Information for Patients

During a routine eye examination your optometrist will take a photograph of the back of your eye, called the retina. You may wonder "what are they looking for"?

What is the retina?

scone retina — The optic nerve is responsible for transferring light signals to the brain for visual processing. The macula is the most sensitive spot of the retina and is responsible for central vision. The blood vessels provides nutrients around the retina.

The retina is a thin layer of tissue that lines the back of your eye that allows us to see.

Due to the retina’s vital role for vision, your optometrist will capture a digital image of the retina to examine its health, called a fundus photograph.

A fundus photograph can be easily and comfortably captured and is much like having a photograph taken, except the flash is focused through your pupil to the retina.

Your optometrist can assess the health of your:

optic disc/nerve
macula
blood vessels

What is SCONe?

The Scottish Collaborative Optometry-Ophthalmology Network eResearch (SCONe) is a new collaborative venture aiming to build a world-leading nationwide retinal image resource for innovation in eye research, healthcare and education.

SCONe's team of optometrists, ophthalmologists and researchers are working together with IT experts to securely transfer eye photographs captured in participating optometry practices to the National Safe Haven. This will allow approved researchers to discover new information about eye diseases such as age-related macular degeneration (AMD), the leading cause of blindness in the UK.

Early detection in AMD is vital to maintaining vision [Malcolm's story]. SCONe's core aim aligns with the aspirations of Action Against AMD to better understand early/intermediate macular degeneration and its evolution.

What are the challenges in early AMD diagnosis?

There is a large reliance on optometrists to identify early features of AMD, called drusen. Increasing number and size of drusen increases the risk of developing late AMD, however this is difficult to monitor manually. SCONe aims to support optometrists in their clinical decision-making by discovering new biomarkers for the early detection and prediction of progression of AMD.

The National Safe Haven

The National Safe Haven is a secure storage facility run by Public Health Scotland. SCONe’s retinal image research resource will reside within the National Safe Haven. Data will not be shared outwith this secure storage facility, and Public Health Scotland will control who has access to the data.

At no point will any personal identifiable data be shared with researchers.

SCONe follows the strictest governance protocols. In October 2021, SCONe received approval from NHS Scotland's Public Benefit and Privacy Panel for Health and Social Care to collect retinal images from participating optometry practices and securely transfer these to the National Safe Haven.

All research conducted using the SCONe research resource will be subject to stringent ethics approvals.

You can view a statement of our commitment to upholding the highest levels of data privacy here.

Why should we have a Scotland-wide retinal image research resource?

A Scotland-wide retinal image research resource will allow:

Better understanding of eye disease
Better understanding of how the eyes can be a window to our general health
Better outcomes for patients
Support for community optometrists
Provision of educational resources

The eye as window to your health

With the recent advances in retinal imaging and computing technology a retinal image can quickly, cheaply and non-invasively tell us more than just the health of the retina.Retinal changes may be the first sign of systemic and neurodegenerative diseases such as:

scone unlocking the eye — Through building a large retinal image repository that is collaborative, commercially independent with controlled access can we begin to unlock the full potential of the retina.

Cardiovascular disease.
Chronic kidney disease.
Diabetes.
Stroke.
Hypertension.
Parkinson's disease.
Dementia/Mild cognitive decline.
Alzheimer's disease.
Multiple Sclerosis.

Measurements obtained from retinal images can be used for:

Biomarker discovery.
Early detection of disease.
Improved referral accuracy.
Progression monitoring.
Patient stratification/treatment.
Increasing our understanding of the mechanisms of disease.

Retinal Image Analysis

scone drusen — A fundus photograph containing drusen. A deep learning algorithm has been applied to detect regions that are likely to contain drusen (red). From this detection, we can begin to measure drusen in these regions to see if they can predict AMD progression and to explore the association of drusen in other diseases.

Machine learning and deep learning are subfields of artificial intelligence and has proven to be a powerful tool in medical image analysis with application to disease prediction and diagnosis.

A retinal image can be analysed using automatic computerised techniques such as analysis of the blood vessels (https://vampire.computing.dundee.ac.uk/) and drusen.

Machine learning and deep learning works by learning patterns in the data and images to automatically determine what is contained in them, such as the presence of disease in an image or to predict a disease from measurements obtained from the blood vessels.

SCONe has already begun work on implementing automatic drusen quantification in fundus photographs using deep learning for diagnosis and prediction of early AMD.

With advances in technology there are more ways to examine the health of the retina than a traditional fundus photograph. Optical coherence tomography (OCT) uses light waves to take cross-sectional images of the retina and its distinctive layers. OCT images can reveal the health of many structures including the retinal pigment epithelium (RPE) that is an important layer of cells responsible for nourishing the surrounding cells responsible for vision.

In the future, SCONe may work with OCT images to develop methods of drusen quantification for early AMD prediction.