How remote retinal imaging raises the bar across service, research and education

The International SPECTRALIS Symposium (ISS) concluded the first day of its scientific programme with a keynote lecture about performing retinal imaging on astronauts in-orbit. The theme of remote care, and especially remote imaging, continues into the second day of the meeting, which will include a session on distributed care models.

Baljean Dhillon, FRCPS, FRCS, FRCOphth, FRCPE. Image courtesy of Prof Dhillon.

Ahead of the meeting, Ophthalmology Times Europe interviewed Baljean Dhillon, FRCPS, FRCS, FRCOphth, FRCPE. Dhillon is a professor of Clinical Ophthalmology at the University of Edinburgh, and an honorary consultant ophthalmologist at the Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, Scotland.

In his presentation at the ISS, Prof Dhillon acknowledged remote monitoring as a tool which helps patients from several populations, in a range of environments and with diverse lifestyle limitations. Here, he describes the research which serves as a basis for his presentation, acknowledging the imposing nature of adopting distributed care while also emphasising its urgency.

Ophthalmology Times Europe: Your presentation at the International SPECTRALIS Symposium is titled “Looking across the gap: Retinal imaging between community and hospital.” What’s significant about this era of distributed care?

Baljean Dhillon, FRCPS, FRCS, FRCOphth, FRCPE: In the context of current NHS care in Scotland, there are both challenges and opportunities in bridging the gap between primary and secondary care through retinal digital imaging. Reaching across this divide enhances efficiency and innovation across clinical service, education and research. Building on pre-existing partnerships between high street optometry, specialist hospital ophthalmology and academia, I describe in my session how we approached the digital divide, the steps taken to bridge the gap and the potential benefits for the long queue of people crossing the bridge in their journey from community to hospital, and back again. 

OTE: What are some underrecognised barriers to bridging that “gap” between community health centres and hospitals?

BD: Barriers include issues around interprofessional communication and multidisciplinary teamwork; data security and curation; ethics and governance; expertise and funding; imaging interpretation and education; population demographics, rural or remote service provision and accessibility; patient pathway design and delivery planning; and resilience and flexibility for vulnerable populations, specifically frail, elderly patients with multi comorbidities.

OTE: As the Day 1 oculomics sessions demonstrated, retinal imaging is about much more than eye health. Are there areas of systemic health where you see ocular imaging, outside a hospital setting, improving patient experiences/treatment?

BD: Retinal imaging, if presented, described and translated in an understandable and meaningful way, represents a powerful resource for engaging individuals to ‘see’ their own ocular health, understand therapeutic options, participate in decision-making and encourage self-care and lifestyle modification. Strategies to extend this conversation outside the narrow time window of a short consult require far more attention to be paid to the patient voice through participation, co-design and rollout. This requires resource, planning and expertise across disciplines, which I hope to highlight.

OTE: Conversely, are there areas of systemic health where community-based or home-based oculomics could be introduced or strengthened?

BD: In my presentation, I describe some of our recently published work related to this topic, including SCONe: a community-acquired retinal image repository enabling ocular, cardiovascular and neurodegenerative disease prediction. See the publication in BMJ Health & Care Informatics here, or visit our page on the University of Edinburgh website here.

OTE: Are there patient groups who can especially benefit from a distributed care model? Are there patient groups that you, specifically, hope to learn more about using collaborative, distributed care networks?

BD: Underserved communities may have little to no healthcare contact, which might arise from geography (remote or rural residence), socioeconomics, ethnicity or language, and limitations posed by frailty, poor mobility, cognitive decline and dementia. Vulnerable populations require remote access of community-captured images across a distributed pathway. Some elements were considered during the pandemic lockdown and the learning can be leveraged in implementing virtual clinics, tele-consults and clinical trial delivery.

OTE: What message do you hope attendees take away from your presentation—or what would you like clinicians to know if they weren’t able to attend in-person?

BD: That taking steps to bridging ‘the gap’ in the context of clinicians’ local healthcare system is undoubtedly daunting, but presents a great opportunity for raising the bar in quality across service, multi-professional education and clinical research in retinal imaging. Above all, it is essential to place the individual having to navigate the digital divide at the core of any bridge-building process in order to ensure it is fit for purpose, robust and sustainable.