Dr Michael Chiang Chronicles the NEI's Research Into AI, Telemedicine in Ophthalmology

Advances in imaging and data science are changing the nature of retina practice, and retina specialists need to stay on top of these, said Michael F. Chiang, MD, director of the National Eye Institute (NEI), who also discussed some of the current research the agency is conducting into artificial intelligence (AI) and telemedicine.

Michael F. Chiang, MD, director of the National Eye Institute (NEI), explained some of the current research the agency is conducting regarding the use of artificial intelligence (AI) and telemedicine in ophthalmology and why ophthalmologists should be paying attention.


What are some of the biggest actions that the National Eye Institute has taken recently that retinal specialists should be following?

What I would highlight—2 things that we've done at the National Eye Institute—that should be important to every single retina specialist.

Number 1 is imaging and data science. Within the past 20 years, there have been advances, things like OCT [optical coherence tomography] and artificial intelligence [AI] that are really changing the nature of retina practice, making it go from qualitative to quantitative.

So, I think it's going to be important for every retina specialists to stay on top of that and to really think very hard about how you can use those technologies to become a better physician. How you can take advantage of them and use them in your practices.

The other thing is, how to understand what those technologies do not do and how to cultivate those skills in yourself, like, for example, communication with patients. So, I think that those are the ways that retina practice is going to be changing. And so, definitely stay on top of that.

Another thing that I would highlight is that because imaging is so fundamental to retina practice—that's obvious—but the problem is that these imaging devices often don't talk to each other and they don't talk to electronic health records. That's a huge problem for clinical care and for research, and when these data are all locked in proprietary standards. At the NEI, we've been working really hard with the FDA and with the Office of National Coordinator for Health Care it because we regulate research and they're the bodies that regulate devices and data. We're really trying to address this problem.

The good news is that the vendors really seem to want to do the right thing for the community. I think this is going to really make a big difference for clinical practice. And so just definitely keep that in mind. You know, these devices really need to talk to each other and there are going to be huge benefits of that.

What has been the NEI’s approach to telemedicine and AI for the purposes of diagnosing and treating ophthalmic conditions?

There's obviously been enormous work, especially in artificial intelligence in the past 5 years. My perspective, at the National Eye Institute, is that there's a lot of potential for that. But there's also risk.

One of the risks is that many of these studies in AI are done in relatively narrow populations. And the problem is that our country is very broad. There's, men and women, different races, different populations. And what we really do not want to have is a world where AI systems work in one population but not in other populations. And so we're really, really trying to drive the fact that we've got to have broad validation and broad generalizability of these systems.

One program that we're really excited about is something that's called Bridge to AI. It is a trans–[National Institutes of Health] program, so it applies to every field. The premise is basically that we're spending $130 million over 4 years to support building data, data that are broad, diverse, and AI ready.

And one thing that I'm really excited about is that we announced the recipients of these grants about 2 weeks ago. And of the 4 data generation sites that got funded, one of them is actually led by ophthalmologists Aaron Lee, MD, and Cecilia Lee, MD, at the University of Washington. I obviously think that there's so much about AI that ophthalmology can really contribute to. So, it's very exciting.

In terms of telemedicine. I think we all learned from this pandemic, that we're moving into a remote world. And so, I really think that what we need to do is to move away from studies that are framed around "Well, how can I get a CPT [Current Procedural Terminology] code for doing this service?" more toward studies that try to develop new models of remote care, that are based on telemedicine and data collection—Who's going to collect the data? Who's going to aggregate it? Who's going to look at it?—because I think that's really how we're going to advance the field and how we're going to use things like telemedicine to really address things like health disparities in this country by increasing accessibility to eye care.

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