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Ophthalmology
Cohort profile
AlzEye: longitudinal record-level linkage of ophthalmic imaging and hospital admissions of 353 157 patients in London, UK
  1. Siegfried Karl Wagner1,2,
  2. Fintan Hughes3,
  3. Mario Cortina-Borja4,
  4. Nikolas Pontikos1,2,
  5. Robbert Struyven1,2,
  6. Xiaoxuan Liu5,6,7,
  7. Hugh Montgomery8,
  8. Daniel C Alexander9,
  9. Eric Topol10,
  10. Steffen Erhard Petersen11,12,
  11. Konstantinos Balaskas1,2,13,
  12. Jack Hindley14,
  13. Axel Petzold1,15,16,
  14. Jugnoo S Rahi1,2,17,18,19,
  15. Alastair K Denniston5,6,7,
  16. Pearse A Keane1,2,13
  1. 1Institute of Ophthalmology, University College London, London, UK
  2. 2NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  3. 3Department of Anaesthesiology, Duke University Hospital, Durham, North Carolina, USA
  4. 4Institute of Child Health, University College London, London, UK
  5. 5University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  7. 7Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
  8. 8Centre for Human Health and Performance, University College London, London, UK
  9. 9Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
  10. 10Scripps Research Institute, La Jolla, California, USA
  11. 11William Harvey Research Institute, Queen Mary University of London, London, UK
  12. 12Barts Heart Centre, Barts Health NHS Trust, London, UK
  13. 13Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  14. 14Department of Information Governance, University College London, London, UK
  15. 15Institute of Neurology, University College London, London, UK
  16. 16Department of Neurophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  17. 17Great Ormond Street Institute of Child Health, University College London, London, UK
  18. 18Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  19. 19Ulverscroft Vision Research Group, University College London, London, UK
  1. Correspondence to Dr Pearse A Keane; p.keane{at}ucl.ac.uk

Abstract

Purpose Retinal signatures of systemic disease (‘oculomics’) are increasingly being revealed through a combination of high-resolution ophthalmic imaging and sophisticated modelling strategies. Progress is currently limited not mainly by technical issues, but by the lack of large labelled datasets, a sine qua non for deep learning. Such data are derived from prospective epidemiological studies, in which retinal imaging is typically unimodal, cross-sectional, of modest number and relates to cohorts, which are not enriched with subpopulations of interest, such as those with systemic disease. We thus linked longitudinal multimodal retinal imaging from routinely collected National Health Service (NHS) data with systemic disease data from hospital admissions using a privacy-by-design third-party linkage approach.

Participants Between 1 January 2008 and 1 April 2018, 353 157 participants aged 40 years or older, who attended Moorfields Eye Hospital NHS Foundation Trust, a tertiary ophthalmic institution incorporating a principal central site, four district hubs and five satellite clinics in and around London, UK serving a catchment population of approximately six million people.

Findings to date Among the 353 157 individuals, 186 651 had a total of 1 337 711 Hospital Episode Statistics admitted patient care episodes. Systemic diagnoses recorded at these episodes include 12 022 patients with myocardial infarction, 11 735 with all-cause stroke and 13 363 with all-cause dementia. A total of 6 261 931 retinal images of seven different modalities and across three manufacturers were acquired from 1 54 830 patients. The majority of retinal images were retinal photographs (n=1 874 175) followed by optical coherence tomography (n=1 567 358).

Future plans AlzEye combines the world’s largest single institution retinal imaging database with nationally collected systemic data to create an exceptional large-scale, enriched cohort that reflects the diversity of the population served. First analyses will address cardiovascular diseases and dementia, with a view to identifying hidden retinal signatures that may lead to earlier detection and risk management of these life-threatening conditions.

  • ophthalmology
  • medical ophthalmology
  • medical retina
  • health informatics

Data availability statement

No additional data are available. The data are subject to the contractual restrictions of the data sharing agreements between National Health Service Digital, Moorfields Eye Hospital and University College London and are therefore not available for access beyond the AlzEye research team.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjopen-2021-058552

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    Data availability statement

    No additional data are available. The data are subject to the contractual restrictions of the data sharing agreements between National Health Service Digital, Moorfields Eye Hospital and University College London and are therefore not available for access beyond the AlzEye research team.

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    Footnotes

    • Twitter @sktywagner, @fintanhughes, @cortina_borja, @s_e_petersen, @konbalaskas, @pearsekeane

    • Contributors SKW, AKD and PAK wrote the first draft of the manuscript, which was critically revised by FH, MCB, RS, NP, XL, HM, DCA, ET, SEP, KB, JH, AP and JSR. Authors SKW, FH, NP, HM, JH, AP, JSR, AKD and PAK were involved in the original design of the study. RS, NP and DCA: computer science expertise. JH: information governance. MCB, AP, JSR and AKD provided statistical and epidemiological guidance. All authors have approved the final version of this manuscript. The Chief Investigator (PAK) accepts full responsibility, as guarantor, for the finished work, the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This study was funded through a small grant awarded by Fight for Sight (grant reference: 24AZ171). This research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests SKW is funded through a Medical Research Council Clinical Research Training Fellowship (MR/TR000953/1). NP is funded by a Moorfields Eye Charity Career Development Award (R190031A). HM is supported by the National Institute for Health Research’s (NIHR) Comprehensive Biomedical Research Centre (BRC) at University College London Hospitals. SEP receives support from the NIHR BRC at Barts. KB has received speaker fees from Novartis, Bayer, Alimera, Allergan, Roche and Heidelberg; meeting or travel fees from Novartis and Bayer; compensation for being on an advisory board from Novartis and Bayer; consulting fees from Novartis and Roche and research support from Apellis, Novartis and Bayer. AP receives financial support from the NIHR BRC based at Moorfields Eye Hospital (MEH) NHS Foundation Trust and UCL Institute of Ophthalmology; is part of the Steering Committee of the Advanced Nerve and Glaucoma Imaging (ANGI) network which is sponsored by ZEISS and Steering Committee of the OCTiMS Study which is sponsored by Novartis and reports speaker fees from Heidelberg Engineering. JSR receives support from the NIHR as a senior investigator and via the NIHR BRCs at MEH and Great Ormond Street Hospital. AKD is director of INSIGHT, the HDRUK Health Data Research Hub for Eye Health. PAK is supported by a Moorfields Eye Charity Career Development Award (R190028A) and a UK Research & Innovation Future Leaders Fellowship (MR/T019050/1); receives research support from Apellis; is a consultant for DeepMind, Roche, Novartis, Apellis and Bitfount; is an equity owner in Big Picture Medical and has received speaker fees from Heidelberg Engineering, Topcon, Allergan, Roche and Bayer, meeting or travel fees from Novartis and Bayer and compensation for being on an advisory board from Novartis and Bayer.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Cohort Description section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.