“The process of extracting systemic health insights by analyzing ocular data, including retinal images with AI, is referred to as oculomics. We define prescreening as a preliminary assessment of disease or potential disease in asymptomatic individuals. Healthcare From the Eye (Topcon Healthcare Inc) prescreening is utilization of retinal images to identify ocular or systemic disease or potential disease in asymptomatic individuals in a coordinated care system that includes eye care professionals (ECPs), primary care professionals (PCPs), and specialty care professionals using secure and responsible technology. It offers the potential for rapid, cost-effective, and accessible prescreening for a wide range of devastating diseases. Such an initiative has the potential to triage asymptomatic patients for screenings where doctors can perform medical tests to check for disease and health conditions, accompanied by follow-up monitoring when applicable. Not only should this have the potential to reduce soaring health care expenditures, but it also might help address chronic disease burdens worldwide by facilitating earlier detection for timely clinical management, leading to better patient outcomes and optimized utilization of health care resources [..]
Advancements in ophthalmic diagnostic imaging technologies have led to 3-dimensional (3-D) structural optical coherence tomography (OCT) and 3-D vascular OCT angiography, enabling assessment of micron-level changes to disease biomarkers. [..] Peer-reviewed studies have consistently demonstrated a strong correlation between retinal images and the detection of multiple systemic diseases, including, but not limited to, cardiovascular disease (CVD), chronic kidney disease (CKD), and Alzheimer disease.
Besides the robust scientific rationale, several operational factors contribute to the feasibility of using the retina for health assessments and prescreenings. First, regular ophthalmic examinations are conducted for both adults and children. Second, automated ophthalmic imaging devices rapidly capture high-resolution retinal images that are safe, noninvasive, and relatively inexpensive compared with other diagnostic methods such as computer tomography scans, ultrasound imaging, electrocardiograms, and blood draws. Moreover, these devices are increasingly being placed in eye care centers and PCP offices. The accessibility of this imaging technology potentially further enhances the feasibility of Healthcare From the Eye prescreening. Third, many vision and medical insurance plans (eg, Medicare Advantage) cover annual eye examinations. Images captured during these examinations could be leveraged for prescreening, particularly for patients with chronic conditions at risk of blindness, including racial and ethnic minority youth with diabetes.
Expanding Healthcare From the Eye prescreening to more than 60 000 ECPs and 270 000 PCPs across the US is a compelling idea for enabling earlier detection of systemic conditions, in addition to ocular conditions. [..]
With the FDA-cleared fully autonomous AI algorithms that identify referrable and/or treatable DR within minutes while the patient is on site, the adoption of DR screening in PCP settings may increase. Autonomous detection of referrable DR is now possible using portable or handheld cameras within a few minutes, enabling the possibility of health care professionals (HCPs) offering this service even to patients without access to traditional health care settings.
In addition to AI for DR screening gaining traction, prescreening with the same retinal image can also be assessed via other AI algorithms to detect CVD, CKD, and more. Unlike traditional screening, which is performed on indicated populations and often requires the patient’s proactive request in the testing process, prescreening can be conducted at a population level with patient consent. The use of retinal images may provide patients with the possibility for health checks while enabling HCPs to leverage existing health care interactions and data to identify individuals who may require further evaluation in primary care or by a specialist.
[..] it may be important to assess whether current health care systems can handle the increased patient volumes that advanced AI-powered retinal imaging prescreening technologies may bring early on in a patient’s clinical journey. On the one hand, the infrastructure for general screening or early disease detection ideally should be scalable enough to manage more patients without sacrificing the quality of care. On the other hand, the shift toward early clinical management of chronic conditions may lead to better prognosis over time, with potentially remarkable medical and socioeconomical benefits in multiple levels: better quality of life for individual patients, optimization of health care resources with less severe diseases, and overall benefit for society at large by addressing the main causes of morbidity and mortality globally. Although promising, implementation of such a program state presumably requires trustworthy technologies with both high sensitivity and specificity for the targeted diseases. A truly personalized health care system ideally should be accessible and affordable for high-risk patients, while reducing the overall clinical burden for low-risk patients for sustained feasibility. However, prescreening everyone may not always be cost-effective and may burden certain health care systems. Moreover, prescreening which is cost-effective and valuable in some health care systems may not be cost-effective or valuable in other health care systems.
The required performance of such technologies also includes rigorous testing of AI systems on local datasets to assess their performance across diverse populations and identify potential biases because patient safety is paramount. AI systems that are not sufficiently accurate or are biased risk creating distrust among the already overwhelmed HCP communities, potentially leading to lack of or even resistance to adoption.
One should also focus on the challenge of providing follow-up care for at-risk patients who lack access to health care or insurance. Innovative strategies are needed to ensure underserved populations receive continuous care regardless of their socioeconomic status or insurance situation. One way to potentially overcome this obstacle is to ensure that widespread deployment of prescreening solutions by ECPs, PCPs, pharmacies, malls, retail offices, and home visits are digitally connected through various image and data management platforms.”
Full article, RN Weinreb, AY Lee and SL Baxter, JAMA Ophthalmology, 2025.5.8