FEATURE A New Model for Eye Care Patients requiring specialist eye care services currently wait up to four years for an appointment in the public healthcare system, leaving those with chronic, degenerative blinding conditions at risk. Professor Christopher Leung Kai-shun, Chairperson of the Department of Ophthalmology, School of Clinical Medicine, and Director of the HKU Eye Centre, is leading a new Strategic Topics Grant (STG) project to slash that wait-time to only two months. Working with District Health Centres (DHCs) and leveraging his experience with Orbis in screening Hong Kong residents of public housing estates for blinding eye diseases, Professor Leung has partnered with Professor Sophia Chan Siu-chee, from the HKU Primary Health Care Academy, and researchers from The Chinese University of Hong Kong, The Hong Kong Polytechnic University and United Christian Hospital. Together, they will deploy advanced imaging technologies and artificial intelligence (AI) to provide fast and accurate eye tests. The tests will be conducted through a streamlined service model led by ophthalmic nurses and optometrists, who will determine which patients require treatment by ophthalmologists at the specialist outpatient clinics (SOPC) and which can be managed at the DHC, including those with refraction errors or dry eye disease. Currently, patients are mainly referred by other doctors and all must wait for specialist care. The imaging technology consists of an optical coherence tomography (OCT) diagnostic system to detect blinding diseases, enhanced by AI that analyse data across various conditions to provide accurate diagnoses. This technology refinement will take up the first year of the five-year project, aiming for a sensitivity and specificity of at least 90 to 95 per cent. The AI-augmented OCT diagnostic system will then be rolled out to two DHCs, in Southern and Kwun Tong districts, where on-site ophthalmic nurses and optometrists will conduct eye tests on an estimated 20,000 patients. If a blinding eye disease is detected, patients will be referred to the SOPC. Those with refractive errors or dry eye disease will be managed by the DHC team, which will provide eye health education, glasses prescriptions, and lubricants for dry eyes. Through this streamlined service model, referred patients are expected to wait only about two months to see an ophthalmologist. The project also involves a ‘pragmatic’ clinical trial to test how well it improves on the current system while providing necessary treatment. Unlike conventional clinical trials, this study will include all non-urgent patients referred to the eye clinics. Patients will be randomly assigned to either the new service model or the old one (i.e., waiting for an ophthalmologist to assess their conditions), ensuring that all are seen by ophthalmologists to evaluate the accuracy and reliability of the AI-augmented OCT diagnostic system. The final phase will examine its cost-effectiveness. ‘We know this model works from our previous collaboration with Orbis (HKU x Orbis AIROTA glaucoma screening programme),’ Professor Leung added. ‘It can save sight and save money. But we need data to build up the evidence so that it can eventually be applied as an innovative and cost-effective eye care model across Hong Kong.’ ‘Urgent visual problems, such as ocular trauma, or sudden acute vision loss, will be prioritised for early assessment at the specialist outpatient clinics. With advanced imaging technology, we can gain a clearer understanding of chronic blurry vision issues early on and tailor referral times to meet patient needs.’ Professor Christopher Leung Kai-shun 8
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