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Subspecialties Retina, Imaging & Diagnostics, Health Economics and Policy

Thoroughly Modern Medicine

The Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO) is used to image individual cells at the back of the living human eye, namely cone and rod photoreceptors. Such cells are about 50 times smaller than the width of a human hair.

We are lucky to have unprecedented multimodal abilities to non-invasively image the retina these days. Understandably, this has transformed the practice of many retinal physicians and vision scientists. And yet, though our capabilities may be the envy of most other subspecialties, personalized medicine introduces a number of challenges for applications of retinal imaging in ophthalmology.

A major issue is that imaging is still not routine in unaffected or “normal” individuals. This knowledge gap is problematic; to understand whether a feature in a given image represents pathology or just a normal variant demands the availability of patient-specific normative databases. By this we mean that the demographics of the reference or normative database needs to match that of the patient – one cannot necessarily compare image features from a 68-year-old black man to normative data comprised of white women aged 19-23 years of age. The field remains surprisingly naïve with respect to the need for stratifying normative data by age, gender and race. There may well be certain features in retinal images that clearly signify active disease (such as intraretinal fluid viewed on optical coherence tomography), but the utility of images to detect subtle and early changes associated with pathology is limited by the quality of the image and the robustness of the reference database.

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About the Author

Michel Michaelides

Michel Michaelides is Professor of Ophthalmology and Consultant Ophthalmic Surgeon, UCL Institute of Ophthalmology and Moorfields Eye Hospital

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