Aipedia: Optometrists and opticians

AI retinal photo screening in optical practices

Aipedia, by the Apex broking team · Last reviewed 2026-10-30

AI grading software can help sort fundus photographs, but the optometrist must still look at every image and decide what it shows. Retinal photos are confidential images under GOC Standard 14, and a missed lesion is judged against your review, not the software's.

Part of: AI in Optometrists and opticians

In short

Some practices take fundus photographs as part of the sight test, and AI tools can now grade them for features such as diabetic changes, drusen, haemorrhages or suspicious optic discs. GOC Standard 7.8 requires professional judgement on technology-generated data, and Standard 14 requires images to be kept confidential and secure, including when uploaded for analysis. The 2025 standards specifically flag confidentiality of patient images shared online. If a melanoma, retinal detachment or other lesion is missed, the question is usually whether a competent optometrist reviewing the photo would have seen it. Indemnity usually responds, subject to terms.

How AI grading is used in practices

Fundus photography may be offered routinely or as an add-on in high-street practices. AI grading tools analyse the image and return a grade, a list of detected features or a simple pass, review or refer flag. Some are built into the camera software; others require images to be uploaded to a cloud service. Practices use them to prioritise which images the optometrist looks at closely, to support less experienced clinicians or to provide a second read.

Grading tools may be trained on particular conditions and image types. A tool designed for diabetic changes may say nothing useful about a peripheral naevus, an unusual disc or a lesion at the edge of the field. The practice needs to know exactly what the tool claims to do.

What the optometrist must still review

Whatever the AI grade, the optometrist still needs to review the following:

Every image: Standard 7.8 in the GOC Standards of Practice requires professional judgement when using data from digital technologies, so the grade informs your review rather than replacing it.
Image quality: decide whether the photo is good enough to rely on, and whether dilation or another test is needed.
Areas outside the tool's scope: the periphery, the disc and anything the software was not designed to assess.
Context: symptoms, history and other findings that change what a borderline feature means.
Scope of practice: under Standard 6.1, refer or seek advice when a finding is beyond your competence.

Consent and image confidentiality

Retinal images are patient records. Standard 14.1 requires confidentiality and 14.7 requires records to be stored securely and protected against loss, theft and inappropriate disclosure. The GOC launch note for the 2025 standards listed confidentiality of patient images shared online among the changes. Before uploading images to a cloud grading service, the practice should know where the data goes, whether the supplier uses it for training and what the contract says. Standards 2 and 3 on communication and consent support telling patients that software will assess their photographs. Where AI produces a solely automated significant decision on health data, section 80 of the Data (Use and Access) Act 2025 adds restrictions, which is another reason to keep the optometrist in the decision.

Liability where a lesion is missed

Illustrative scenario: a practice uses AI grading to sort photos into "no action" and "review". A patient's image is graded no action because the tool assesses the central retina only. A pigmented lesion near the edge of the photo is not looked at. When it is later diagnosed elsewhere, the claim asks why the optometrist did not see what was on the image.

Such claims are usually judged on whether a competent optometrist reviewing the image would have noticed the lesion and acted. Saying the software did not flag it is unlikely to be a defence on its own. Indemnity under Standard 12.2 usually responds to the claim as one about professional judgement, subject to the policy terms; a data breach involving uploaded images may need separate data breach cover.

Practical controls

Useful controls include:

Look at every photograph yourself, including the periphery and disc.
Use "no action" grades only to prioritise, never to skip review.
Record your own findings and any disagreement with the grade.
Check the supplier contract and data location before uploading images.
Tell patients that software helps assess their photographs.

How Apex helps

Apex arranges PI for optometrists and opticians. A broker reviews whether your cover, and the practice's, responds to claims involving AI-graded images and image data held by suppliers; see our optometrist PI guide.

Sources

Frequently asked

Do I need to look at photos the AI grades as normal?

Yes. Standard 7.8 requires professional judgement on technology-generated data, and grading tools may assess only some areas or conditions. A missed lesion on an image you did not review would be hard to defend.

Can I upload retinal photos to a cloud AI service?

Only with proper safeguards. Standard 14 requires confidentiality and secure storage, and the 2025 standards specifically flag images shared online. Check where the data is stored, whether it is reused and what the contract says, and tell patients.

Is a supplier liable if its grading tool misses a lesion?

Possibly, depending on the contract and the facts, but the patient will usually claim against the optometrist or practice first. Your professional duty to review the image remains, so supplier liability rarely removes your exposure.

Should I tell patients that software grades their photos?

Yes, as good practice. Standards 2 and 3 on communication and consent support explaining how their images are assessed, and patients may ask where the images go. Explain that the optometrist reviews every photo and makes the decision, and note any objection in the record.

Check your PI covers how you use AI

Tell us about your firm and the work you do. A broker will review how your current PI treats AI-assisted work, or arrange new cover. No fee for a quote. Or call 0117 325 0027.

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Apex Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales, company number 07014570. This page is general information about how AI is used in the profession and how insurance may respond. It is not legal, regulatory or insurance advice on your circumstances, and it does not guarantee that cover will be available or on what terms.