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Telehealth to continue gathering pace post-pandemic

Rapid uptake of telehealth services amid the COVID-19 pandemic is energising research focused on new ways to remotely diagnose and monitor eye disease, according to one of Australia’s top-ranked eye research institutes.

Researchers from the Centre for Eye Research Australia (CERA) believe telehealth has moved into the mainstream in recent months, as health practitioners replace many routine face-to-face appointments with video consultations.

The institute is developing innovative diagnostic tools to be used in the home or outside traditional eye clinic settings. CERA researchers predict the shift to telehealth services will continue to gather pace after the pandemic ends.

“Video communication has moved into the mainstream and this is an irrevocable change that will also translate into the health system,” CERA deputy director Associate Professor Peter van Wijngaarden said.

“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 eyecare 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.’’

Van Wijngaarden said many eye diseases don’t have symptoms in the early stages, meaning many don’t get tested early enough to prevent vision loss. He said new screening technologies not only needed to be accessible and convenient, but people needed 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,” he added.

An app for AMD

Professor Robyn Guymer, deputy director and head of macular research at CERA, is one such researcher attempting to achieve this. Along with international colleagues, she is developing a digital application that will enable neovascular age-related macular degeneration (AMD) patients to monitor their vision at home.

It is hoped new tests will replace the Amsler grid. It involves patients taking a simple weekly test on an electronic tablet to monitor for early signs of sight-threatening ‘bleeds’ in the back of the eye.

Professor Robyn Guymer says if testing systems are boring people won’t continue to use them over time. Image: Anna Carlile

Unlike the Amsler grid, which requires patients to self-report, they hope it will incorporate an electronic test that could be accessed remotely by specialists. Patients with noticeable deterioration would be alerted to take action, such as repeating their test more often or visiting their optometrist.

In the longer term, Guymer hopes remote monitoring will reduce the number of review appointments, minimising pressure on the health system.

In 2018, Guymer’s team published research demonstrating their technology was a feasible solution for testing AMD vision. The group also found the test’s ability to detect abnormal visual function was comparable to tests taken in the clinic.

The next challenge is to make the digital tests more interesting through ‘gamifying’ them, she said.

“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.’’

The virtual clinic

Professor Mingguang He is leading research trialling the use of an artificial intelligence (AI) tool to identify people at early risk of blinding eye diseases, including diabetic retinopathy, glaucoma, AMD and cataract.

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.

Professor Mingguang He believes virtual clinics will become a new model of care. Image: Anna Carlile

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

In a separate project, 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.

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