Over the past twenty years, screening for diseases of the retina has become widely accepted as the best way to reduce preventable blindness. Yet most countries do not have a nationwide program for retinal disease screening. Why?
In “AI in Ophthalmology from a Developing Countries Perspective,” his talk at the recent World Ophthalmology Congress (WOC2020 Virtual), Dr. Stephen Cook described implementing an eye-screening program in South Africa and shared what he has learned about advocating for these programs in developing countries.
Despite the compelling evidence that retinal images can be used to identify eye diseases, says Dr. Cook, governments and health-care organizations do not implement national retina-screening programs because “screening is not cost-effective,” “blindness is just another end-organ failure,” and “specialists are already overwhelmed.”
Instead, developing countries are interested in dealing with the most widespread and expensive health-care problems: hypertension, diabetes, and chronic kidney disease, among others. Dr. Cook argues that to grab governments’ attention, we should reframe retinal screening as a tool to help manage those diseases. And indeed, we are already addressing that need.
What does the retina tell us about our health?
It is often said that the retina is a window to the body. By examining the retina, a doctor can diagnose not only sight-threatening diseases like diabetic retinopathy and macular degeneration, but also other diseases that cause end-organ damage, like cardiovascular disease (CVD), hypertension, chronic kidney disease (CKD), and peripheral neuropathy. Multiple studies have demonstrated these associations, including those by Tapp and colleagues (CVD and hypertension), Grunwald (CKD), and Dehghani and colleagues (peripheral neuropathy).
Retinal screening in primary-care settings gives doctors a full picture of their patients’ health, which is important because the retina is the one area of the body where the vasculature can be imaged non-invasively.
What is the role of AI in retinal screening?
AI (artificial intelligence) uses the same retinal images traditionally examined by doctors to detect the same diseases in a fraction of the time. Its use in retinal screening is gaining clinical acceptance and expanding worldwide. Dr. Cook argues that by using tools like AI, we can help public health initiatives to better stratify risk and thus save the time of both general practitioners and specialists, lower screening costs, and prevent blindness.
We wholeheartedly agree.
At VisionQuest, we are developing technology that provides a full view of patient health from just one retinal picture. Our tools detect not only diabetic retinopathy, but also cerebral malaria, cardiovascular disease and hypertension, and diabetic peripheral neuropathy.
Showing physicians, health-care organizations, and even governments how AI and retinal screening can help them manage disease throughout the body is our next step forward.