Abstract by Josefine Freiberg
The digitalisation of healthcare and the implementation of electronic health records have created large amounts of data that can be used for research. To gain insight into the eye health of Danes, Project FOREVER (Finding Ophthalmic Risks and Evaluating the Value of Eye exams and their predictive Reliability) has been initiated. Project FOREVER collects data from customers of the optician chain Synoptik A/S and aims to include 280,000 customers. The data consists of eye examination results and questionnaire responses. Further, the blood pressure measurements of a group of participants will be taken, and saliva samples will be collected from them.
The design and methodology of the FOREVER project were described in paper I. Strengths of the study design include the nationwide recruitment of participants, a large sample size and an expected high quality of the data collected. Biases in the study design are assumed to include a skewed age distribution, refractive changes, a higher prevalence of eye diseases compared with the general population and limited ethnic differences.
Routine eye examinations often include retinal images, which clinical experts examine for potential pathology. The analysis and interpretation of retinal images are dependent on the person’s knowledge and expertise. QUARTZ (QUantitative Analysis of Retinal vessel Topology and siZe) is a software that can be used for an automated analysis of retinal blood vessels. QUARTZ allows measuring blood vessels from the entire retina and thereby converting image data into quantitative measurements, which can then be compared with other examination results of the person. QUARTZ has been validated on a FOREVER Pilot dataset (paper II) and showed high performance on the dataset, even when compared with previously published data from the UK Biobank.
The validation of the method presented in paper II enabled the analysis of the retinal vasculometry in the FOREVER cohort, including measurements of arteriolar and venular diameter and vessel tortuosity (paper III). Based on data from 2,089 subjects, narrower arterioles were associated with increased blood pressure and elevated intraocular pressure. Using data from two different visits at least three years apart, showed that decreased arteriole diameter at follow-up compared with baseline was associated with increased blood pressure at follow-up visits. In addition, arterioles that became more tortuous from baseline to follow-up were associated with an increase in intraocular pressure at follow-up adjusted for baseline values.
The results from the cross-sectional and longitudinal study add to the growing body of evidence, suggesting that changes in retinal morphology may be a potential biomarker for both systemic and ocular diseases. The perspectives for the image analysis of retinal images are wide-ranging, with the18 ultimate goal of developing artificial intelligence–powered software that can be used to triage patients and support decision-making in clinics and optician shops.