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AI-Supported Test Gives Early Warning on Glaucoma Progression

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■ A new test that uses artificial intelligence (AI) has detected glaucoma progression 18 months earlier than the current gold standard method, according to results obtained by UK researchers in a phase 2 clinical trial. Results were published in Expert Review of Molecular Diagnostics. Lead researcher Professor Francesca Cordeiro (UCL Institute of Ophthalmology, Imperial College London) said, “We have developed a quick, automated, and highly sensitive way to identify which people with glaucoma are at risk of rapid progression to blindness.”

The test, called DARC (detection of apoptosing retinal cells), involves injecting into the arm a fluorescent dye that attaches to retinal cells and illuminates cells that are in the process of apoptosis, a form of programmed cell death. The damaged cells appear bright white when viewed in eye examinations — the more damaged cells detected, the higher the DARC count.

In the DARC trial, AI was used to assess 60 of the study participants (20 with glaucoma and 40 healthy control subjects). AI was initially trained by analyzing the retinal scans (after injection of the dye) of the healthy control subjects. The AI was then tested on the glaucoma patients. Those taking part in the AI study were followed up 18 months after the main trial period to see whether their eye health had deteriorated. The researchers were able to accurately predict progressive glaucomatous damage 18 months before that seen with the current gold standard of OCT retinal imaging technology, because every patient with a DARC count over a certain threshold was found to have progressive glaucoma at follow-up.

“What is really exciting, and actually unusual when looking at biological markers, is that there was a clear DARC count threshold above which all glaucoma eyes went on to progress,” said Dr. Cordeiro.