Researchers are developing a powerful, new kind of patient registry by using optical coherence tomography, angiography, and ultra-widefield fundus photography. The Duke Neurodegenerative Disease Retinal Imaging (DNRI) repository initiative led by retinal surgeons Dilraj Grewal, MD, and Sharon Fekrat, MD, is a novel worldwide registry of deidentified multimodal retinal and optic nerve images. The patient registry possibly opens up important implications for the diagnosis and the treatment of neurodegenerative disease patients. By hosting an accumulating array of images, the DNRI investigators seek to understand whether they can serve as an economical, less time-consuming, and less-invasive diagnostic tool.
Recently, Lindsay Kenton, writing for Duke University School of Medicine, educates the reader that this new patient registry could allow support faster, more economical, and earlier diagnosis for key neurodegenerative diseases. Dr. Dilraj Grewal reported, “Because of the noted correlation between ocular pathology and select neurodegenerative disease, imaging of the eye may assist clinicians in making a diagnosis earlier in the disease course and also create a baseline for comparison and future study.”
The DNRI Repository
Presently, the DNRI Repository contains the images, categorized based on diagnosis, of over 800 patients. These images are then subjected to multi-institutional and multi-disciplinary review for assessment to determine if they are sufficient for diagnoses.
Intervene Earlier in Development of Dementia
What if Alzheimer’s Disease could be diagnosed and addressed earlier in its lifecycle? Dr. Grewal reminds the reader that not only could physicians produce a more accurate diagnosis, but additionally, patients could be enrolled in clinical trials earlier. He notes, “At the very least, we can deploy lifestyle changes that may slow the progression of dementia.”
Dr. Fekrat adds that if this growing patient registry can facilitate expedited diagnosis, this helps all as “it may help physicians and scientists ultimately find an effective treatment.”
The Registry Plus Board Certified Neurologists
Currently, the accumulating images of those patients with neurodegenerative diseases are diagnosed by board-certified neurologists, reports Ms. Kenton at Duke. These specialists bring expertise to probe and diagnose the DNR repository on the lookout for Alzheimer’s disease (AD), mild cognitive impairment, Parkinson’s disease, multiple sclerosis, and other conditions.
Can Images Alone Support a Diagnosis?
Probably not as of yet, but the movement is gaining speed. After all, with the infusion of AI and deep learning, researchers can begin identifying and distinguishing various patterns that support a particular diagnosis.
Implications for Drug Development & Pharma
The implications are huge. For example, Dr. Fekrat commented that pharma has been focusing on amyloid plaque in relation to Alzheimer’s disease clinical trials. In fact, “More than 400 clinical trials studying medications to lessen or remove amyloid plaque have failed,” notes the doctor. Her point is clear: “Not everyone with amyloid has AD. Having the most accurate diagnosis is important when studying new medications.”
The point, touts Grewal, “Studying longitudinal images and observing changes in these images over time may have important implications with regard to studies of pharmaceutical interventions, as these images may be used to monitor treatment effect.”
The Duke repository could change how pharmaceutical companies research and develop treatments for neurodegenerative diseases.
Wisdom from an Expert
Richard J. O’Brien, MD, PhD, and Duke neurologist specializes in the treatment of neurodegenerative disease. He believes that the DNRI shows great potential commenting, “Important future work will be to determine if this technique can differentiate different types of dementia, and whether it can detect changes in those at risk rather than just those who are symptomatic.”
Dilraj Grewal, MD, Ophthalmologist (Board Certified), Retinal Surgeon
Sharon Fekrat, MD, Professor of Ophthalmology, Associate Professor, Department of Surgery
Call to Action: For referring a patient who has been diagnosed with a neurodegenerative disease for ophthalmic imaging as part of this Institutional Review Board-approved study protocol, reach out to Duke at [email protected]