Telehealth, Independent Prescribing and AI Simulation for Ophthalmologists with Iain Livingstone on the Eye Views Podcast
Eye ViewsShow Notes
In this episode of the #EyeViews podcast from Eye News, host Loren Butler is joined by Consultant Ophthalmologist Dr Iain Livingstone to discuss the transformative role of mobile technology and artificial intelligence (AI) in eyecare, specifically within patient pathways for ophthalmology and optometry. The discussion begins with how a smartphone can assist an eye specialist and their patient. Dr Livingstone recounts his early innovation as a registrar, developing an app called Eyesight Test (one of the first to be CE marked) by scaling Kay's Picture Tests on his phone. This initial project affirmed his interest in mobile technology and led to the founding of Peak Vision, a technology which allows the extraction of a beautiful picture of the optic disc with zero experience, mobilising the eye clinic and enabling transatlantic retinal exams.The conversation moves to the impact of the COVID-19 pandemic, where their work in peer-to-peer video conferencing and decision support rapidly mobilised a decision-support service across optometry in Scotland, particularly Central Scotland. This placed them unexpectedly in the public health space. By leveraging systems like NHS Near Me (re-labeled Attend Anywhere) and equipping optometrists with tools like the video slit lamp, the eye casualty was spread across the community.Dr Livingstone emphasises the continued focus on consolidating and maximising the link between community optometry and secondary/tertiary care. Strategies for maintaining this relationship include increasing independent prescribing and utilising simulation for training, shifting from "see one, do one, teach one" to "do one virtually a hundred times" before the first real case. The role of safety netting and understanding the attitude to risk and comfort with uncertainty are crucial in this blended care model.Discussing the origins of his involvement in digital tech, Dr Livingstone calls it his "burnout prevention part of the week" and explains it originated from the need for remote support as a first-on consultant with no juniors. The segment on patient-centered care explores the impact of mobile technology for the patient, citing a case where a patient with a cavernous sinus fistula was directed straight to neurosurgeons, bypassing the ophthalmology department, after a video consultation. However, Dr Livingstone cautions that the technology is not a panacea, noting a case where relying solely on the video call missed the crucial detail of dangerously high intraocular pressure in a young patient with a hyphaema.Regarding uptake, he notes that technology is a "totally polarizing prospect" among colleagues. While some embrace it, others see it as a distraction from an already saturated service. The lack of change in job plans to accommodate the time needed for unscheduled care and the subsequent drop in usage since the pandemic are significant challenges. He shares an example of successful video-first services at Moorfields Eye Hospital, where a 999 call can lead to a video consultation with an eye health specialist. Dr Livingstone's dream is to have a team of video-first ophthalmologists working across boards in Scotland to protect time for unscheduled care, especially in remote areas.Finally, Dr Livingstone addresses the use of AI in daily practice, emphasising the need for transparency, being the "biggest critic," and taking full responsibility. He quotes a colleague: "AI won't replace a doctor, but it will make you a more competitive doctor than your colleagues," arguing that not using it is a disadvantage. For those interested in AI, Dr Livingstone encourages them to start, noting the rise of "vibe coding" (describing what you want and letting AI create it) allows for rapid prototyping without a computing degree, making it a great time to be interested in digital tech in healthcare.
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