Vasculometry low cost, noninvasive and with high street availability
They concluded: “Retinal imaging is established within clinic and hospital eye care and in optometric practices in the U.S. and U.K. AI-enabled vasculometry risk prediction is fully automated, low cost, noninvasive and has the potential for reaching a higher proportion of the population in the community because of “high street” availability and because blood sampling or sphygmomanometry are not needed.
“[Retinal vasculature] is a microvascular marker, hence offers better prediction for circulatory mortality and stroke, compared with MI, which is more macrovascular, except perhaps in women.
“In the general population it could be used as a noncontact form of systemic vascular health check, to triage those at medium-high risk of circulatory mortality for further clinical risk assessment and appropriate intervention.”
In the United Kingdom, for example, it could be included in the primary care NHS Health Check for those aged 41-74 years, they suggested. In addition, “high street” retinal scanning could directly feed into primary medical services and help achieve greater screening coverage for older age groups, who are likely to attend an optometric practice for visual correction, especially with the onset of presbyopia. “This would offer a novel approach to identify those at high risk of circulatory mortality, which is not currently screened for,” the team said.
Test could help to identify high-risk individuals
In a linked editorial, Ify Mordi, MD, and Emanuele Trucco, MD, of the University of Dundee (Scotland), said that CVD remains a significant cause of mortality and morbidity and the most common cause of death worldwide, accounting for a quarter of all U.K. deaths – and its burden is increasing. “Identification of individuals at high risk is particularly important,” they said, but current clinical risk scores to identify those at risk “are unfortunately not perfect,” so miss some of those who might benefit from preventative therapy.
“The retina is the only location that allows non-invasive direct visualisation of the vasculature, potentially providing a rich source of information.” In the new study, the measurements derived with the software tool, QUARTZ, were significantly associated with CVD, they said, with similar predictive performance to the Framingham clinical risk score.
“The results strengthen the evidence from several similar studies that the retina can be a useful and potentially disruptive source of information for CVD risk in personalised medicine.” However, a number of questions remain about how this knowledge could be integrated into clinical care, including who would conduct such a retinal screening program and who would act on the findings?
The editorial concluded: “What is now needed is for ophthalmologists, cardiologists, primary care physicians, and computer scientists to work together to design studies to determine whether using this information improves clinical outcome, and, if so, to work with regulatory bodies, scientific societies and healthcare systems to optimize clinical work flows and enable practical implementation in routine practice.”
‘Exciting development that could improve outcomes’
Asked to comment, Farah Topia, clinical and regulatory adviser at the Association of Optometrists, said: “This is an exciting development that could improve outcomes for many patients by enabling earlier detection of serious health risks. Patients attend optometric practice for a variety of reasons and this interaction could be used to a greater extent to help detect disease earlier. With optometrists available on every High Street, in the heart of communities, it’s an element of primary care that can be accessed quickly and easily, and optometrists are also already trained to have health and lifestyle discussion with patients.”
She added: “Retinal photographs are regularly taken when patients visit an optometrist, so being able to further enhance this process using AI is exciting.
“We look forward to seeing how this area develops and how optometrists can work together with other healthcare sectors to improve patient outcomes and ease the burden the NHS currently faces.”
The study was funded by the Medical Research Council Population and Systems Medicine Board and the British Heart Foundation.
A version of this article first appeared on Medscape UK.