“Quo Vadis” Optometry: Understanding the Perspectives of Optometrists and Ophthalmologists in Scotland (Preprint)

Abstract

A repository of ocular images for research is being established. It will provide an infrastructure to allow researchers to conduct approved research validating, tuning and refining AI decision-support algorithms that could potentially be deployed in Scottish optometry and beyond. Research studies all over the world have been successful in demonstrating the potential of AI systems in optometry and ophthalmology. Researchers are investigating how to translate these into medical practice. Widespread adoption of these methods in eyecare has yet to happen.

18 optometrists and 5 ophthalmologists were interviewed to: (1) identify their expectations and concerns about the establishment of the national image research repository and the deployment of AI-decision support tools in practice, as well as; (2) gather their suggestions about how eye healthcare services might be improved by using these digital tools. The main goal was to clarify aspects of primary eye healthcare conducted by optometrists as this is less well studied. A smaller sample of ophthalmologists were interviewed to better understand their working relationships with optometrists and their perceptions regarding a national image research repository and the use of AI-decision support tools.

Individual semi-structured interviews were conducted between March and August 2021. They lasted between 30 and 60 minutes and were conducted online, via Teams. The transcribed and pseudonymised recordings (around 15 hours) were analysed using Thematic Analysis using NVivo (March 2020 release).

All the optometrists and ophthalmologists supported ocular image data sharing and were keen to see an extensive and long-running research repository of patients’ images. Our main findings are summarised as follows: 1. Optometrists were willing to share images of their patients' eyes but expressed concern about technical difficulties, lack of standardisation (e.g., in software and instrumentation, in capturing and transferring images) and the effort involved. 2. Optometrists were concerned to retain skills and professional responsibility when judging patients’ conditions if they were assisted by AI-tools. 3. Optometrists and ophthalmologists saw digital infrastructures for sharing ocular images as a means to improve collaboration, e.g., when patients are referred to secondary healthcare or move between optometry practices. 4. An expanded healthcare role of community optometrists in diagnosis and management of ocular diseases coupled with new technologies has significant potential patient health benefits but may be in tension with commercial pressures.

Our investigation of attitudes focusing on optometrists’ roles in eyecare is novel. The following dominant findings were consistent with studies of ophthalmology and other medical disciplines: • near universally positive attitudes to applying AI and digital tools in biomedical research to improve ocular healthcare. • concerns related to the time spent on training, cost of equipment, but also impact of the use of future digital infrastructure and AI decision-support tools on optometrists’ practices. Our study revealed opportunities and potential innovations not previously foregrounded: • Respondents, particularly optometrists, anticipated transforming service delivery using digital infrastructure and tools. • They also envisaged changes to practice, standards, roles and responsibilities. Attention needs to be given to establishing a supportive professional environment to ensure widespread and sustainable provision of advances in ocular healthcare exploiting concurrently advances in EHR, digital-image handling and analysis. We propose next steps¬ to gather the views of other stakeholders, e.g., patients, technical assistants and healthcare administrators and a wider range of ophthalmologists and optometrists. To facilitate exploitation of emerging digital technology, future work should clarify the issues flagged up and develop with all stakeholders a viable and sustainable path for service innovation.