As the COVID-19 pandemic has spurred Australia’s health care practitioners to replace many routine face-to-face appointments with phone or video consultations – telehealth has moved into the mainstream.

CERA researchers are leading major projects to develop innovative new diagnostic tools that can be used in the home or outside of traditional eye clinic settings. They predict the shift to telehealth services will continue to gather pace after the COVID-19 pandemic has ended.

Innovation in eye research

CERA Deputy Director Associate Professor Peter van Wijngaarden is leading research to develop a simple eye test to detect the early signs Alzheimer’s disease. He is also Clinical Director of KeepSight, a national reminder system to encourage people with diabetes to have regular eye checks.

“In times of crisis, innovation really comes to the fore,’’ says Associate Professor van Wijngaarden. “Video communication has moved into the mainstream and this is an irrevocable change that will also translate into the health system.

“Powerful imaging technology, combined with artificial intelligence, is transforming the ability to screen for the early signs of eye disease.

“Making eye screening more convenient and accessible for patients, so that we can diagnose disease earlier and prevent vision loss, is moving hand in hand with tremendous improvements in technology.

“New technologies have the potential to detect the early signs of disease – without the need to attend an eye clinic – and determine who needs to be referred to an eye care professional for a more detailed clinical assessment.

“Research is now revealing the potential to test patients at locations that suit them – in their own home, a photobooth in a shopping centre or during a visit to another health care provider like a GP.’’

Associate Professor van Wijngaarden says one of the great challenges is that many eye diseases have no symptoms in the early stages – and many people do not get tested early enough to prevent vision loss.

This means that new screening technologies not only need to be accessible and convenient – but people also need to be motivated to use them.

“Just because you have a digital solution or an app, doesn’t mean that people will use them. For a technology to be truly transformative it has to meet the needs of the consumer.’’

From Amsler grid to AMD app

Professor Robyn Guymer AM is Deputy Director and Head of Macular Research at CERA. She is working with international colleagues to develop a digital application that will enable people with age-related macular degeneration (AMD) to monitor their vision at home.

It’s hoped new tests will replace the Amsler grid – the traditional paper-based tool which has been widely used to monitor patient vision in recent decades.

Professor Guymer and her team developed a digital application – which involved patients with ‘wet’ AMD taking a simple weekly test on an electronic tablet– to monitor for early signs of sight-threatening ‘bleeds’ in the back of the eye.

They envisaged that unlike the Amsler grid which required patients to self-report – an electronic test could be accessed remotely by specialists and analysed regularly. Patients with noticeable deterioration in their vision would be alerted to take action, such as repeating their test more often or visiting their optometrist.

“Although we now have very good treatments to prevent vision loss from bleeds in ‘wet’ AMD, one of the great challenges is making sure patients are treated at the right time,’’ says Professor Guymer.

Professor Guymer was inspired to develop a test to improve the chances of saving patients’ sight and reduce the number for elderly patients arriving at hospital emergency departments with sudden, profound loss of vision.

In the longer term, she hopes that remote monitoring will also reduce the number of review appointments patients need, minimising pressure on the health system caused by a rapidly ageing population.

In 2018, Professor Guymer’s team published research which showed their technology was a feasible solution for testing AMD patient’s vision.

The group also found the test’s ability to detect abnormal visual function was comparable to tests taken in the clinic.

Professor Guymer says the next challenge is to make the digital tests more interesting.

“We hope to ‘gamify’ these tests to make them more engaging,’’ Professor Guymer says.

“If tests are boring people won’t continue to do them over many years, especially if the result doesn’t change over many hundreds of tests.

“We want to create something that is engaging and fun so that people will want to continue to use it without it feeling like a chore.’’

Professor Guymer says the COVID-19 pandemic has also highlighted the need for technologies which enable patients to test their vision on their own phone or tablet without having to spend extended periods in small, often cramped, examination spaces in eye clinics.

“A tool that can minimise the amount of contact time will play an important role in protecting patients and health care professionals,’’ she says

AI bridging the eye health gap

Professor Mingguang He is leading research  trialling the use of an artificial intelligence tool to identify people at early risk of blinding eye diseases including diabetic retinopathy, glaucoma, age related macular degeneration and cataract.

After taking a photo of the back of the patient’s eye, the AI system scans for signs of disease and prints out a report identifying if the patient should be referred to a specialist for further assessment and treatment.

“Vision impairment and blindness are major public health problems in Australia with to 50 per cent of major eye diseases remaining undiagnosed,’’ says Professor He.

“Artificial intelligence has the potential to close the gap in eye care by enabling screening programs to be introduced in remote and regional areas that are currently missing out on eye care services.’’

The AI tool’s algorithm has been developed over five years using more than 200,000 images of the back of the eye and has been found to be highly accurate.

It is now being trialled in real-world setting, including remote Indigenous communities in the APY Lands in Central Australia in a collaboration with the Nganampa Health Council and The Fred Hollows Foundation.

The next step will be to compare the AI tool against current telehealth models and measure accuracy, cost-effectiveness, ease of use and patient and clinician acceptance.

“After COVID-19, face-to-face consultation will become increasingly challenging,’’ says Professor He.

“Artificial intelligence integrated with automation and robotic technology will enable us  to develop a virtual clinic as a new model of care.

“We are working hard to not only making AI more accurate, but also faster, easier to use and less dependent on operators and physicians.”

In a separate project, Professor He, supported by the Google Impact Challenge, has led the development of an app which enables people to measure their visual acuity at home.

The app, which calibrates distance using face recognition technology, has an accuracy level similar to tests taken in clinical settings.