Revolutionizing Eye Care Through AI-Powered Patient Insights

Singapore's Singapore Eye Research Institute (SERI) and Duke-NUS Medical School have launched a groundbreaking initiative via their spin-off company PROMinsight. This innovation leverages artificial intelligence (AI) to transform lengthy patient questionnaires into concise, adaptive assessments that capture vital quality-of-life data in vision care. Traditional patient-reported outcome measures (PROMs)—standardized tools clinicians use to gauge how eye conditions affect daily living—often involve 30 to 100 questions, taking 15 to 45 minutes to complete. PROMinsight's computerised adaptive tests (CATs) reduce this to just 5 to 10 targeted questions, completed in 2 to 5 minutes, making them practical for busy clinics.

This development addresses a critical gap in ophthalmology, where understanding patients' subjective experiences is as important as objective metrics like visual acuity. By integrating seamlessly into electronic medical records, these tools enable real-time scoring and personalized care adjustments, promising enhanced outcomes for conditions prevalent in Singapore's aging population.

What Are PROMs and CATs? A Step-by-Step Explanation

Patient-Reported Outcome Measures (PROMs) quantify the functional, emotional, and social impacts of health conditions from the patient's viewpoint, beyond clinical tests. In vision care, they assess mobility limitations, emotional distress from blurred vision, or challenges with daily tasks like reading or driving. Computerised Adaptive Testing (CAT), powered by AI algorithms, revolutionizes this process:

• Item Bank Calibration: Thousands of validated questions form a 'bank', calibrated using psychometric methods from SERI's extensive patient data.
• Real-Time Adaptation: The first question is neutral; subsequent ones adjust based on responses—easier if high functioning, harder if severe impairment—zeroing in on precise ability levels.
• Scoring and Output: AI computes a score instantly, comparable to full questionnaires, with high reliability (test-retest >0.90).
• Cloud Integration: Delivered via tablets or apps, results feed directly into workflows for immediate discussion.

This step-by-step dynamism ensures efficiency without sacrificing depth, validated across diverse Asian populations.

SERI and Duke-NUS: Singapore's Vanguard in Ophthalmic Innovation

The Singapore Eye Research Institute (SERI), established in 1997 and affiliated with the Singapore National Eye Centre (SNEC), Duke-NUS Medical School, and the National University of Singapore's Yong Loo Lin School of Medicine, stands as Asia-Pacific's largest eye research institute. With over 253 staff, 6,212 publications, $489 million in grants, and 201 patents, SERI leads globally in per-capita eye research output. Duke-NUS Medical School, a postgraduate institution partnering with Duke University, excels in clinician-scientist training, fostering spin-offs like PROMinsight.

Co-founded by Professor Ecosse Lamoureux (Duke-NUS/SERI) and Dr. Eva Fenwick (CEO), PROMinsight builds on two decades of PROM research, boasting 200+ papers and ICHOM endorsement for AMD outcomes. Their collaboration exemplifies how Singapore's academic ecosystem translates research into clinical tools.

Tailored AI Tools: MyoRI-CAT, GlauCAT-Asian, and MacCAT

PROMinsight's licensed technologies target Singapore's top vision threats:

• MyoRI-CAT: For myopia interventions (spectacles, contacts, laser). Singapore's myopia crisis—26% in Primary 1 students (down from 30%), 65% by Primary 6—affects 80-90% of adults by 2050. Measures refractive intervention impacts.
• GlauCAT-Asian: Glaucoma-specific for Asian contexts (prevalence 2.7-7% in Singaporeans over 40). Covers 7 domains: ocular comfort, activity limits, mobility. Validated in studies showing high precision (DOI: 10.1167/tvst.13.1.25).
• MacCAT: For age-related macular degeneration (AMD), projected to rise 54% by 2040. Assesses central vision loss effects.

These tools expand to diabetic retinopathy, cataract, supporting holistic care.

Photo by Eddie Zhang on Unsplash

Real-World Validation and High Uptake at SNEC

A one-year SNEC study on diabetic macular edema, glaucoma, and cataract patients showed >80% uptake—far exceeding expectations. Patients reported positive experiences, with one noting: "The questionnaire asked about things my doctor doesn’t usually ask, like coping with daily vision problems." Prof. Shamira Perera highlighted: "One patient had good vision but poor QoL scores. Without CAT, I'd have assumed everything was fine."

Psychometric rigor confirms reliability, with GlauCAT-Asian papers in Translational Vision Science & Technology detailing efficiency and validity. For more, see the validation study.

Singapore's Mounting Eye Health Burden

Vision impairment affects 70% of Asians needing services, with Singapore facing myopia epidemics, stable glaucoma (5-7%), and rising AMD/cataract. SEED studies project all conditions increasing by 2040, straining resources. AI tools like these enable proactive, patient-centered interventions amid an aging society (1 in 4 over 65 by 2030).

Empowering Clinical Trials and Value-Based Care

Beyond clinics, CATs aid pharma in trials, measuring therapy efficacy precisely. PROMinsight supports CROs, enabling robust data for regulators like FDA. In value-based care, real-time QoL tracking justifies interventions, optimizes follow-ups, and reduces burdens—crucial for Singapore's efficient healthcare.

Assoc. Prof. Christopher Laing notes: "PROMinsight shows what’s possible when clinicians, researchers, and entrepreneurs collaborate."

Stakeholder Perspectives: From Patients to Policymakers

Patients value the brevity and relevance; clinicians gain actionable insights. Dr. Fang Xiaoqin emphasizes accelerated innovation via partnerships. Prof. Lamoureux: "AI-enabled PROMs capture QoL more accurately than fixed questionnaires." This multi-stakeholder approach positions Singapore as an AI-health leader.

Photo by Lucas Gallone on Unsplash

Challenges, Solutions, and Future Outlook

Challenges include digital literacy and data privacy, addressed via user-friendly interfaces and secure clouds. Future: Expand to more conditions (DiabCAT), global trials, ICHOM standards. SERI's AI ecosystem, including joint labs, foreshadows agentic AI autonomy in eye care.

Explore SERI's work further at their site.

AI's Role in Singapore's Academic Healthcare Landscape

Duke-NUS and SERI exemplify clinician-scientist training, producing spin-offs and patents. This fosters research careers; opportunities abound in AI-ophthalmology. Singapore's push for precision medicine amplifies such innovations, benefiting universities and patients alike.