IMAGING could provide eye watering results with $1bn!
Julian Jackson – Director, VisionBridge

Patients are quite rightly continuing to ask how eye research can better predict, detect, diagnose and monitor eye disease, and indeed ultimately restore sight! As the Founder of social enterprise “VisionBridge” which promotes all aspects of eye research, Julian Jackson believes that the answers can be found in the fast moving world of Imaging and a $1bn investment would help us get there a lot more quickly!

Whilst tremendous innovation is taking place across the wide range of eye research activities, it is clearer than an intraocular lens that the real catalyst is Imaging which will deliver the maximum potential for positive patient outcomes, and most notably and critically influence if not determine the direction of travel for the greatest number of future research activities.

Imaging is beginning to make a noticeable impact on positive surgical outcomes by assisting ophthalmic surgeons in better understanding the context in which they are operating. It also provides greater accuracy in the delivery of treatments and pinpoints the areas of greater or lesser risk prior to invasive surgery. All of this is being achieved with optical coherence tomography (OCT) in support of Robotics.

We are always told “being forewarned is forearmed” and this is beautifully illustrated in the extraordinary advances in detection. Adaptive Optics (AO), for example, is allowing clinicians to view biomarkers of disease in the form of damaged tissue structures, toxic proteins, inflammation and debris as well as individual cellular abnormalities and dysfunction. The molecular level is following closely and will soon be reached, creating even clearer predictors of impending eye disease by revealing more detail about individual cell metabolisms, cortical remodelling and adaptation to retinal degeneration and cell death (senescence). And let’s not forget the role that Imaging could play in detecting the early onset of Alzheimer’s and Parkinson’s as well as spotting diseases such as diabetes and diabetic neuropathy, high blood pressure, meningitis, brain tumours and malaria which can all impact on sight if not treated early.

Improved detection can enhance clinicians’ ability to predict the likelihood of eye disease and so determine the need for early medical intervention. The most appropriate type of treatment can be identified, assisting patients’ planning and chances to make more informed lifestyle choices. Parents of young children could surely be greatly helped by improved, less invasive imaging devices that can spot abnormal microscopic structures in the retina or gauge the density of photoreceptors. We believe that older patients would be hugely reassured if there was a surefire technique for predicting the chance of dry macular degeneration progressing to the wet form.

Imaging can also ride to the rescue in the form of improved monitoring of eye disease. The secondary sector’s ability to cope with increasing demands and numbers of patients could be greatly enhanced if advanced imaging techniques and equipment were widely adopted by practitioners in the primary sector. Numbers of referrals that currently do not subsequently require an ophthalmological appointment could be drastically cut. Patients with stabilised conditions and in post surgical phases could be well supported by an up skilled workforce of optometrists.

Peering even further over the horizon, the degrees of predictability drawn from Imaging could be greatly enhanced by an emerging and powerful ally in the form of Artificial Intelligence (AI). If patients are to receive meaningful and timely treatments then human error  during image analysis must be minimised and speed of analysis accelerated. Correlations and patterns amongst images that perhaps clinicians have not even thought about, need to be examined. So AI in the form of DeepMind’s so called “Machine Learning” should be deployed to facilitate in reaching such goals.

As Mr Pearse Keane (NIHR Clinician Scientist and Honorary Consultant Ophthalmologist, NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology), a strong supporter of VisionBridge noted:

“Advances in ocular imaging will be fundamental to all aspects of vision research, and are likely to drive many breakthroughs in eye disease diagnosis and treatment in the next decade. These advances will allow visualisation of every cell type within the eye, from cellular ultrastructure to underlying molecular processes. In parallel, advances in machine learning and artificial intelligence will allow clinicians and scientists to improve patient care and derive new insights into disease pathophysiology. Taken together, new imaging hardware and new artificial intelligence techniques are likely to reinvent the eye examination for the 21st Century.”

There is no doubt that the eye, which is such an indescribably complex and infinitely adaptable organ, is under attack on a daily basis from mutant genes, injury, auto-immune responses, infection, lifestyle choices and the ageing process.  Further and faster developments in the hardware and software within Imaging will constitute the most effective shield against such attacks, in both developing and developed countries, but a $1bn injection would help to sustain and secure this exciting progress.