Dr. Nima Ghadiri

Uveitis Through the Ages

Article here: https://www.nature.com/articles/s41433-024-03519-x This editorial in EYE outlines the captivating history of #Uveitis (inflammation in the eye), the understanding and management of which having evolved alongside advancements in medicine. From early descriptions in ancient Egyptian papyri, to the primogenitors of modern medicine laying the foundation of the link between eye inflammation to systemic disease, to innovations of the 19th and 20th century – the eras have seen a narrative of progress, collaboration and innovation as we strive to understand and treat this complex disease. Pivotal breakthroughs in immunology, imaging, and biologic therapies that transformed uveitis treatment, and who knows what the future holds for precision medicine in the management of ocular inflammation. Here’s to the journey ahead…

An introduction to oculomics

The concept of oculomics was discussed in Dr Nima Ghadiri’s main stage session at the Hospital and Specialty Optometrists Conference (HSOC) in September. Oculomics is the study of how eye health relates to the rest of the body, and how eye care practitioners have the potential ability to screen for systemic conditions early and identify potential diagnoses via biomarkers. Ghadiri is a consultant medical ophthalmologist at Liverpool University Hospitals, and is trained in both ophthalmology and internal medicine. He is one of only 15 medical ophthalmologists in the country – a role he described as dealing “with the eye in relation to full-body diseases.” “Oculomics is putting into one word the eyes being a window not just to the soul, but to our overall health,” Ghadiri said. The cornea can show genetic biomarkers, and its connection to the vast neural network means that eye movement directly correlates to neurological function, Ghadiri told attendees. Oculomics means healthcare professionals can explore metabolic and immune systems, brain and nervous systems, and vasculature, non-invasively, he added. He noted that not many eye care practitioners are aware of the concept of oculomics, but that the field is likely to increase in importance in the coming years – and that a lot of the research is being carried out in the UK. It is something that “could be a game-changer for how we approach the big diseases,” Ghadiri believes. He added: “Hopefully, over the next few years or decades, oculomics may be able to revolutionise diagnostics by predicting systemic health conditions years or decades in advance.” Ghadiri noted that “there will be a pivotal role that both hospital and community optometrists will have in clinical applications and in future research.” A long history The session, entitled Oculomics – the eye as a window to the body, began with an overview of oculomics from history – including how Egyptian physician Imhotep saw eye problems as an extension of the diseases of the body. Historic figures including philosopher Hippocrates and physician Galen also had an interest in this subject, Ghadiri said. He went on to explain that German physicist Hermann von Helmholz invented a direct ophthalmoscope in 1851, allowing medical practitioners to see high blood pressure, before the first fundus camera image was taken in 1886. A century later, in 1991, optical coherence tomography (OCT) was developed by a Massachusetts Institute of Technology PhD student. Since then, “we have seen how certain features in the eye can predict on these scans things like blood pressure, age, body mass index, sex and smoking status,” Ghadiri said. In the future, he believes, if healthcare professionals could predict markers of systemic diseases such as Alzheimer’s through ophthalmic imaging, this would be “game-changing.” In 2024, Ghadiri noted, there have been papers created using data from the UK Biobank on schizophrenia, Parkinson’s, stroke and cardiovascular disease. In all, almost 600 associations have been made between systemic diseases and retinal biomarkers, he said, with the majority being renal diseases – but also cardiovascular and endocrine diseases, as well as diabetes and high blood pressure. Non-image biomarkers in the eye, including proteins in tears and other ocular metrics that can be identified at the pre-clinical stage, are also vital, especially when there is no obvious way to capture brain imaging, Ghadiri said. He noted that, “despite the small volume available for sampling, we can eliminate invasively evaluating health and pathology in this key source of biological material.” “The most desirable biomarkers are rapidly quantifiable and cost-effective. We want to accurately identify the disease and identify risk factors and early signs of diseases using these biomarkers at the pre-clinical stage,” he added. “These kinds of technologies help narrow gaps in healthcare inequality, not just within part of the UK but around the world.” The nation’s relationship with eye health Statistics shared with HSOC attendees during Ghadiri’s presentation included: 80% of people expect a High Street optometrist to be able to check for eye health conditions 27% expect their general health to be covered during a visit to the optometrist 80%+ are unaware that an eye test can detect signs of cardiovascular disease 23% of people say they will get a health check twice over a two-year period 78% of people identified sight as the sense they would least like to lose The future Oculomics has until recently centred on retinal imaging because of large datasets that have been collected from across the world, Ghadiri noted. However, work now taking place in the UK has an increasingly large focus on Biobank data. Artificial intelligence (AI) is also allowing for generation of insights that would not have been possible previously, he said. Ghadiri predicts that more papers relating to AI and oculomics will be published in the coming months, and that awareness of oculomics in general will have vastly increased by 2026. Optometry-led oculomics could also be seen on the High Street in the future, Ghadiri believes, with the creation of oculomic profiles that can predict the risk of systemic disease a possibility. “Potentially exciting times are ahead, I hope,” Ghadiri said. He added that the field of oculomics has the potential to revolutionise the way that healthcare professionals approach diseases. “Eye care professionals of all different types may have a pivotal role in screening, in prognostication, and in multi-disciplinary management,” he said, “hopefully to give us a simpler, quicker, less invasive way of predicting whether someone might get a serious condition.” Ghadiri also believes that the future could mean increasingly affordable and accessible digital health integration, leading to more personalised medicine. “The goal is personalised medicine and customisation of treatment strategies, based on individual profiles,” he said. “Hopefully, as more devices become capable of extracting and analysing eye health data, we can get more seamless integration with digital health platforms and get real time data and analysis so healthcare providers will have more to go on.” Ghadiri sees this potential collaboration and sharing of data sets as enriching the clinical role. He also emphasised that legislation would be vital to underpin such movements, with ethics and privacy key considerations. “It is very important to underpin patient safety,” he said. Another vital aspect identified is affordability, and with it access to care. Screening for systemic diseases could be hugely beneficial in areas that do not have neurologists or rheumatologists, Ghadiri noted. “Reducing barriers to implementation means that we need to make sure that our telecommunications, our cloud-based services, and our networking, continue to improve,” he added. Ghadiri also noted that oculomics has the potential to widen the public’s understanding of how eye care can intersect with their health more broadly. “More than 80% of the nation are not aware that an eye test can detect signs of cardiovascular disease, one of the most common causes of death in the UK,” he said. “That’s where, eventually, oculomics can change things.”

Dogmatic ideas in medicine and uveitis - from the Behçet's UK Q & A

"You can't have XYZ in this disease". Full Behçet's Uveitis video available here: https://youtu.be/KHlZ7aElCJU Medicine, while grounded in evidence, has historically been shaped by traditions and assumptions that sometimes do not withstand scrutiny in light of new data, technologies, or even insights Questioning entrenched beliefs encourages critical thinking and a willingness to adapt practices based on emerging evidence, and we need to keep fostering a culture that values curiosity and respectful debate to ensure that patient care remains dynamic, equitable, and responsive to the ever-evolving landscape of healthcare knowledge. Behcet's Uveitis tends to affect either the front of the eye (anterior uveitis) or the back (posterior uveitis). It tends not to cause intermediate uveitis - wherein inflammatory cells can be seen suspended within the vitreous. These cells are appreciated similar to that of anterior chamber cells but with the slit lamp focused behind the lens. Larger inflammatory collections known as "snowballs" may also be identified within the vitreous. They aren't classically seen in Behçet's Disease but "never say never"... Isolated intermediate uveitis, albeit rare, can occur - (and more common in early rather than late disease) https://behcetsuk.org/conference/2024conf/

Anterior Uveitis & Axial SpA - HLA-B27 Testing, Features, Support? (feat Detective Pikachu & others)

The most common type of Uveitis (inflammation in the eye) is anterior uveitis, or iritis, and almost 50% of patients with this condition test positive for th...