New study by researchers from Birmingham and London shows people with atrial fibrillation have signs in their eyes years before diagnosis.
Researchers have discovered that routine eye scans may reveal signs of atrial fibrillation (AF) up to four years before the condition is clinically diagnosed, highlighting new possibilities for earlier detection.
The study, published in PLOS Digital Health was led by researchers from the UCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and the University of Birmingham. They analysed images from different layers in the retina, the structure in the eye that converts light to vision. Using data from more than 90,000 people, their findings suggest that changes in retinal structure could help identify individuals at increased risk of AF long before symptoms appear.
Atrial fibrillation affects more than 1.5 million people in the UK and significantly increases the risk of stroke, heart failure and premature death. Birmingham researchers have also identified a clear association between this common heart condition and developing vascular dementia. Because the condition can occur intermittently, it is often difficult to detect through standard diagnostic tests, meaning many people remain undiagnosed until they experience a serious complication.
The work in Birmingham was supported by the NIHR Biomedical Research Centre: Birmingham, which brings together the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust to translate scientific discoveries into improvements in patient care.
With photographs of the back of the eye and a technique using light waves that many people have at the opticians, researchers found that people with atrial fibrillation had thinning in specific layers of the retina that could be an early marker of blood vessel damage due to atrial fibrillation.
Once proven, this study opens up the prospect of using high street opticians in the future to predict and prevent the onset of common heart conditions that have a major impact on both patients and health services across the world.
Importantly, the same retinal changes were also observed in individuals who went on to develop atrial fibrillation, with differences detectable on average four years before a hospital diagnosis. The association remained significant after accounting for factors including age, gender, ethnicity, hypertension, diabetes, smoking and alcohol consumption.
Professor Dipak Kotecha at the University of Birmingham and NIHR Biomedical Research Centre: Birmingham, one of the senior authors of the paper, said:
“Once proven, this study opens up the prospect of using high street opticians in the future to predict and prevent the onset of common heart conditions that have a major impact on both patients and health services across the world. We are already running a clinical trial across England called DaRe2THINK that is testing earlier treatment of atrial fibrillation – with outcomes related to the eye and brain function due to be released in 2027 and 2028.”
The findings add to growing evidence from the field of "oculomics", which uses detailed eye imaging to identify signs of disease elsewhere in the body. Researchers believe retinal imaging could one day complement existing heart screening approaches, helping doctors identify high-risk patients earlier and reducing the likelihood of stroke, dementia and other complications from heart disease.
Notes to editor:
The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.
The University of Birmingham is committed to achieving operational net zero carbon. It is seeking to change society and the environment positively, and use its research and education to make a major global contribution to the UN Sustainable Development Goals. Find out about our Sustainability strategy.
The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients.
DaRe2THINK is clinical trial platform embedded in the NHS, testing whether early blood-thinning medication prevents strokes and dementia in younger patients with atrial fibrillation. Using an advanced digital platform and funded by the NIHR, it integrates directly with GP health records to run remotely; entirely eliminating the need for hospital visits.
DaRe2THINK NeuroVascular is a sub-study of the main trial funded by the NIHR and Medical Research Council that is investigating how atrial fibrillation leads to cognitive decline and vascular dementia, including the use of blood vessel imaging in the eye and brain.
About the National Institute for Health and Care Research
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
Funding high quality, timely research that benefits the NHS, public health and social care;
Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low- and middle-income countries is principally funded through UK international development funding from the UK government.
The NIHR Birmingham Biomedical Research Centre: Birmingham (BRC) is part of the NIHR and hosted by University Hospitals Birmingham NHS Foundation Trust (UHBFT) in partnership with the University of Birmingham (UoB). The BRC’s research programme focuses on inflammation and the diagnosis, prevention and treatment of its associated long-term illnesses.
Professor of Cardiology & Consultant Cardiologist
Staff profile for Professor Dipak Kotecha, Professor of Cardiology, Department of Cardiovascular Sciences, University of Birmingham.
