DeepMind is a British company who want to address some of the toughest challenges in healthcare today, and make a difference by changing how technology works with the NHS. DeepMind and Moorfields Eye Hospital are collaborating on a research project to investigate how artificial intelligence could help to better analyse these scans, giving clinicians a better understanding of eye disease. We hope this will lead to earlier detection and treatment for patients and ultimately help to avoid cases of preventable eye disease.
Faster and more efficient diagnosis of eye disease could help prevent many thousands of cases of sight loss due to wet age-related macular degeneration and diabetic retinopathy, which together affect more than 625,000 people in the UK
Learn more about the partnership by watching the video of Professor Sir Peng Tee Khaw and consultant consultant ophthalmologist Pearse Keane.
My name is Pearse Keane and I'm a consultant ophthalmologist at Moorfields Eye Hospital I'm Professor Sir Peng Tee Khaw I'm a consultant eye surgeon here at Moorfields Eye Hospital.
Moorfields is the oldest Eye Hospital in the world and we see over 600,000 patient visits a year, which is more than twice any other Hospital in either United States or Europe.
It's a wide ranging Hospital where we see very common conditions and also very rare conditions every week we do many thousands of ooc scans o gives us very high resolution images of the eye in a very non-invasive manner.
Some people are waiting long periods of time to see specialists in the eye clinics and therefore have the potential to lose sight in that waiting period.
This is where Deep Mind is able to help us understand these huge data sets and then put it together so it benefits towards making a good diagnosis and achieving the best possible treatment for our patients if you have an OC scan done a machine learning algorithm will be able to tell you if it's something urgent versus something that's not so urgent.
I think that this has huge potential for patients it will allow us to get much earlier detection of these blinding diseases and as a result of that I think we'll get much earlier intervention and much earlier treatment for these patients
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My name is Pearse Keane I'm a consultant ophthalmologists at Moorfields Eye Hospital. Moorfields Eye Hospital is the
oldest eye Hospital in the world.
In terms of worldwide basis more than 285 million people have some form of visual impairment. And one of the key things is
that in about 80% of those cases, if those patients are diagnosed and treated, that visual impairment is reversible.
The way that we've diagnose retinal diseases is using a technique called OCT. And OCT is kind of like ultrasound, and it gives us very very high resolution images of the back of people's eyes.
OCT imaging at Moorfields, and in fact at eye hospitals all around the world has revolutionised ophthalmology to the extent that we now, even in Moorfields, do many thousands of o CT scans per week.
One of the challenges that we face is being able to analyse the OCT scans and make the diagnosis in a timely fashion, and unfortunately that delays people getting the treatment that they need. All the evidence suggests that if we can get earlier diagnosis we can start treatment earlier and we can save sight.
That's why we've been working with DeepMind over the past 18 months to see whether artificial intelligence could help us solve this problem and so we're really excited now that we have the first results of this work.
My name is Trevor Back, I'm the research lead for DeepMind Health. DeepMind Health is researching how artificial intelligence could help solve some of the most pressing challenges in healthcare today we've been working with Moorfields Eye Hospitals since 2016.
We've been exploring whether we can develop artificial intelligence to help eye care professionals analyse OCT scans more effectively than they can at present that could give them a better and faster understanding of their patient’s eye disease. The AI system we've
been out to develop in collaboration with Moorfields is able to detect a wide range of different sight threatening diseases in these OCT scans, and amazingly to the same accuracy as an expert doctor.
They’re also able to do it while also providing information that enables eye care professionals to review the recommendation that it makes. So, the eye care professionals can scrutinize that decision and ensure that the right decision is taken for those patients.
I believe this technology could lead to a system where eye care professionals can prioritise those patients with the most serious eye conditions that can take us one step closer to preventing avoidable sight loss.
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It's really hard to explain to people what AMD is like.
It was in the year 2000, I'd noticed the television was going wavy, I felt like us wearing glasses with a raindrop blob, and the line on the
computer was going all weird. They looked at my eye and he just looked at me and he said this is very serious. I realised that I couldn't see anything out of the eye, nothing. They did several checks and then they said there's nothing more now that we can do for that eye. I was really worried thinking “oh my gosh, what if I wake up the next morning and I'm blind?” It can happen with AMD.
In the United Kingdom alone nearly 200 people developed a blinding form of macular degeneration every single day. Experts recommend that patients who are suspected of having sight threatening retinal diseases, such as age-related macular degeneration, are seen and treated within two weeks of the onset of their symptoms.
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Unfortunately, this target is often not met because hospitalised services in the UK, and around the world, receive too many referrals and they struggle to deal with, and to treat these patients within a two week time frame. That's why we've been working with deep mind for the last 18 months to explore how artificial intelligence can deal with this challenge.
We're delighted now that we have the first results from this collaboration between Moorfields and DeepMind. DeepMind have developed an algorithm which can look at an OCT and identify a wide range of eye diseases such as macular degeneration and diabetic eye disease. But also, a range of other conditions.
And what's really exciting is that when it does this it can match the performance of an expert Doctor. Another exciting feature is that it doesn't just give a suggested course of action it also gives the eye care professional an insight into why it's made the decision that it's given.
This is important because it allows specialists to scrutinise the recommendations and support their diagnosis. This is a huge development because it overcomes a lot of the significant barriers to the implementation of artificial intelligence.
In the real world, in the future I could envisage a scenario where a person could just go into their local high street optician and have an OCT scan done, and this algorithm would identify those patients with sight threatening disease at the very earliest stage of their condition. That can take us one step closer to preventing avoidable sight loss.
Where I didn't have this AI in all this knowledge when I was first diagnosed these people are going to have it, there will be hope for those people right away.
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In 2016, Moorfields Eye Hospital NHS Foundation Trust entered into an exciting research partnership with the British technology company DeepMind. In November 2018, it was announced that DeepMind Health would move to Google Health so that the app can grow and support more doctors to deliver faster, better care to patients. In September 2019, after careful consideration, we have now replaced our partnership agreements to continue our work with Google Health.
Two years ago, Pearse Keane, a consultant ophthalmologist at Moorfields Eye Hospital, contacted DeepMind and requested a meeting to discuss whether artificial intelligence (AI) could help meet a growing clinical need to better analyse eye scans.
Pearse and Professor Sir Peng Khaw, Director of the National Institute of Health Research Biomedical Research Centre at Moorfields and the UCL Institute of Ophthalmology, met with the DeepMind Health team and were keen to initiate a collaborative research project between Moorfields and DeepMind.
Eye health professionals use scans of patients’ eyes to detect and diagnose serious eye conditions and diseases.
At Moorfields we perform more than 5,000 optical coherence tomography (OCT) scans every week. It takes eye health professionals a long time to analyse these highly complex eye scans, which can impact on how quickly patients can be seen to discuss their diagnosis and treatment.
Our research project with DeepMind Health is investigating how AI technology could help us to analyse these scans. We hope this will lead to earlier detection and treatment of eye disease before lasting damage occurs.
Artificial intelligence (AI) refers to a wide branch of computer science that attempts to build machines capable of intelligent behaviour.
Machine learning is a type of AI, which refers to the development of programmes that are able to act without being explicitly programmed. A programme will use a variety of techniques to build a mathematical description or ‘model’, based on the data shown to it and ‘learn from’ this data to perform a function, such as making a prediction or identifying specific pixels.
Machine learning programmes will learn patterns that might not be picked up by other types of programmes. This can be useful for problems involving complex information, such as those in the medical domain.
Our first research paper, published on Nature Medicine’s website on Monday 13 August 2018, demonstrated a significant step towards our goal of creating technology which would allow eye health professionals to prioritise patients with the most serious eye conditions and treat them before lasting damage occurs.
Firstly,we have developed AI technology which can match the accuracy of expert ophthalmologists and optometrists when identifying a range of eye conditions – such as age-related macular degeneration and diabetic eye disease – and generating
the correct referral recommendation.
Secondly, the research used de-identified OCT scans taken from routine care and benchmarked against real de-identified referral decisions used at Moorfields Eye Hospital, demonstrating that the AI technology is applicable to real-world healthcare settings.
The AI technology can also provide information that explains to eye health professionals how it arrived at its decisions. We think this is critically important for clinical application, since it will allow doctors, nurses and healthcare professionals to scrutinise these recommendations.
The research also demonstrated that the AI technology can be easily applied to different types of eye scanner, massively increasing the number of people across the world that it could benefit, and future-proofing the technology against new devices and models that could emerge in the future.
It’s still early days, but we believe AI could revolutionise the way eye diseases are diagnosed, treated and managed, creating a system which enables eye care professionals to quickly prioritise patients with the most serious eye diseases before irreversible damage sets in – taking us one step closer to preventing avoidable sight loss.
The AI system was able to detect many forms of macular disease. Age-related macular degeneration (AMD) is the most common macular condition that the AI system is able to detect. Other macular conditions include myopic maculopathy, macular holes, diabetic macular oedema and retinal vein occlusion.
However, unlike previous studies in this area, we didn’t focus on or exclude any specific eye conditions for this research because we want to create technology that can identify all patients in urgent need of eye treatment, regardless of the specific eye diseases they might have.
The AI system is not a treatment for eye conditions like age-related macular degeneration (AMD). It is designed to detect many forms of eye disease so that it can help doctors and eye health professionals decide what care a patient might need.
There are two types of AMD: ‘wet’ and ‘dry’.
Dry AMD is the most common type of macular degeneration and affects about four in every five people who have the condition. Unfortunately, there is no treatment for dry AMD.
Wet AMD can develop very suddenly and causes serious changes to your central vision. The treatment available on the NHS for wet AMD is with a group of medications called anti-vascular endothelial growth factor (anti-VEGF) drugs. These are injected inside your eye.
If you notice a sudden change in your vision, you should have your eyes examined by an eye health professional as soon as you can.
If you or a family member have been diagnosed with macular disease, help and support is available from charities including Macular Society and RNIB. They can answer questions and provide information and advice about any aspect of living with sight loss.
It’s still early days and this technology will need to go through rigorous clinical trials before it could be deployed at Moorfields and in other clinical settings, but we’re excited about the potential it has demonstrated.
No. It is not possible to register your interest to take part in future trials due to the strict recruitment criteria.
At the time a study is recruiting, patients who have been referred to Moorfields as a patient and match against the strict recruitment criteria will be contacted by the care team to ask if they are interested in taking part.
You can always ask your GP or hospital consultant about any clinical trials or other well designed studies that you may be suitable or eligible for.
The NHS also provides further information on participating in research and where to find out about active clinical studies: https://www.nhs.uk/conditions/clinical-trials.
The research project agreement is for five years.
Over the course of the research project, Moorfields Eye Hospital will share approximately one million de-personalised digital eye scans, used by eye health professionals to detect and diagnose eye conditions.
Anonymous clinical diagnoses, information on the treatment of eye diseases, the model of the machine used to acquire the images and demographic information on age (shown to be associated with eye disease) will also be shared during the course of the project.
This is only the first phase of a five year research collaboration. At the end of the research work, the data held on DeepMind drives will be destroyed with 8-pass overwrite and a certificate of destruction will be provided to Moorfields.
When research is conducted using de-personalised data, with no way for researchers to identify individual patients, explicit consent from patients for use of their data is not required. For more information, please refer to the ICO Guide to the General Data Protection Regulation (GDPR).
As with all research collaboration agreements with non-NHS organisations, patients can opt out of any data-sharing system by emailing the trust’s data protection officer moorfields.ig@nhs.net. Patients will need to include their NHS or medical records number in any messages. Opting out of research applies to all research projects at Moorfields, not just the DeepMind collaboration.
If you don't want your confidential patient information to be used for research and planning, you can opt out of this. If you do opt out, there are some specific situations where your data may still be used. Data that does not identify you may still also be used.
In this case, all future research will take place excluding those who have opted out. As with all studies on anonymised datasets, measures will be adopted to render it impossible to identify any individual patients. It is therefore not possible to opt-out of research already underway for this reason.
We rigorously ensure that no personally identifiable data is included in the database of scans which is provided to DeepMind for this project.
During the course of the project DeepMind is taking rigorous measures to protect the security of the data, and avoiding disclosing it to anyone other than the researchers and engineers working on the project.
Data contributing to this study can only be used for research that explores the use of machine learning to support clinicians in their management and diagnosis of eye diseases. The data itself cannot be linked with any other dataset, although any new models or software produced by the research may be linked to other datasets to allow for it to be used to help treat patients in the future, and also to enable further research to improve the models by drawing upon other approved sources of data.
Anonymisation procedures are thoroughly validated and formally approved by the Moorfields Eye Hospital information governance team before any data transfer to DeepMind takes place.
A data custodian has been appointed by DeepMind to control access to the data. Only those who require access to conduct the research work will be granted access. All researchers who are involved in the study are required to complete Health and Social Care Information Centre (HSCIC) and internal DeepMind information governance training before beginning research work.
DeepMind has been given permission for data access via a Research Collaboration Agreement with Moorfields Eye Hospital, and an approval to carry out research from the Moorfields Research & Development department through their Research On Anonymised Data (ROAD) approval pathway.