A window to the mind: Developing adaptive optics to understand changes in visual behaviour with eye disorders

Blindness and visual impairments (excluding presbyopia) affect 277 million people worldwide and sight loss affects around 2 million people in UK, with this set to double by 2050. For nearly a million people, their sight loss has very limited or no treatment options. Vision loss has significant cost to society, affecting an individual's quality of life, educational and job prospects.

Adaptive optics (AO) has revolutionised the way that we study the eye. By correcting for naturally occurring optical aberrations in the eye that cause blurring, AO allows the highest possible resolution imaging such that individual cells can be seen in the living human retina. This is beyond the capabilities of standard clinical instrumentation and gives unprecedented access to a wealth of information on the healthy and diseased eye.

Higher resolution will enable detection of pathological changes earlier, and closer monitoring of disease progress and treatment outcomes in the future. The potential is enormous, from improving basic biomedical research into disease mechanisms and development of therapies, through to development of new diagnostic, monitoring, and screening tools for earlier and more effective intervention.

An exciting area of exploration is oculomics – a term coined by UK researchers in 2020 to describe ocular biomarkers of systemic disease. We have known for a long time that diabetes, which is now a public health crisis, affects the blood vessels in the retina and causes vision loss, and this is monitored through diabetic eye screening. Recent evidence is increasingly demonstrating the power of retinal imaging for detection of a wide range of neurodegenerative and vascular diseases.

AO retinal imaging, therefore, has the potential to be transformative much more broadly in healthcare by providing more sensitive measures of early disease. This is particularly important for the NHS long-term plan, which recognises research, innovation, and technology as critically important for illness prevention and improving outcomes. It also aligns with the need for healthcare to move to a proactive (i.e. screening) rather than reactive approach to promote long-term health and reduce the social and economic burdens of delaying treatment.

The aim of this FLF renewal is to drive forward development and use of AO retinal imaging, and increase capacity and capability in the UK for high resolution ophthalmic imaging. I will build on recent work to develop new methods for biomarker detection and robust and validated tools to aid wider adoption. These will be deployed in participant studies, focusing on vascular and eye movement markers of disease.