The institute conducts research and post-graduate teaching in the area of ophthalmology (the anatomy, physiology and diseases of the eye).The institute has a staff of around 200, including around 45 principal investigators, and cooperates closely with Moorfields Eye Hospital, which it is located adjacent to and with which it is a partner in the National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology. Together with Moorfields Eye Hospital, the institute is the oldest and largest centre for ophthalmic treatment, teaching and research in Europe.
Objectives This process evaluation explores patient and healthcare professional acceptability of community-based monitoring versus hospital-based care for patients with quiescent neovascular age-related macular degeneration (QnAMD).Design Qualitative process evaluation was conducted as part of a randomised controlled trial.Setting Six hospitals and six community-based practices.Participants 25 patients and 16 healthcare professionals (ophthalmologists and optometrists). This approach helped differentiate between common issues and those specific to community-based monitoring.Intervention The Quality-Assured Follow-Up of QnAMD by non-medical practitioners trial aimed to examine whether non-medical practitioners follow-up patients with QnAMD in the community in a safe and clinically and cost-effective way. The process evaluation aimed to examine whether the intervention was acceptable by patients and professionals. The process evaluation was based on interviews which contained open-ended questions focused on patient experience and confidence in community-based care, issues concerning the practicalities of the organisation and management of the clinic, and resources including IT and digital equipment. The theory of acceptability framework was used to interpret the findings.Results Patients reported positively on the experience of receiving QnAMD services in the community and highlighted staff professionalism and clear communication. Key themes were the proximity of care provision for patients, IT interoperability and the real-world costs of running the service. Some patients randomised to the hospital showed preference for the intervention to take place in the hospital, mediated mainly by prior experience of hospital care and travel distance. The location of the clinic and transport routes affected the experience of attending appointments, with strong preference expressed for proximity to one’s home. Inaccessibility due to non-modifiable internal building structures in the community and parking in hospital eye services was reported by a small proportion of patients. Healthcare professionals reported positively about their ability to deliver QnAMD services in community settings but raised concerns about the compatibility of technological infrastructure that facilitates the sharing of optical coherence tomography image and video files. Some optometrists were also concerned about the financial sustainability of the intervention after the end of the trial due to the costs involved in the administration of QnAMD follow-up care.Conclusions The delivery of QnAMD services in the community by non-medical personnel was broadly accepted by both patients and practitioners. This implies that non-medical practitioners can follow up patients with QnAMD in the community in a safe way. Further research would be needed to establish whether similar results would be obtained during routine practice outside a research project and whether the long-term follow-up for QnAMD would be financially sustainable for independent as well as chain community optometry practices.Trial registration number NCT03893474.
BACKGROUND:Early detection of individuals at high risk of disease onset is crucial for health-care systems to cope with changing demographics and an ever-increasing patient population. Images of the retinal fundus are a non-invasive, low-cost examination routinely collected and potentially scalable beyond ophthalmology. Previous work showed the potential of retinal images for risk assessment for some diseases, but it remains unclear whether this potential extends to a broader range of human diseases. We aimed to systematically assess the extent to which retinal fundus photographs can predict incident disease onset across the human phenome, and to benchmark their added value beyond readily available patient characteristics. METHODS:In this modelling study using data from population-based cohorts, we extended a retinal foundation model (RETFound) to systematically explore the predictive potential of retinal images as a screening strategy for disease onset across 752 incident diseases in 61 256 individuals (33 285 [54%] females and 27 971 [46%] males; median age 58 years [IQR 50-63]) from the UK Biobank cohort. Participants had retinal images collected at baseline (Dec 7, 2009, to July 21, 2010) and were linked to routinely collected hospital and death records in the UK. External validation was performed in 7248 individuals (median age 67 years [IQR 62-73]) from the EPIC-Norfolk Eye Study. Predictive improvements were investigated by extracting image attributions from risk models and performing genome-wide association studies. FINDINGS:We showed improved discriminative performance compared with readily available patient characteristics for 306 (41%) of the 752 investigated disease endpoints, including 280 outside of ophthalmology. Retinal information did not improve the prediction for the onset of cardiovascular diseases compared with established primary prevention scores. Predictive improvements were attributable to retinal vascularisation patterns and less obvious features, such as eye colour or lens morphology. Genetic findings highlighted commonalities between eye-derived risk estimates and complex disorders: across 84 retinal risk phenotypes, we identified 1385 genome-wide statistically significant variant associations across 178 loci, including a low-frequency missense variant in IMPA1 (rs204781; minor allele frequency 2·0%) associated with decreased risk estimates across 48 diseases, with the strongest association observed for iron deficiency anaemia (β=-0·16; p<7·2 × 10-16). INTERPRETATION:We present one of the first comprehensive evaluations of predictive information derived from retinal fundus photographs, illustrating the potential and limitations of readily accessible and low-cost retinal images for risk assessment across common and rare diseases. Our findings show the potential of retinal images to complement screening strategies more widely, but also demonstrate the need for rigorous benchmarking and disease-agnostic efforts to design cost-efficient screening strategies to improve population health. FUNDING:Charité - Universitätsmedizin Berlin.
To evaluate the feasibility of integrating genetic, imaging, and demographic data for predictive modelling of treatment outcomes in neovascular age-related macular degeneration (nAMD). Proof-of-concept retrospective cohort study with prospective DNA collection. Patients with unilateral nAMD receiving anti-vascular endothelial growth factor (anti-VEGF) therapy on a treat-and-extend regimen at a single tertiary centre were recruited. Polygenic risk scores (PRS) for AMD were derived from genotyping data (NIHR Bioresource). Optical coherence tomography (OCT) biomarkers-intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), and subretinal hyperreflective material (SHRM)-were automatically quantified using a deep learning segmentation model. Predictors of treatment outcomes included PRS, age at first injection, and OCT feature volumes at baseline. XGBoost was used for binary outcomes and linear regression for continuous outcomes, employing five-fold cross-validation. (1) macular dryness (no IRF/SRF) at 24 months, (2) average treatment interval in year 2, and (3) age at first injection. 106 participants were included. The multimodal model integrating age, imaging, and PRS predicted macular dryness at 24 months with AUC = 0.903, outperforming imaging alone (AUC = 0.701). PRS was associated with younger age at first injection (β = –4.69, 95% CI [–8.93, –0.44], P = 0.031) but not with treatment burden (β = –6.39, P = 0.13). Integrating PRS with OCT-derived imaging biomarkers and patient age is technically feasible and improves predictive performance of modelling for anatomical treatment outcomes in nAMD. PRS reflects genetic susceptibility to nAMD and contextualizes the predictive value of imaging biomarkers for treatment response.
