HCI for ophthalmology: Tele-ophthalmology-enabled and AI-ready referral between community optometry and hospital-based eye clinics for retinal disease

Brief description of the context of the research including potential impact

Hospital eye clinics receive a very large number of referrals for patients who had an eye check-up at a high street optometrist. Of those a significant proportion relate to problems with the retina. The best way to detect problems of the retina is by doing a quick, non-invasive scan called Optical Coherence Tomography (OCT). Increasingly, high street opticians are equipped with this technology, but there is a shortage of trained staff for interpreting these scans. The result can be a 'deluge' of referrals that overwhelm hospital eye clinics and delay access to care for patients that do require treatment. Recently, revolutionising technology based on Artificial Intelligence and tele-ophthalmology has been developed that can read OCT scans in an automated way and/or by a specialist and offer advice on whether a referral to hospital clinics is needed and how urgently.

This research project aims to investigate the facilitators and barriers to implementing the AI and tele-ophthalmology platform at scale. The project will involve a number of high street optometry practices with OCT that refer patients to hospital based clinics, as well as two hospital based clinics.

This project should enable the smooth adoption of novel interventions for triaging referrals between primary and secondary ophthalmology at scale.

Aims and Objectives

The specific objectives are to: review relevant literature on AI in healthcare, ophthalmology referral, and related topics; conduct studies to identify factors at different levels that affect the implementation of novel interventions; and propose best practice in the design of technology and workflows to facilitate the integration of novel technologies in routine ophthalmology practice.


Novelty of Research Methodology

The research methodology will adapt established techniques from HCI and Human Factors to address the specific needs of the work contexts (primary and secondary ophthalmology care), take into account the perceptions, expectations and experiences of patients as well as clinicians, and develop best practices in "explainable AI" interfaces as appropriate to the context.

Alignment to EPSRC's strategies and research areas

The project particularly addresses the EPSRC Health Technologies strategy of accelerating the translation of EPSRC research to healthcare applications, with a particular focus on AI-enabled healthcare.

Any companies or collaborators involved

The project is in collaboration with the Moorfields BRC, and will involve Moorfields Eye Hospital and referring primary care ophthalmology practices.

The critical mass of scientists and engineers that i4health will produce will ensure the UK's continued standing as a world-leader in medical imaging and healthcare technology research. In addition to continued academic excellence, they will further support a future culture of industry and entrepreneurship in healthcare technologies driven by highly trained engineers with deep understanding of the key factors involved in delivering effective translatable and marketable technology. They will achieve this through high quality engineering and imaging science, a broad view of other relevant technological areas, the ability to pinpoint clinical gaps and needs, consideration of clinical user requirements, and patient considerations. Our graduates will provide the drive, determination and enthusiasm to build future UK industry in this vital area via start-ups and spin-outs adding to the burgeoning community of healthcare-related SMEs in London and the rest of the UK. The training in entrepreneurship, coupled with the vibrant environment we are developing for this topic via unique linkage of Engineering and Medicine at UCL, is specifically designed to foster such outcomes. These same innovative leaders will bolster the UK's presence in medical multinationals - pharmaceutical companies, scanner manufacturers, etc. - and ensure the UK's competitiveness as a location for future R&D and medical engineering. They will also provide an invaluable source of expertise for the future NHS and other healthcare-delivery services enabling rapid translation and uptake of the latest imaging and healthcare technologies at the clinical front line. The ultimate impact will be on people and patients, both in the UK and internationally, who will benefit from the increased knowledge of health and disease, as well as better treatment and healthcare management provided by the future technologies our trainees will produce.

In addition to impact in healthcare research, development, and capability, the CDT will have major impact on the students we will attract and train. We will provide our talented cohorts of students with the skills required to lead academic research in this area, to lead industrial development and to make a significant impact as advocates of the science and engineering of their discipline. The i4health CDT's combination of the highest academic standards of research with excellent in-depth training in core skills will mean that our cohorts of students will be in great demand placing them in a powerful position to sculpt their own careers, have major impact within our discipline, while influencing the international mindset and direction. Strong evidence demonstrates this in our existing cohorts of students through high levels of conference podium talks in the most prestigious venues in our field, conference prizes, high impact publications in both engineering, clinical, and general science journals, as well as post-PhD fellowships and career progression. The content and training innovations we propose in i4health will ensure this continues and expands over the next decade.