Artificial intelligence (AI) is the next piece in the puzzle required to provide greater access to eye care for people in Australia’s remote communities.
With this in mind, research projects are being conducted at the Kimberley Eye Hub in Broome – a part of the Lions Eye Institute in Perth. Collaborations with Google, Topcon, Novartis and CERA are looking at the ability of an AI platform to detect common eye diseases within Indigenous Australian populations.
Collaborative care is lifted to new levels when we can share our imaging more effectively (this)… has enabled better referrals and therefore patients can be treated within a much more refined pathway
Ophthalmologist Associate Professor Angus Turner, who heads the innovative Kimberley Eye Hub, said the Google study is working out whether it is possible to teach the AI platform how to use 2D fundus photos to detect centre involving maculopathy and identify when treatment is required, without needing a more expensive optical coherence tomographer (OCT) in small communities.
Although the Hub and larger spokes have access to optical coherence tomography angiography (OCT-A), the ability to detect disease from 2D photos would enable eye health workers on outreach programs, and those based in smaller communities, to quickly and effectively screen for eye disease.
A CENTRAL SERVICE
The Kimberley Eye Hub was opened in Broome in 2020 and comprises state-of-the-art diagnostic equipment, a tertiary retinal surgical service, an education centre, accommodation and a statewide Telehealth centre. In the future, it will be expanded to become a multi-disciplinary clinic as new facilities are completed in 2022.
The Hub is housed in a donated backpacker’s hostel that has been extensively renovated with Commonwealth support, and equipped with devices, many of which were provided free of charge by companies including Zeiss and Topcon. State and Federal Government funding, as well as the land and buildings from Wen Giving and Hawaiian Foundation and support from Fred Hollows Foundation, were integral to its establishment.
From here, ophthalmologists, optometrists, Aboriginal health workers and nurses provide care for people with cataracts, trachoma, glaucoma and diabetic eye disease, and those with low vision and permanent blindness. As well as an on-site clinic, the Hub’s health workers travel from Broome to provide outreach services at local hospitals in Derby, Fitzroy Crossing, Halls Creek, Kununurra, Wyndham and Warmun as well as 15 smaller communities with visiting optometry.
A/Prof Turner said that until the Hub was built, remote communities were serviced by the Lions Outback Vision Van for ophthalmology outreach.
“About five years ago, we realised the van’s services were not able to cope with growing demand for anti-VEGF treatments and diabetic retinopathy screening across the state. While it was, and still is going strong, it just wasn’t enough,” A/Prof Turner explained to optometrists attending a free clinical conference hosted by Specsavers.
SUPPORTED BY TECHNOLOGY
A/Prof Turner said telehealth has been integral to the success of service accessibility via the Hub, its outreach services and indeed the Vision Van.
“Telehealth brings optometry, ophthalmology, general health services and patients together, providing the best chance to deliver efficiency whether for diabetes screening, encouraging patient compliance with management plans, or surgeries.
“Optometry is key – we can’t make decisions about management without the right imaging, checking pressures, ruling our refractive error etc. – all the things GPs don’t feel comfortable with,” said A/Prof Turner.
“When all of this is done, when specialists are able to view images remotely then engage with the patients and primary health care providers via telehealth, they can arrive in the community and perform surgeries rather than duplicate consults,” he said.
Impressively, even patients with dense cataract, who arrive at the Broome Hub, or at an outreach service in a regional hospital for first contact with a specialist, can be on their way home on the same or next day, thanks to this level of efficiency.
A/Prof Turner said research has shown that this Medicare funded telehealth model has halved surgery wait time. “This makes a big difference when there is a one year wait time in the public health system,” he said, adding that it may now be faster to have cataract surgery within the public system in remote areas of Western Australia than it is in most major cities of Australia.
“The on-call service has increased access to eye health surgery 10 fold for Aboriginal people – it is cost effective and has very high patient satisfaction; outcomes are equal or better than they were, and we can stop duplication of the work we do – if an eye examination has been done thoroughly, there’s no need for a patient to see a specialist before surgery, they can be directed straight to assessment and surgery on the same day.”
ON THE SPOT ASSESSMENT
While a hospital or eye clinic can have all the equipment in the world, unless there are people to effectively operate it, it becomes valueless.
A/Prof Turner says this has now become one of the greatest barriers to accessing care in remote and regional communities, and hence the focus on artificial intelligence.
He explained that while a remote health worker may be able to use a retinal camera to image a patient’s eye, ophthalmologists and optometrists are not available in real time to review every image. This means patients leave the clinic without a ‘next step’. Follow-up – making contact with the patient to arrange a further consultation or arrange treatment – can be complicated by geography and logistics.
The answer is the use of AI to determine whether the patient needs a telehealth consultation on the spot.
“This is vital – the operator needs to know whether the photo is adequate or whether the patient needs further dilation and another photo taken; and once an adequate photo is taken, whether the patient is referable. If the patient is referable then an immediate telehealth consultation, while the patient is in the clinic, is warranted and can be facilitated. The telehealth consult can be used to discuss next steps, make arrangements, and encourage patient compliance with the management plan – this keeps everyone in the loop,” A/Prof Turner said.
The Kimberley Eye Hub’s research is also looking to determine whether an AI platform developed by Centre for Eye Research Australia is as effective in a real world environment as it has been in research. They aim to determine whether the images the platform has been trained with, which were taken using a Topcon OCT, are relevant to an Australian Indigenous population.
“In the Broome Hub, we have new capacity to undertake research and this has been exciting to explore with the Aboriginal community as we discuss participation in population-based research to determine prognostic factors linked to systemic disease and the eye images.
“The potential is great, but what is fascinating is watching this space where an optometrist works closely with an ophthalmologist. Collaborative care is lifted to new levels when we can share our imaging more effectively on the Oculo platform for example, which has enabled better referrals and therefore patients can be treated within a much more refined pathway,” he concluded.