Further pressure on care will also be caused by new active substances for the largest group of patients with AMD, the so-called dry form. Treatment availability for this so far untreated group will increase the volume of patients 2-3 times. Without the adaptation of the care structures, this quantitative and qualitative expansion in therapy will inevitably lead to an undersupply.There is increasing scientific evidence that significant efficiency gains in the care of chronic diseases can be achieved through better networking of stakeholders in the healthcare system and greater patient involvement. Digitalization can make an important contribution here. Many technological solutions have been developed in recent years and the time is now ready to exploit this potential. The exceptional setting during the SARS-CoV-2 pandemic has shown many that new technology is available safely, quickly, and effectively. The emergency has catalyzed innovation processes and shown for post-pandemic time after that we are equipped to tackle the challenges in ophthalmic healthcare - ultimately for the benefit of patients and society.
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Affiliation(s)
- Livia Faes
- Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
| | - Peter M Maloca
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
- Institute of Molecular and Clinical Ophthalmology (IOB), Basel, Switzerland
- OCTlab, University Basel, Mittlere Strasse 91, CH-4056, Basel, Switzerland
- Hirslanden St. Anna im Bahnhof Luzern, Lucerne, Switzerland
| | - Katja Hatz
- Vista Eye Clinic Binningen, Hauptstrasse 55, CH-4102, Binningen, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Marion R Munk
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Dawn A Sim
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, England
| | - Lucas M Bachmann
- Medignition AG, Engelstrasse 6, 8004, Zurich, Switzerland.
- University of Zurich, CH-8091, Zurich, Switzerland.
| | - Martin K Schmid
- Eye Clinic, Lucerne Cantonal Hospital LUKS, 6000 16, Lucerne, Switzerland
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13
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Scanzera AC, Beversluis C, Potharazu AV, Bai P, Leifer A, Cole E, Du DY, Musick H, Chan RVP. Planning an artificial intelligence diabetic retinopathy screening program: a human-centered design approach. Front Med (Lausanne) 2023; 10:1198228. [PMID: 37484841 PMCID: PMC10361413 DOI: 10.3389/fmed.2023.1198228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of vision loss in the United States and throughout the world. With early detection and treatment, sight-threatening sequelae from DR can be prevented. Although artificial intelligence (AI) based DR screening programs have been proven to be effective in identifying patients at high risk of vision loss, adoption of AI in clinical practice has been slow. We adapted the United Kingdom Design Council's Double-Diamond model to design a strategy for care delivery which integrates an AI-based screening program for DR into a primary care setting. Methods from human-centered design were used to develop a strategy for implementation informed by context-specific barriers and facilitators. The purpose of this community case study is to present findings from this work in progress, including a system of protocols, educational documents and workflows created using key stakeholder input.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
| | - Cameron Beversluis
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Archit V. Potharazu
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Patricia Bai
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
| | - Ariel Leifer
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States
| | - David Yuzhou Du
- Segal Design Institute, Northwestern University, Evanston, IL, United States
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
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14
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Development of a Cloud-Based Clinical Decision Support System for Ophthalmology Triage Using Decision Tree Artificial Intelligence. OPHTHALMOLOGY SCIENCE 2023; 3:100231. [DOI: 10.1016/j.xops.2022.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022]
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15
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Bjerager J, Schneider M, Potapenko I, van Dijk EHC, Faber C, Grauslund J, Pfau K, Huemer J, Muttuvelu DV, Rasmussen MLR, Sabaner MC, Subhi Y. Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2023; 141:315-323. [PMID: 36795396 DOI: 10.1001/jamaophthalmol.2022.6396] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Importance Patients with nonneovascular age-related macular degeneration (AMD) are encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis. The test is widely recommended, suggesting a belief that it signals worsening AMD, warranting its use in home monitoring. Objective To systematically review studies of the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD and to perform diagnostic test accuracy meta-analyses. Data Sources A systematic literature search was conducted in 12 databases for relevant titles from database inception until May 7, 2022. Study Selection Studies included those with groups defined as having (1) neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index test was the Amsler grid. The reference standard was ophthalmic examination. After removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened the remaining references in full text for potential eligibility. Disagreements were resolved by a third author (Y.S.). Data Extraction and Synthesis Two authors (J.B. and I.P.) independently extracted all data and evaluated quality and applicability of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2. Disagreements were resolved by a third author (Y.S.). Main Outcomes and Measures Sensitivity and specificity of the Amsler grid for detecting neovascular AMD with comparators being either healthy control participants or patients with nonneovascular AMD. Results Of 523 records screened, 10 studies were included with a total of 1890 eyes (mean participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively, when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63% (95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular AMD. Overall, potential sources of bias were low across studies. Conclusions and Relevance Although the Amsler grid is easy and inexpensive to use for detection of metamorphopsia, its sensitivity may be at levels typically not recommended for monitoring. Coupling this lower sensitivity with only moderate specificity to identify neovascular AMD in a population at risk, these findings suggest that such patients typically should be encouraged to undergo ophthalmic examination regularly, regardless of any results of Amsler grid self-assessment.
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Ivan Potapenko
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Ophthalmology, Haga Hospital, The Hague, the Netherlands
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kristina Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Josef Huemer
- National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Danson V Muttuvelu
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,MitØje Aps, Skive, Denmark
| | - Marie L R Rasmussen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Cem Sabaner
- Department of Ophthalmology, Kütahya Health Sciences University, Evliya Celebi Training and Research Hospital, Kütahya, Turkey
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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16
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Massie J, Block SS, Morjaria P. The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review. Telemed J E Health 2022; 28:1753-1763. [PMID: 35612473 PMCID: PMC9805855 DOI: 10.1089/tmj.2021.0537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: Optometrists are increasingly adopting teleoptometry as an approach to delivering eye care. The coronavirus disease 2019 (COVID-19) pandemic has created further opportunities for optometrists to utilize innovation in telehealth to deliver eye care to individuals who experience access barriers. A systematic literature review is presented detailing the evidence to support the use of teleoptometry. Methods: Databases of MEDLINE, Global Health, and Web of Science were searched, and articles were included if they reported any involvement of optometrists in the delivery of telehealth. Findings were reported according to the mode of telehealth used to deliver eye care, telehealth collaboration type, and the format and geographical areas where eye care via telehealth is being delivered. Results: Twenty-seven relevant studies were identified. Only 11 studies included the role of optometrists as a member of the telehealth team where the scope of practice extended beyond creating and receiving referrals, collecting clinical data at in-person services, and continuing in-person care following consultation with an ophthalmologist. Both synchronous and asynchronous telehealth services were commonly utilized. Optometrists were most commonly involved in ophthalmology-led telehealth collaborations (n = 19). Eight studies reported optometrists independently delivering primary eye care via telehealth, and commonly included videoconferencing. Conclusion: The application of teleoptometry to deliver eye care is rapidly emerging, and appears to be a viable adjunct to the delivery of in-person optometry services. The review highlighted the scarcity of evidence surrounding the clinical benefits, safety, and outcomes of teleoptometry. Further research is required in this area.
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Affiliation(s)
- Jessica Massie
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Address correspondence to: Jessica Massie, BVisSci/MOptom, MScPHEC, International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | | | - Priya Morjaria
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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17
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Singh VM, Akkulugari V, Reddy JC, Gogri PY, Vaddavalli PK. Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19. Indian J Ophthalmol 2022; 70:3272-3277. [PMID: 36018101 DOI: 10.4103/ijo.ijo_313_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To assess the role of remote teleconsultation (TC) follow-up care following a successful and uneventful laser vision correction. Methods The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID-19) pandemic and were followed up with physical consultations during their follow-up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post-operative follow-up (Group 2). Results A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/- 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre-COVID period (3.53 +/- 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight-threatening complication. Conclusion Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult.
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Affiliation(s)
- Vivek M Singh
- Cataract and Refractive Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vidhyadhar Akkulugari
- Cataract and Refractive Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jagadesh C Reddy
- Cataract and Refractive Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pratik Y Gogri
- Cataract and Refractive Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pravin Krishna Vaddavalli
- Cataract and Refractive Services, L V Prasad Eye Institute; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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18
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Ophthalmologic emergency room visits during COVID-19 lockdown–Characterization from Haifa, Israel. PLoS One 2022; 17:e0273033. [PMID: 35984780 PMCID: PMC9390934 DOI: 10.1371/journal.pone.0273033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To characterize quantitative differences among ophthalmologic emergency room (OER) encounters at Rambam Health Care Campus during a 6-week complete lockdown at the peak of the first COVID-19 wave as compared to a corresponding uneventful period a year earlier. Methods A retrospective chart analysis of all OER encounters during the lockdown and non-lockdown period was conducted. Patients were stratified into primary ophthalmological conditions (OER visits) and cases in which ophthalmologic consultations were requested by a non-ophthalmologist (OER consultations). The following parameters were compared: total number of cases, age, gender, chief complaint/diagnosis categorized into major entities, and discharge vs. hospitalization. For continuous variables a t-test was used and for categorical variables a chi-squared or Fisher’s exact test was used. A 2-sided p value <0.05 was considered statistically significant. Results The total number of patients in the lockdown and non-lockdown groups was 486 and 992, respectively, showing a 51% decrease in visits during lockdown. In the non-lockdown and lockdown groups 56% and 61% of patients were male (p = 0.07), with an average age of 42 (range 0–97, SD 23) and 43 (range 0–90, SD 22) years, respectively (p = 0.44). No statistically significant proportional increase was found for any diagnostic category between the OER visits (p = 0.07) and OER consultation groups (p = 0.77). Nevertheless, analysis revealed a non-significant increase in the proportion of eye trauma from 14.8% to 21.2%, and reduction in eyelid conditions from 10.7% to 5.8%. The total number of OER visits demanding urgent intervention on admission was 43 (non-lockdown) and 24 (lockdown), while hospitalization ratio (hospitalizations/visits) was 8.8% and 10.6%, respectively (p = 0.44). Conclusions During the COVID-19 lockdown the guideline for patients in Israel was to avoid unnecessary hospital visits. Since patients tended to avoid the OER rather uniformly regardless of their specific eye condition, determining the risk-benefit of such recommendations and identifying high-risk sub-populations are critical public health issues.
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19
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Blandford A, Abdi S, Aristidou A, Carmichael J, Cappellaro G, Hussain R, Balaskas K. Protocol for a qualitative study to explore acceptability, barriers and facilitators of the implementation of new teleophthalmology technologies between community optometry practices and hospital eye services. BMJ Open 2022; 12:e060810. [PMID: 35858730 PMCID: PMC9305899 DOI: 10.1136/bmjopen-2022-060810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Novel teleophthalmology technologies have the potential to reduce unnecessary and inaccurate referrals between community optometry practices and hospital eye services and as a result improve patients' access to appropriate and timely eye care. However, little is known about the acceptability and facilitators and barriers to the implementations of these technologies in real life. METHODS AND ANALYSIS A theoretically informed, qualitative study will explore patients' and healthcare professionals' perspectives on teleophthalmology and Artificial Intelligence Decision Support System models of care. A combination of situated observations in community optometry practices and hospital eye services, semistructured qualitative interviews with patients and healthcare professionals and self-audiorecordings of healthcare professionals will be conducted. Participants will be purposively selected from 4 to 5 hospital eye services and 6-8 affiliated community optometry practices. The aim will be to recruit 30-36 patients and 30 healthcare professionals from hospital eye services and community optometry practices. All interviews will be audiorecorded, with participants' permission, and transcribed verbatim. Data from interviews, observations and self-audiorecordings will be analysed thematically and will be informed by normalisation process theory and an inductive approach. ETHICS AND DISSEMINATION Ethical approval has been received from London-Bromley research ethics committee. Findings will be reported through academic journals and conferences in ophthalmology, health services research, management studies and human-computer interaction.
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Affiliation(s)
- Ann Blandford
- UCL Interaction Centre, University College London, London, UK
| | - Sarah Abdi
- UCL Interaction Centre, University College London, London, UK
| | | | - Josie Carmichael
- UCL Interaction Centre, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Giulia Cappellaro
- School of Management, University College London, London, UK
- Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Rima Hussain
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
| | - Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
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20
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Tan ACS, Schwartz R, Anaya D, Chatziralli I, Yuan M, Cicinelli MV, Faes L, Mustapha M, Phasukkijwatana N, Pohlmann D, Reynolds R, Rosenblatt A, Savastano A, Touhami S, Vaezi K, Ventura CV, Vogt D, Ambati J, de Smet MD, Loewenstein A. Are intravitreal injections essential during the COVID-19 pandemic? Global preferred practice patterns and practical recommendations. Int J Retina Vitreous 2022; 8:33. [PMID: 35672810 PMCID: PMC9171474 DOI: 10.1186/s40942-022-00380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/01/2022] [Indexed: 11/12/2022] Open
Abstract
Tertiary outpatient ophthalmology clinics are high-risk environments for COVID-19 transmission, especially retina clinics, where regular follow-up is needed for elderly patients with multiple comorbidities. Intravitreal injection therapy (IVT) for chronic macular diseases, is one of the most common procedures performed, associated with a significant burden of care because of the vigorous treatment regimen associated with multiple investigations. While minimizing the risk of COVID-19 infection transmission is a priority, this must be balanced against the continued provision of sight-saving ophthalmic care to patients at risk of permanent vision loss. This review aims to give evidence-based guidelines on managing IVT during the COVID-19 pandemic in common macular diseases such as age-related macular degeneration, diabetic macula edema and retinal vascular disease and to report on how the COVID-19 pandemic has affected IVT practices worldwide. To illustrate some real-world examples, 18 participants in the International Retina Collaborative, from 15 countries and across four continents, were surveyed regarding pre- and during- COVID-19 pandemic IVT practices in tertiary ophthalmic centers. The majority of centers reported a reduction in the number of appointments to reduce the risk of the spread of COVID-19 with varying changes to their IVT regimen to treat various macula diseases. Due to the constantly evolving nature of the COVID-19 pandemic, and the uncertainty about the normal resumption of health services, we suggest that new solutions for eye healthcare provision, like telemedicine, may be adopted in the future when we consider new long-term adaptations required to cope with the COVID-19 pandemic.
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Affiliation(s)
- A C S Tan
- Singapore National Eye Centre, Singapore, Singapore. .,Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
| | - R Schwartz
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - D Anaya
- Department of Retina, Clínica de Oftalmología de Cali, Valle del Cauca, Colombia
| | - I Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - M Yuan
- Department of Retina, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - M V Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Faes
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - M Mustapha
- Department of Ophthalmology, Universiti Kebangsaan Malaysia, Kulala Lumpur, Malaysia
| | - N Phasukkijwatana
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - D Pohlmann
- Charité - Universitätsmedizin Berlin, FreieUiversität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - R Reynolds
- Department of Ophthalmology, Aneurin Bevan University Health Board, Wales, UK
| | - A Rosenblatt
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center Tel-Aviv, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Savastano
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Touhami
- Department of Ophthalmology, Reference Center in Rare diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - K Vaezi
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - C V Ventura
- Department of Ophthalmology, Altino Ventura Foundation (FAV), Recife, Brazil.,Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - D Vogt
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - J Ambati
- Center for Advanced Vision Science, Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, USA
| | - M D de Smet
- Department of Ophthalmology, Leiden University, Leiden, The Netherlands.,MIOS sa, Lausanne, Switzerland
| | - A Loewenstein
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center Tel-Aviv, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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21
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Ashour DM, Elkitkat RS, Gabr H, Yosef M, Singh Grewal D, Saleh MI. Challenges of personal protective equipment use among ophthalmologists during the COVID-19 pandemic: A multicenter international study. Eur J Ophthalmol 2022; 32:1398-1405. [PMID: 34180262 PMCID: PMC9111902 DOI: 10.1177/11206721211028037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/05/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To explore the possible challenges and difficulties of using Personal Protective Equipment (PPE) in ophthalmic practice during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS This is a multicenter, international survey among practicing ophthalmologists across different countries. The survey was conducted from September 9th to October 24th, 2020. It included a total of 23 questions that navigated through the currently adopted recommendations in different clinical situations. The survey also assessed the convenience of using various PPE in ophthalmic practice and addressed the clarity of the examination field while using various PPE during clinical or surgical procedures. RESULTS One hundred and seventy-two ophthalmologists completed the survey (101 from Egypt, 50 from the USA, and 21 from four other countries). The analysis of the responses showed that most ophthalmologists use face masks without significant problems during their examinations, while face shields followed by protective goggles were the most inconvenient PPE in the current ophthalmic practice. Moreover, most of the participants (133, 77.3%) noticed an increase in their examination time when using PPE. Furthermore, a considerable percentage of the respondents (70, 40.7%) stopped using one or more of the PPE due to inconvenience or discomfort. CONCLUSIONS Due to the unique nature of the ophthalmic examination, certain PPE are not ophthalmologist-friendly. Innovative PPE should be tailored for prompt, more convenient, and clearer ophthalmological practice.
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Affiliation(s)
- Doaa Maamoun Ashour
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Serag Elkitkat
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
- Watany Research and Development Center,
Cairo, Egypt
| | - Hesham Gabr
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
- Department of Ophthalmology, Duke
University, Durham, NC, USA
| | - Mostafa Yosef
- Department of Community, Environmental
and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Ibrahim Saleh
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
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22
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Birtel J, Heimann H, Hoerauf H, Helbig H, Schulz C, Holz FG, Geerling G. [Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation]. Ophthalmologe 2022; 119:567-576. [PMID: 35451609 PMCID: PMC9024069 DOI: 10.1007/s00347-022-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Die Klimakrise bedroht die Gesundheit heutiger und künftiger Generationen und stellt das Gesundheitssystem vor besondere Herausforderungen. Zur Anpassung an den anthropogene Klimawandel sind umfängliche Adaptationsstrategien und eine Mitigation des Klimawandels notwendig. In der Medizin sowie in der Augenheilkunde gibt es vielfältige Möglichkeiten zur Reduktion des CO2(Kohlendioxid)-Fußabdrucks, die es zu ergreifen gilt, die ordnungspolitisch gefördert und eingefordert werden sollten. Das aufkommende Feld der datengesteuerten Nachhaltigkeit kann Werkzeuge liefern, um den ökologischen Fußabdruck der eigenen Tätigkeit zu evaluieren sowie Optimierungen zu initiieren. Lebenszyklusanalysen können Instrumente für systematische Ökobilanzen sein und nachhaltige Produkt- und Praxisentscheidungen ermöglichen. Das deutsche Gesundheitssystem sollte eine quantifizierbare und holistische Strategie zur CO2-Reduktion entwickeln; Nachhaltigkeit könnte zukünftig ein Leistungsindikator sein. Dieser Artikel diskutiert mit augenärztlicher Perspektive Beispiele zur Adaptation an die Klimakrise und zur Mitigation; dies schließt kleine Maßnahmen, die jeder Einzelne umsetzen kann, als auch größere, strukturelle Ansätze ein.
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Affiliation(s)
- Johannes Birtel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Großbritannien.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Großbritannien.
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Heinrich Heimann
- St. Paul's Eye Unit, Royal Liverpool University Hospitals Foundation Trust, Liverpool, Großbritannien
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Christian Schulz
- Deutsche Allianz Klimawandel und Gesundheit, Berlin, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - Frank G Holz
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Gerd Geerling
- Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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23
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Ip W, Prahalad P, Palma J, Chen JH. A Data-Driven Algorithm to Recommend Initial Clinical Workup for Outpatient Specialty Referral: Algorithm Development and Validation Using Electronic Health Record Data and Expert Surveys. JMIR Med Inform 2022; 10:e30104. [PMID: 35238788 PMCID: PMC8931647 DOI: 10.2196/30104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/22/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Millions of people have limited access to specialty care. The problem is exacerbated by ineffective specialty visits due to incomplete prereferral workup, leading to delays in diagnosis and treatment. Existing processes to guide prereferral diagnostic workup are labor-intensive (ie, building a consensus guideline between primary care doctors and specialists) and require the availability of the specialists (ie, electronic consultation). OBJECTIVE Using pediatric endocrinology as an example, we develop a recommender algorithm to anticipate patients' initial workup needs at the time of specialty referral and compare it to a reference benchmark using the most common workup orders. We also evaluate the clinical appropriateness of the algorithm recommendations. METHODS Electronic health record data were extracted from 3424 pediatric patients with new outpatient endocrinology referrals at an academic institution from 2015 to 2020. Using item co-occurrence statistics, we predicted the initial workup orders that would be entered by specialists and assessed the recommender's performance in a holdout data set based on what the specialists actually ordered. We surveyed endocrinologists to assess the clinical appropriateness of the predicted orders and to understand the initial workup process. RESULTS Specialists (n=12) indicated that <50% of new patient referrals arrive with complete initial workup for common referral reasons. The algorithm achieved an area under the receiver operating characteristic curve of 0.95 (95% CI 0.95-0.96). Compared to a reference benchmark using the most common orders, precision and recall improved from 37% to 48% (P<.001) and from 27% to 39% (P<.001) for the top 4 recommendations, respectively. The top 4 recommendations generated for common referral conditions (abnormal thyroid studies, obesity, amenorrhea) were considered clinically appropriate the majority of the time by specialists surveyed and practice guidelines reviewed. CONCLUSIONS An item association-based recommender algorithm can predict appropriate specialists' workup orders with high discriminatory accuracy. This could support future clinical decision support tools to increase effectiveness and access to specialty referrals. Our study demonstrates important first steps toward a data-driven paradigm for outpatient specialty consultation with a tier of automated recommendations that proactively enable initial workup that would otherwise be delayed by awaiting an in-person visit.
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Affiliation(s)
- Wui Ip
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Priya Prahalad
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Jonathan Palma
- Neonatology & Perinatal Medicine, Orlando Health Winnie Palmer Hospital for Women & Babies, Orlando, FL, United States
| | - Jonathan H Chen
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.,Stanford Center for Biomedical Informatics Research, Stanford, CA, United States
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24
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Ho S, Kalloniatis M, Ly A. Clinical decision support in primary care for better diagnosis and management of retinal disease. Clin Exp Optom 2022; 105:562-572. [PMID: 35025728 DOI: 10.1080/08164622.2021.2008791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Misdiagnosis of retinal disease is a common problem in primary care that can lead to irreversible vision loss and false-positive referrals, resulting in inappropriate use of health services. Clinical decision support systems describe tools that leverage information technology to provide timely recommendations that assist clinicians in the decisions they make about the care of a patient. They, therefore, have the potential to reduce the rate of misdiagnosis by promoting evidence-based medicine and more effective and efficient healthcare. This narrative review aims to support primary care practitioners in better understanding the current and emerging capacity of clinical decision support systems in eye care. Different types of clinical decision support systems are discussed, using current examples and evidence from the available literature to demonstrate how they may improve diagnostic effectiveness and aid the management of retinal disease. Comments are made on the future directions of clinical decision support in primary eye care and the potential applications of artificial intelligence.
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Affiliation(s)
- Sharon Ho
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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25
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Korot E, Pontikos N, Drawnel FM, Jaber A, Fu DJ, Zhang G, Miranda MA, Liefers B, Glinton S, Wagner SK, Struyven R, Kilduff C, Moshfeghi DM, Keane PA, Sim DA, Thomas PBM, Balaskas K. Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings. JAMA Ophthalmol 2021; 140:153-160. [PMID: 34913967 PMCID: PMC8678899 DOI: 10.1001/jamaophthalmol.2021.5269] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Question What are the enablers and barriers of patient engagement for app-based home vision monitoring at scale? Findings In this cohort and survey study including 417 adults, 258 patients were active users (61.9%) of whom 166 patients (64.3%) were compliant users. Engagement was positively associated with higher comfort with technology, White British ethnicity, visual acuity, neovascular age-related macular degeneration diagnosis, and the number of intravitreal injections and was negatively associated with increased age. Meaning These findings suggest effective smartphone app-based home vision monitoring should address the risk factors for low engagement and digital exclusion during clinical practice setting deployment. Importance Telemedicine is accelerating the remote detection and monitoring of medical conditions, such as vision-threatening diseases. Meaningful deployment of smartphone apps for home vision monitoring should consider the barriers to patient uptake and engagement and address issues around digital exclusion in vulnerable patient populations. Objective To quantify the associations between patient characteristics and clinical measures with vision monitoring app uptake and engagement. Design, Setting, and Participants In this cohort and survey study, consecutive adult patients attending Moorfields Eye Hospital receiving intravitreal injections for retinal disease between May 2020 and February 2021 were included. Exposures Patients were offered the Home Vision Monitor (HVM) smartphone app to self-test their vision. A patient survey was conducted to capture their experience. App data, demographic characteristics, survey results, and clinical data from the electronic health record were analyzed via regression and machine learning. Main Outcomes and Measures Associations of patient uptake, compliance, and use rate measured in odds ratios (ORs). Results Of 417 included patients, 236 (56.6%) were female, and the mean (SD) age was 72.8 (12.8) years. A total of 258 patients (61.9%) were active users. Uptake was negatively associated with age (OR, 0.98; 95% CI, 0.97-0.998; P = .02) and positively associated with both visual acuity in the better-seeing eye (OR, 1.02; 95% CI, 1.00-1.03; P = .01) and baseline number of intravitreal injections (OR, 1.01; 95% CI, 1.00-1.02; P = .02). Of 258 active patients, 166 (64.3%) fulfilled the definition of compliance. Compliance was associated with patients diagnosed with neovascular age-related macular degeneration (OR, 1.94; 95% CI, 1.07-3.53; P = .002), White British ethnicity (OR, 1.69; 95% CI, 0.96-3.01; P = .02), and visual acuity in the better-seeing eye at baseline (OR, 1.02; 95% CI, 1.01-1.04; P = .04). Use rate was higher with increasing levels of comfort with use of modern technologies (β = 0.031; 95% CI, 0.007-0.055; P = .02). A total of 119 patients (98.4%) found the app either easy or very easy to use, while 96 (82.1%) experienced increased reassurance from using the app. Conclusions and Relevance This evaluation of home vision monitoring for patients with common vision-threatening disease within a clinical practice setting revealed demographic, clinical, and patient-related factors associated with patient uptake and engagement. These insights inform targeted interventions to address risks of digital exclusion with smartphone-based medical devices.
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Affiliation(s)
- Edward Korot
- Byers Eye Institute, Stanford University, Palo Alto, California.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Nikolas Pontikos
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Faye M Drawnel
- Personalised Healthcare Ophthalmology, F. Hoffmann La Roche AG, Basel, Switzerland
| | - Aljazy Jaber
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom
| | - Dun Jack Fu
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Gongyu Zhang
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Marco A Miranda
- UCL Institute of Ophthalmology, London, United Kingdom.,Personalised Healthcare Ophthalmology, Roche Products, Welwyn Gardens City, United Kingdom
| | - Bart Liefers
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Sophie Glinton
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Siegfried K Wagner
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Robbert Struyven
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Caroline Kilduff
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | | | - Pearse A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Dawn A Sim
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Peter B M Thomas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
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26
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Li YYS, Vardhanabhuti V, Tsougenis E, Lam WC, Shih KC. A Proposed Framework for Machine Learning-Aided Triage in Public Specialty Ophthalmology Clinics in Hong Kong. Ophthalmol Ther 2021; 10:703-713. [PMID: 34637117 PMCID: PMC8507354 DOI: 10.1007/s40123-021-00405-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022] Open
Abstract
The public specialty ophthalmic clinics in Hong Kong, under the Hospital Authority, receive tens of thousands of referrals each year. Triaging these referrals incurs a significant workload for practitioners and the other clinical duties. It is well-established that Hong Kong is currently facing a shortage of healthcare workers. Thus a more efficient system in triaging will not only free up resources for better use but also improve the satisfaction of both practitioners and patients. Machine learning (ML) has been shown to improve the efficiency of various medical workflows, including triaging, by both reducing the workload and increasing accuracy in some cases. Despite a myriad of studies on medical artificial intelligence, there is no specific framework for a triaging algorithm in ophthalmology clinics. This study proposes a general framework for developing, deploying and evaluating an ML-based triaging algorithm in a clinical setting. Through literature review, this study identifies good practices in various facets of developing such a network and protocols for maintenance and evaluation of the impact concerning clinical utility and external validity out of the laboratory. We hope this framework, albeit not exhaustive, can act as a foundation to accelerate future pilot studies and deployments.
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Affiliation(s)
- Yalsin Yik Sum Li
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR, China
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | | | - Wai Ching Lam
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR, China
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR, China.
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27
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Zwingelberg SB, Mercieca K, Elksne E, Scheffler S, Prokosch V. [Attitude of patients to possible telemedicine in ophthalmology : Survey by questionnaire in patients with glaucoma]. Ophthalmologe 2021; 119:374-380. [PMID: 34542691 PMCID: PMC8450718 DOI: 10.1007/s00347-021-01501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/04/2022]
Abstract
Hintergrund Die COVID-19-Pandemie im Jahr 2020 und 2021 schränkt die Versorgung augenärztlicher Patienten vielfach ein. Teleophthalmologische Leistungen wie Videokonsultation oder medizinische Telefonberatungen könnten den Mangel an notwendigen Kontrollen bei chronischen Erkrankungen, zumindest teilweise, kompensieren. Teleophthalmologische Angebote sind jedoch in Deutschland aktuell noch deutlich unterrepräsentiert. Ziel der Arbeit Um die Bereitschaft auf Patientenseite zur Telemedizin und virtuellen Klinik zu ermitteln, führten wir bei Patienten der Hochschulmedizin mit bekanntem Glaukom als chronische Erkrankung eine Umfrage mittels Fragebogen während der ersten Welle der COVID-19-Pandemie zum Thema Teleophthalmologie durch. Methoden Es wurden 100 Patienten befragt. Der Fragenkatalog beinhaltete 22 Fragen mit Mehrfachwahl-Antwortmöglichkeiten. Als Einschlusskriterium galten das Vorhandensein eines Glaukoms als chronische Erkrankung, Alter über 18 Jahre sowie eine ausreichende sprachliche Verständigung zur Beantwortung der Fragen. Die Daten wurden anonymisiert erhoben, analysiert und ausgewertet. Ergebnisse In der Patientenumfrage konnte aufgezeigt werden, dass eine hohe Bereitschaft zur Teleophthalmologie bei den Befragten im Bereich des Glaukoms als chronische Erkrankung vorhanden ist und diese in Anspruch genommen werden würde; 74,0 % der Befragten würden Telemedizin und virtuelle Kliniken akzeptieren; 54,0 % der Befragten ophthalmologischen Patienten gab an, dass ihr Arzt‑/Klinikbesuch aufgrund von SARS-CoV‑2 nicht stattfinden konnte; 17,0 % der Patienten gaben an, dass sich durch die SARS-CoV-2-Pandemie ihre Meinung gegenüber der Telemedizin geändert hat. Diskussion Die Akzeptanz der Patienten für Telemedizin bei Patienten mit chronischem Offenwinkelglaukom scheint erstaunlich hoch. Diese ist durch die SARS-CoV-2-Pandemie noch weiter gesteigert worden. Diese Ergebnisse spiegeln eine generelle Bereitschaft bei Patienten mit chronischer Augenerkrankung wider, reflektieren jedoch nicht die Anwendbarkeit sowie die Akzeptanz aus ärztlicher Sicht. Diese Form der virtuellen Konsultation findet jedoch bei einem Großteil der Patienten mit Glaukom Akzeptanz und könnte überdacht werden.
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Affiliation(s)
- Sarah B Zwingelberg
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Karl Mercieca
- Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland
| | - Eva Elksne
- Department of Ophthalmology, Riga Stradins University, Pauls Stradiņš Clinical University Hospital 13, Pilsoņuiela, Riga, Lettland
| | - Stephanie Scheffler
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Verena Prokosch
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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28
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Ly A, Zangerl B, Kalloniatis M. Introduction of structured record keeping in age-related macular degeneration: a before and after study. Clin Exp Optom 2021; 105:754-760. [PMID: 34538228 DOI: 10.1080/08164622.2021.1971490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Structured record keeping improves documentation in age-related macular degeneration; however, it may have a more limited effect on the management decisions of a group of already highly trained clinicians, especially in the context of other well-embedded clinical decision support tools. BACKGROUND Structured record keeping has been associated with a range of advantages including improved history taking and communication, reduced number of unnecessary referrals, and enhanced diagnostic accuracy. The aim of this study was to examine the impact of a structured record keeping, quality improvement tool on recording, reporting and management congruency. METHODS A before and after retrospective record review study was performed in a single academic, intermediate-tier care institute in New South Wales, Australia. The structured record keeping tool intervention captured 31 items in addition to the prior pre-existing medical record: six items relating to historical risk factors, two items relating to patient activation, 13 items signifying core clinical signs, five items for change analysis and five items regarding the ongoing patient management plan. RESULTS Two hundred medical records from 151 patients with age-related macular degeneration were analysed. There was a statistically significant improvement in the number of reports that explicitly specified the number of clinical structural risk factors (from 24 to 75%; Fisher's exact p < 0.001) and risk of progression to advanced disease (from 71 to 84%; p = 0.041); however, this documentation had no statistically significant effect on the report-recommended management plan and/or the final report-recommended review period. CONCLUSION Disease-specific, structured record keeping improves the outgoing documentation of key clinical signs and is effective in prompting the transposition of these signs into a quantified risk progression score. It has limited value in improving management consistency among a group of highly trained eye care staff.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Unsw Sydney, Sydney, Australia.,School of Optometry and Vision Science, Unsw Sydney, Sydney, Australia
| | - Barbara Zangerl
- Centre for Eye Health, Unsw Sydney, Sydney, Australia.,School of Optometry and Vision Science, Unsw Sydney, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Unsw Sydney, Sydney, Australia.,School of Optometry and Vision Science, Unsw Sydney, Sydney, Australia
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29
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Nikolaidou A, Tsaousis KT. Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic. Cureus 2021; 13:e16392. [PMID: 34408945 PMCID: PMC8363234 DOI: 10.7759/cureus.16392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
Abstract
The current COVID-19 pandemic has boosted a sudden demand for telemedicine due to quarantine and travel restrictions. The exponential increase in the use of telemedicine is expected to affect ophthalmology drastically. The aim of this review is to discuss the utility, effectiveness and challenges of teleophthalmological new tools for eyecare delivery as well as its implementation and possible facilitation with artificial intelligence. We used the terms: “teleophthalmology,” “telemedicine and COVID-19,” “retinal diseases and telemedicine,” “virtual ophthalmology,” “cost effectiveness of teleophthalmology,” “pediatric teleophthalmology,” “Artificial intelligence and ophthalmology,” “Glaucoma and teleophthalmology” and “teleophthalmology limitations” in the database of PubMed and selected the articles being published in the course of 2015-2020. After the initial search, 321 articles returned as relevant. A meticulous screening followed and eventually 103 published manuscripts were included and used as our references. Emerging in the market, teleophthalmology is showing great potential for the future of ophthalmological care, benefiting both patients and ophthalmologists in times of pandemics. The spectrum of eye diseases that could benefit from teleophthalmology is wide, including mostly retinal diseases such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration but also glaucoma and anterior segment conditions. Simultaneously, artificial intelligence provides ways of implementing teleophthalmology easier and with better outcomes, contributing as significant changing factors for ophthalmology practice after the COVID-19 pandemic.
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Affiliation(s)
- Anna Nikolaidou
- Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Shen YT, Chen L, Yue WW, Xu HX. Digital Technology-Based Telemedicine for the COVID-19 Pandemic. Front Med (Lausanne) 2021; 8:646506. [PMID: 34295908 PMCID: PMC8289897 DOI: 10.3389/fmed.2021.646506] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/31/2021] [Indexed: 12/23/2022] Open
Abstract
In the year 2020, the coronavirus disease 2019 (COVID-19) crisis intersected with the development and maturation of several digital technologies including the internet of things (IoT) with next-generation 5G networks, artificial intelligence (AI) that uses deep learning, big data analytics, and blockchain and robotic technology, which has resulted in an unprecedented opportunity for the progress of telemedicine. Digital technology-based telemedicine platform has currently been established in many countries, incorporated into clinical workflow with four modes, including "many to one" mode, "one to many" mode, "consultation" mode, and "practical operation" mode, and has shown to be feasible, effective, and efficient in sharing epidemiological data, enabling direct interactions among healthcare providers or patients across distance, minimizing the risk of disease infection, improving the quality of patient care, and preserving healthcare resources. In this state-of-the-art review, we gain insight into the potential benefits of demonstrating telemedicine in the context of a huge health crisis by summarizing the literature related to the use of digital technologies in telemedicine applications. We also outline several new strategies for supporting the use of telemedicine at scale.
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Affiliation(s)
- Yu-Ting Shen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Liang Chen
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China
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Kim SE, Logeswaran A, Kang S, Stanojcic N, Wickham L, Thomas P, Li JPO. Digital Transformation in Ophthalmic Clinical Care During the COVID-19 Pandemic. Asia Pac J Ophthalmol (Phila) 2021; 10:381-387. [PMID: 34415246 DOI: 10.1097/apo.0000000000000407] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT COVID-19 has placed unprecedented pressure on health systems globally, whereas simultaneously stimulating unprecedented levels of transformation. Here, we review digital adoption that has taken place during the pandemic to drive improvements in ophthalmic clinical care, with a specific focus on out-of-hospital triage and services, clinical assessment, patient management, and use of electronic health records. We show that although there have been some successes, shortcomings in technology infrastructure prepandemic became only more apparent and consequential as COVID-19 progressed. Through our review, we emphasize the need for clinicians to better grasp and harness key technology trends such as telecommunications and artificial intelligence, so that they can effectively and safely shape clinical practice using these tools going forward.
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Affiliation(s)
- Soyang Ella Kim
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, United Kingdom
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Campbell JP, Mathenge C, Cherwek H, Balaskas K, Pasquale LR, Keane PA, Chiang MF. Artificial Intelligence to Reduce Ocular Health Disparities: Moving From Concept to Implementation. Transl Vis Sci Technol 2021; 10:19. [PMID: 34003953 PMCID: PMC7991919 DOI: 10.1167/tvst.10.3.19] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- John P Campbell
- Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - Ciku Mathenge
- Rwanda International Institute of Ophthalmology, Kigali, Rwanda
| | | | - Konstantinos Balaskas
- Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Louis R Pasquale
- Eye and Vision Research Institute, New York Eye and Ear Infirmary at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pearse A Keane
- Institute of Ophthalmology, University College London, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michael F Chiang
- Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA.,National Eye Institute, National Institute of Health, Bethesda, MD
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Willis JR, Ali FS, Argente B, Domalpally A, Gannon J, Gao SS, Grover S, Kanodia P, Russell-Puleri S, Sun D, Thrasher C, Tsougarakis C, Hopkins JJ. Feasibility Study of a Multimodal, Cloud-Based, Diabetic Retinal Screening Program in a Workplace Environment. Transl Vis Sci Technol 2021; 10:20. [PMID: 34111266 PMCID: PMC8131994 DOI: 10.1167/tvst.10.6.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the feasibility of capturing and interpreting retinal images in a workplace environment using a multimodal, cloud-based, diabetic retinal screening program combined with electronic self-reported questionnaires. The burden of diabetic retinopathy (DR) and other retinal conditions, healthcare utilization, and visual function were also assessed. Methods A cross-sectional feasibility study was conducted at the Genentech, Inc., Campus Health Center. Eyes of participants were imaged using ultra-widefield (UWF) color fundus photography (CFP) and spectral-domain optical coherence tomography (SD-OCT). A cloud-based platform was used for the automated, seamless transfer of images to a remote reading center for evaluation for DR and other retinal pathologies. Electronic surveys collected participants’ self-reported medical histories, healthcare utilization, and visual function data. Results Among 100 participants (mean age, 43.9 years; 44% male), 33% of them self-reported diabetes. Eye examinations within the past 12 months were reported by 71% of all participants (n = 71/100) and by 85% (n = 28/33) of those with self-reported diabetes. Among participants with complete screening images from both UWF-CFP and SD-OCT, 20% (n = 6/30) of those with self-reported diabetes and 8.5% (n = 5/59) of participants with no history of diabetes were unaware they had mild/moderate nonproliferative DR. Among all participants, 20% (20/100) had a retinal finding, on either UWF-CFP or SD-OCT, or both, which prompted a referral for further evaluation. Conclusions A retinal screening program deployed via a secure, scalable, and interoperable cloud-based platform was feasible and conveniently integrated into the workplace. Translational Relevance Cloud-based platforms could be used to promote a secure, scalable, and interoperable system for retinal screening in nontraditional environments.
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Affiliation(s)
| | | | | | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Simon S Gao
- Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | - Diana Sun
- Genentech, Inc., South San Francisco, CA, USA
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Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond) 2021; 34:1-51. [PMID: 32504038 DOI: 10.1038/s41433-020-0961-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
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Li JPO, Liu H, Ting DSJ, Jeon S, Chan RVP, Kim JE, Sim DA, Thomas PBM, Lin H, Chen Y, Sakomoto T, Loewenstein A, Lam DSC, Pasquale LR, Wong TY, Lam LA, Ting DSW. Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective. Prog Retin Eye Res 2021; 82:100900. [PMID: 32898686 PMCID: PMC7474840 DOI: 10.1016/j.preteyeres.2020.100900] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022]
Abstract
The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a "new normal", the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.
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Affiliation(s)
- Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hanruo Liu
- Beijing Tongren Hospital; Capital Medical University; Beijing Institute of Ophthalmology; Beijing, China
| | - Darren S J Ting
- Academic Ophthalmology, University of Nottingham, United Kingdom
| | - Sohee Jeon
- Keye Eye Center, Seoul, Republic of Korea
| | | | - Judy E Kim
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Peter B M Thomas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Haotian Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, China
| | - Youxin Chen
- Peking Union Medical College Hospital, Beijing, China
| | - Taiji Sakomoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | | | - Dennis S C Lam
- C-MER Dennis Lam Eye Center, C-Mer International Eye Care Group Limited, Hong Kong, Hong Kong; International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tien Y Wong
- Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore
| | - Linda A Lam
- USC Roski Eye Institute, University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel S W Ting
- Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore.
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Gheorghe CM, Purcărea VL, Gheorghe IR. Trick or treat: Social Media's dissemination power of ophthalmologic information in the pandemic context. Rom J Ophthalmol 2021; 65:125-129. [PMID: 34179576 PMCID: PMC8207867 DOI: 10.22336/rjo.2021.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Social Media in the COVID-19 pandemic context has become a real dissemination medium of ophthalmology information for both physicians and health care consumers. This trend of sharing information has revealed new and innovative interventions in Ophthalmology such as teleophthalmology on Social Media by providing synchronous and asynchronous consultations, education, and prevention solutions as well as scientific research findings. This paper is a review of the current challenges and limitations faced by ophthalmologists and health care consumers during the COVID-19 pandemic.
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Affiliation(s)
- Consuela-Mădălina Gheorghe
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Victor Lorin Purcărea
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Iuliana-Raluca Gheorghe
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Tham YC, Husain R, Teo KYC, Tan ACS, Chew ACY, Ting DS, Cheng CY, Tan GSW, Wong TY. New digital models of care in ophthalmology, during and beyond the COVID-19 pandemic. Br J Ophthalmol 2021; 106:452-457. [PMID: 33753407 PMCID: PMC8961770 DOI: 10.1136/bjophthalmol-2020-317683] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 12/14/2022]
Abstract
COVID-19 has led to massive disruptions in societal, economic and healthcare systems globally. While COVID-19 has sparked a surge and expansion of new digital business models in different industries, healthcare has been slower to adapt to digital solutions. The majority of ophthalmology clinical practices are still operating through a traditional model of ‘brick-and-mortar’ facilities and ‘face-to-face’ patient–physician interaction. In the current climate of COVID-19, there is a need to fuel implementation of digital health models for ophthalmology. In this article, we highlight the current limitations in traditional clinical models as we confront COVID-19, review the current lack of digital initiatives in ophthalmology sphere despite the presence of COVID-19, propose new digital models of care for ophthalmology and discuss potential barriers that need to be considered for sustainable transformation to take place.
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Affiliation(s)
- Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Anna Cheng Sim Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Annabel Chee Yen Chew
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Daniel S Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Muttuvelu DV, Buchholt H, Nygaard M, Rasmussen MLR, Sim D. Danish teleophthalmology platform reduces optometry referrals into the national eye care system. BMJ Open Ophthalmol 2021; 6:e000671. [PMID: 33791435 PMCID: PMC7978272 DOI: 10.1136/bmjophth-2020-000671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The purpose of this study was to evaluate the stratification of follow-up and referral pathways after implementation of a systematic cloud-based electronic-referral teleophthalmological service for optometry-initiated ocular posterior segment disease referrals to the Danish national eye care system. Methods and Analysis A retrospective cohort study was conducted in the period from 1 August 2018 to 31 July 2019. Patients with suspected ocular posterior segment disease reviewed by the telemedical ophthalmology service were included. The service stratified patients into the categories: no need for follow-up, follow-up by optometrist, follow-up by the telemedical service and referral to the national Danish eye care service. Results From a pool of 386 361 customers, 9938 patients were enrolled into this study. 19.5% of all patients were referred to the Danish national eye care system, while 80.5% of the patients in the telemedical service were not, in the period from 1 August 2018 to 31 July 2019. 14.4% of the optometrist referrals did not need any follow-up, while a majority of 66.1% needed some follow-up either by the optometrist themselves or within the telemedical service. Conclusion Optometrist posterior segment disease referrals can be considerably reduced with a risk stratified approach and optimal use of technology. New models can improve and streamline the healthcare system.
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Affiliation(s)
- Danson Vasanthan Muttuvelu
- Department of Ophthalmology, Copenhagen University Hospital, Kobenhavn, Denmark.,mitØje ApS, Aarhus, Denmark
| | | | | | | | - Dawn Sim
- Moorfields Eye Hospital City Road Campus, London, London, UK.,University College London, London, London, UK
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Gunasekeran DV, Tham YC, Ting DSW, Tan GSW, Wong TY. Digital health during COVID-19: lessons from operationalising new models of care in ophthalmology. LANCET DIGITAL HEALTH 2021; 3:e124-e134. [PMID: 33509383 DOI: 10.1016/s2589-7500(20)30287-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has resulted in massive disruptions within health care, both directly as a result of the infectious disease outbreak, and indirectly because of public health measures to mitigate against transmission. This disruption has caused rapid dynamic fluctuations in demand, capacity, and even contextual aspects of health care. Therefore, the traditional face-to-face patient-physician care model has had to be re-examined in many countries, with digital technology and new models of care being rapidly deployed to meet the various challenges of the pandemic. This Viewpoint highlights new models in ophthalmology that have adapted to incorporate digital health solutions such as telehealth, artificial intelligence decision support for triaging and clinical care, and home monitoring. These models can be operationalised for different clinical applications based on the technology, clinical need, demand from patients, and manpower availability, ranging from out-of-hospital models including the hub-and-spoke pre-hospital model, to front-line models such as the inflow funnel model and monitoring models such as the so-called lighthouse model for provider-led monitoring. Lessons learnt from operationalising these models for ophthalmology in the context of COVID-19 are discussed, along with their relevance for other specialty domains.
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Affiliation(s)
- Dinesh V Gunasekeran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Medical School, Singapore.
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40
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Chong JC, Tan CHN, Chen DZ. Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping
review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT
Introduction: Teleophthalmology may assist the healthcare sector in adapting to limitations imposed on
clinical practice by a viral pandemic. A scoping review is performed in this study to assess the current
applications of teleophthalmology for its suitability to diagnose, monitor or manage ophthalmological
conditions with accuracy.
Methods: A search of PubMed was conducted for teleophthalmology-related articles published from
1 January 2018 to 4 May 2020. Only articles that focused on the use of teleophthalmology in terms of
diagnosis and management, as well as its benefits and detriments, were included. The Mixed Methods
Appraisal Tool (MMAT) was used to assess the quality of the included articles.
Results: A total of 38 articles were assessed at the full-text level. There were 2 qualitative studies and
1 quantitative randomised controlled trial, while the majority were either quantitative descriptive studies
(19, 50.0%) or quantitative non-randomised studies (16, 42.1%). Overall, 8 studies described reducing
manpower requirements, 4 described reducing direct patient–doctor contact, 17 described storage of
medical imaging and clinical data, and 9 described real-time teleconferencing. The MMAT analysis
revealed limitations in appropriate sampling strategy in both quantitative non-randomised studies (9 of
16, 56.3%) and quantitative descriptive studies (9 of 19, 47.4%). Cost-effectiveness of teleophthalmology
was not performed in any included study.
Conclusion: This current review of the various aspects of teleophthalmology describes how it may
potentially assist the healthcare sector to cope with the limitations imposed by a viral pandemic through
technology. Further research is required to evaluate the cost-effectiveness of the various strategies.
Keywords: Artificial intelligence, health informatics, ophthalmology, teleconsultation, telemedicine
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Gerbutavicius R, Brandlhuber U, Glück S, Kortüm GF, Kortüm I, Navarrete Orozco R, Rakitin M, Strodtbeck M, Wolf A, Kortüm KU. Evaluation of patient satisfaction with an ophthalmology video consultation during the COVID-19 pandemic. Ophthalmologe 2021; 118:89-95. [PMID: 33301067 PMCID: PMC7727093 DOI: 10.1007/s00347-020-01286-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND We introduced a video consultation (VC) during the coronavirus (COVID-19) pandemic in an ophthalmology practice with eight doctors to ensure continuous ophthalmological care, infection prophylaxis and to compensate a decreased number of patient presentations. OBJECTIVE Evaluation of the most common reasons for patient presentations in the VC, the proportion of re-presentations in the practice despite VC, practical challenges associated with the introduction of VC and patient satisfaction. MATERIAL AND METHODS Patients with a recent acute visual deterioration and severe eye pain were excluded from the VC. The VC were carried out by a trained specialist in ophthalmology. A questionnaire with eight questions was completed after the VC appointment in order to evaluate the proportion of completed VC and patient satisfaction. RESULTS We included 29 (13 male, Ø 52.6 years, 16 female, Ø 64.7 years) patients in this analysis. The VC could be performed with 68.97% of the participants who rated their overall experience with an average grade of 1.6 (1 very good to 6 insufficient) and all of them indicated that they would recommend the VC. Of presentations in VC 70% were related to the symptoms of the anterior eye segment. In 70% of the cases no re-presentations took place in the unit. CONCLUSION Our study represents a significant practical application of VC for the management of non-urgent ocular conditions with maximum infection prophylaxis. The introduction of VC was severely limited by technological or user-related issues by the establishment of video connections. Patient satisfaction with VC was high to very high.
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Affiliation(s)
- R Gerbutavicius
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany.
| | - U Brandlhuber
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
| | - S Glück
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
| | - G F Kortüm
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
| | - I Kortüm
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
| | - R Navarrete Orozco
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
| | - M Rakitin
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
| | - M Strodtbeck
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
| | - A Wolf
- Universitätsaugenklinik Ulm, Ulm, Germany
| | - K U Kortüm
- Augenarztpraxis Dres. Kortüm, Solitudestr. 24, 71638, Ludwigsburg, Germany
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Esteva A, Chou K, Yeung S, Naik N, Madani A, Mottaghi A, Liu Y, Topol E, Dean J, Socher R. Deep learning-enabled medical computer vision. NPJ Digit Med 2021; 4:5. [PMID: 33420381 PMCID: PMC7794558 DOI: 10.1038/s41746-020-00376-2] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
A decade of unprecedented progress in artificial intelligence (AI) has demonstrated the potential for many fields-including medicine-to benefit from the insights that AI techniques can extract from data. Here we survey recent progress in the development of modern computer vision techniques-powered by deep learning-for medical applications, focusing on medical imaging, medical video, and clinical deployment. We start by briefly summarizing a decade of progress in convolutional neural networks, including the vision tasks they enable, in the context of healthcare. Next, we discuss several example medical imaging applications that stand to benefit-including cardiology, pathology, dermatology, ophthalmology-and propose new avenues for continued work. We then expand into general medical video, highlighting ways in which clinical workflows can integrate computer vision to enhance care. Finally, we discuss the challenges and hurdles required for real-world clinical deployment of these technologies.
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Affiliation(s)
| | | | | | - Nikhil Naik
- Salesforce AI Research, San Francisco, CA, USA
| | - Ali Madani
- Salesforce AI Research, San Francisco, CA, USA
| | | | - Yun Liu
- Google Research, Mountain View, CA, USA
| | - Eric Topol
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Jeff Dean
- Google Research, Mountain View, CA, USA
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False alarms and the positive predictive value of smartphone-based hyperacuity home monitoring for the progression of macular disease: a prospective cohort study. Eye (Lond) 2021; 35:3035-3040. [PMID: 33414531 PMCID: PMC7790308 DOI: 10.1038/s41433-020-01356-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022] Open
Abstract
Background Home monitoring of hyperacuity allows early detection of progression in exudative neovascular age-related macular degeneration (nvAMD) and diabetic macular oedema (DMO). However, false alarms may pose a significant burden to both patients and healthcare professionals alike. Purpose To assess the false alarm rate and positive predictive value of smartphone-based home monitoring of nvAMD and DMO. Methods Patients treated with anti-angiogenic therapy in a pro re nata scheme for nvAMD or DMO at the Medical Retina service (Lucerne, Switzerland) between March and June 2016 were included in this prospective cohort study. The home monitoring test Alleye (Oculocare Ltd, Switzerland) provided a session score from 0–100 in addition to a traffic-light system feedback via the smartphone application. Three consecutive “red” scores were considered as a positive test or alarm signal. Specificity, 1-specificity (false alarm rate) and the predictive value for optical coherence tomography-based disease progression were analysed. Results 73 eyes of 56 patients performed 2258 tests in 222 “follow-up periods”. Progression was observed in 141 periods (63.5%). The specificity of the test was 93.8% (95% CI: 86.2–98.0%), the false alarm rate 6.1% (95% CI: 2.0–13.8%), and the positive predictive value 80.0% (95% CI: 59.3–93.2%) for the detection of progression. Conclusion False alarm rates for the detection of progression in macular disease via home monitoring is low. These findings suggest that home monitoring may be a useful adjunct for remote management of nvAMD and DMO.
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44
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Lam D, Downie C, Cornish E, McCluskey P, Zagora SL. Telehealth in an acute ophthalmic setting during COVID-19 lock-down. Clin Exp Ophthalmol 2020; 48:1312-1315. [PMID: 33118272 DOI: 10.1111/ceo.13876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Danny Lam
- Sydney Eye Hospital, Sydney, New South Wales, Australia
| | | | - Elisa Cornish
- Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sophia L Zagora
- Sydney Eye Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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45
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Ng SJ, Ong HS, Tong L. A practical framework for telemedicine in dry eye disease. Ocul Surf 2020; 23:143-145. [PMID: 33127597 DOI: 10.1016/j.jtos.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Shi-Jie Ng
- School of Medicine, Trinity College Dublin, Ireland
| | - Hon Shing Ong
- Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Louis Tong
- Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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46
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Jheng YC, Chou YB, Kao CL, Yarmishyn AA, Hsu CC, Lin TC, Chen PY, Kao ZK, Chen SJ, Hwang DK. A novelty route for smartphone-based artificial intelligence approach to ophthalmic screening. J Chin Med Assoc 2020; 83:898-899. [PMID: 32520771 PMCID: PMC7526562 DOI: 10.1097/jcma.0000000000000369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Artificial intelligence (AI) has been widely applied in the medical field and achieved enormous milestones in helping specialists to make diagnosis and remedy decisions, particularly in the field of eye diseases and ophthalmic screening. With the development of AI-based systems, the enormous hardware and software resources are required for optimal performance. In reality, there are many places on the planet where such resources are highly limited. Hence, the smartphone-based AI systems can be used to provide a remote control route to quickly screen eye diseases such as diabetic-related retinopathy or diabetic macular edema. However, the performance of such mobile-based AI systems is still uncharted territory. In this article, we discuss the issues of computing resource consumption and performance of the mobile device-based AI systems and highlight recent research on the feasibility and future potential of application of the mobile device-based AI systems in telemedicine.
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Affiliation(s)
- Ying-Chun Jheng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Big Data Center, Taipei Veterans General Hospital Taipei, Taiwan, ROC
- Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chung-Lan Kao
- Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | | | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Po-Yin Chen
- Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Zih-Kai Kao
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Address correspondence. Dr. De-Kuang Hwang, Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (D.-K. Hwang)
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Kilduff CL, Thomas AA, Dugdill J, Casswell EJ, Dabrowski M, Lovegrove C, Sim DA, Hay GR, Thomas PB. Creating the Moorfields' virtual eye casualty: video consultations to provide emergency teleophthalmology care during and beyond the COVID-19 pandemic. BMJ Health Care Inform 2020; 27:bmjhci-2020-100179. [PMID: 32796085 PMCID: PMC7430180 DOI: 10.1136/bmjhci-2020-100179] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background The COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services. Objective To describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform ‘Attend Anywhere’ in Moorfields Eye Hospital’s accident and emergency (A&E) department (London, UK). Method Patient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service. Results In the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5–31 min) and the wait time was 6 min (range 0–37 min). Conclusion Video consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.
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Affiliation(s)
| | | | - Juliet Dugdill
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Dawn A Sim
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Gordon R Hay
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,UCL Institute of Ophalmology, London, UK
| | - Peter Bm Thomas
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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48
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Wong TY. Academic Ophthalmology during and after the COVID-19 Pandemic. Ophthalmology 2020; 127:e51-e52. [PMID: 32359842 PMCID: PMC7194607 DOI: 10.1016/j.ophtha.2020.04.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Tien Yin Wong
- Correspondence: Tien Yin Wong, MD, PhD, Singapore Eye Research Institute, Singapore National Eye Center, 11 Third Hospital Avenue, Singapore 168751, Republic of Singapore.
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Delivering personalized medicine in retinal care: from artificial intelligence algorithms to clinical application. Curr Opin Ophthalmol 2020; 31:329-336. [DOI: 10.1097/icu.0000000000000677] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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50
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Lang SJ, Böhringer D, Bach M, Reinhard T. Analysis of user behavior on the website of a university eye hospital in Germany. Medicine (Baltimore) 2020; 99:e21348. [PMID: 32791735 PMCID: PMC7387001 DOI: 10.1097/md.0000000000021348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Medical information websites are usually targeted toward patients, physicians, and medical students. Most of the latest studies researched the usability of such websites. However, reports on user numbers and behavior are rare.The goal of our study is to analyze the utility of a website of a large tertiary referral center in ophthalmology in terms of various target audiences (patients, applicants, medical students, referring ophthalmologists).The web access data from our institutional website was assessed with Google Analytics. Data collection started in 2016.From 2016 to 2018, we counted a total of 763,942 page views. The overall number of users dropped from 81,572 to 67,740. This drop's onset correlates with a change in the website structure. All target audience pages received constant traffic from 2016 to 2019, with the patients' and doctors' sites attracting the most traffic. The pages for medical students and job applicants, although not viewed often, revealed a long session duration.Our website is used by all our target audiences. The behavior and the user numbers of each target group differ. Changes to a website's structure can influence the number of users and their behavior. It is not possible to make a direct comparison to other institutions' websites as there are so few similar reports available. By adding more parameters to the analytics profile in a prospective setting, more detailed analyses of user behavior may be possible in the future.
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