Demand for ophthalmology treatment far outstrips the system's ability to cope. There are over 643,000 patients presently waiting for eye treatment in England alone and as many as 22 people a month suffer avoidable loss of sight as a result. Similar pressures are being seen in health systems around the world.
The ophthalmology department is the busiest in the hospital with common disorders like diabetic eye disease and macular degeneration requiring monthly, or quarterly injections. There are over 7.8m NHS appointments each year.
With too few ophthalmologists and growing demand for services, ophthalmology has a particular need to implement precision medicine pathways which lead to better application of human and financial, resources; and, ultimately, better patient outcomes.
And there is cause of hope. Scans, photos and measurements of the structures of the eye, which are routinely collected in ophthalmology, provide a quite unique opportunity to use data and AI technologies to identify those patients with the strongest claim to finite resources, in real time and with the efficiency of a trained clinician.
Research suggests that the warning signs for over 150 different diseases, including heart disease, kidney disease, Alzheimer's and diabetes, may be present in retinal images.
Scans, photos and measurements of the structures of the eye (including blood vessels and nerve endings) not only tell us about a patient's vision, but also give us an incredibly detailed picture of a patient's general health.
The warning signs of poor health, which could be found in these images are, however, often too subtle for a Doctor to pick up on in clinic, or would require impractical levels of detailed attention. But with the help of data like that collected by RAIR, it is possible that in future, AI-driven algorithms can be trained to diagnose these, and potential many other diseases, at the point of capture.
Enticingly, the diagnosis and management of these 150 diseases could therefore move from the hospital into the opticians/optometrists office and eventually, into the home.
The number of people with diabetes, is estimated at 415m including c.3.5m people in the UK and 9.4% of the US population. Vision threatening retinopathy occurs in up to 7% of diabetics. Diabetic macular oedema (DMO) is already the leading cause of vision loss in working age adults.
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in adults over 50 years old affecting over 170 million people worldwide and is expected to increase to 288 million by the year 2040. The "wet" form of the disease (10-15% of individuals) accounts for approximately 90% of all cases of severe vision loss.
Each year, over 16 million people worldwide suffer an occlusion of the venous system which serves the retina. It is the second leading cause of visual loss, behind DMO. Branch occlusions in the distal retinal venous system (BRVO) are most common (c. 85% of patients) but less serious than those which impact the central retinal vein, close to the optic nerve.
Open angle glaucoma is the second leading cause of global irreversible blindness behind AMD. It is estimated that the total number of cases is approaching 76 million worldwide, including c.480,000 in the UK and 2.7m in the US. It is thought that open angle glaucoma is responsible for approximately 5.2 million cases of blindness (15% of the total).
Cardiovascular disease (CVD) is closely association with several eye disorders including DMO and glaucoma. It has proven possible to detect the early signs of CVD in images of the retinal vasculature. CVDs are the leading cause of death globally with an estimated 18 million deaths in each year representing over 30% of all global deaths. Of these 85% are due to heart attack and stroke.
The eye remains the only place where the vasculature and nervous system can be examined directly, providing a unique diagnostic window into the broader health of an individual: A multitude of different disorders spanning cardiology, neurology, rheumatology and others, have already been shown to manifest themselves in the structures of the eye.
Royal College of Ophthlmology
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