Abstract

Medical imaging techniques such as MRI have revolutionised clinical diagnosis, treatment and monitoring of disease. However, they are expensive and not readily accessible outside specialist units. Imagine if instead, there was available a high-street eye test that provided diagnostic information for a range of diseases. These diseases could be neurodegenerative diseases such as Alzheimer’s, systemic diseases (diseases with wide-spread effect on the body) such as heart disease, or psychiatric conditions, such as depression. The test would be sensitive, picking-up signatures of disease before any symptoms were apparent and before irreparable damage had occurred, and allowing fine scale monitoring of changes in response to treatment. It would offer specificity, differentiating between diseases with different aetiologies but similar retinal manifestations. This would allow mechanistic understanding of disease progression, paving the way for future therapies.

The key to realising this vision is the application of recent technological advances from microscopy, image and signal processing to high-resolution optical imaging of the living human retina. The retina, which is the tissue at the back of our eye, is in fact a part of the central nervous system and has long been recognised as a window to the brain and vasculature. In fact, psychiatric, neurodegenerative, and systemic diseases have been shown to have detectable correlates in the eye. However, current clinical technology cannot image individual cells, and so these diseases manifest in gross anatomical changes that cannot be distinguished amongst diseases. We will develop a non-invasive optical instrument, capable of imaging individual cells and testing their function, for sensitive and specific detection of these diseases. The technology would revolutionise point-of-care medicine by providing rapid, non-invasive diagnostics on a range of conditions, replacing costly, time-consuming current gold standard methods.

Our team is a collaboration between technology developers and ophthalmic specialists, spanning engineering and medical science within partner institutions. We already have experience in human participant testing across the life-span with bespoke optical instrumentation, and extensive experience in commercialisation of technology, industrial partnership and spin-outs. The required technological components – for example, optical interferometry, adaptive optics, spectroscopic and polarisation techniques, holography, and dedicated image and signal processing – are available in the related fields of microscopy and ophthalmoscopy, but delivering an integrated instrumentation package remains a significant engineering challenge. The development phase will be vital for establishing proof-of-principle demonstrations to engage stakeholders, and to target efforts to those areas that are most likely to have ‘disruptive’ impact in healthcare. Stakeholders – clinicians, industry partners and patient groups – will be engaged through local NHS Trusts and teaching hospitals, existing industry networks and charities representing specific patient cohorts. During the development phase we will widen and deepen these networks. With a long-term view, we will engage at all levels of medical training – from the pre-clinical undergraduate to the established consultant.

Three significant challenges facing society are the high incidence of mental health issues across the population, cardiovascular disease, and neurodegenerative diseases which disproportionately affect the elderly and are of great concern in an ageing society. Dementia and heart disease are the leading causes of death in the UK, and indeed world-wide. Faster and more effective diagnosis and treatment of such debilitating conditions will significantly improve outcomes for these patients. Widespread uptake of the technology will lead to new business growth through commercialisation.