Advancing Early Detection of Diabetic Retinopathy in Western Australia

An update from Dr Danuta Sampson, 2024 DRWA Research Grant Recipient

Every year Diabetes Research WA supports research that brings us closer to earlier detection, improved treatment and a healthier future for Western Australians living with diabetes. In 2023, we awarded our 2024 grant to a project that reflects these goals with clarity. Led by physicist and vision science researcher Dr Danuta (Danka) Sampson from the Lions Eye Institute and The University of Western Australia, this work is strengthening our understanding of diabetic retinopathy by harnessing the power of advanced imaging and big data.

Why this research matters

More than 128,000 people in Western Australia live with diabetes. Many more are estimated to have the condition without knowing it. One of the most serious complications is diabetic retinopathy, a progressive eye disease that damages the smallest blood vessels at the back of the eye. These tiny vessels, known as the microvasculature, can begin to change long before a person notices any difference in their vision. Catching these changes early is vital because timely intervention can prevent or slow vision loss.

Despite significant progress in eye imaging, clinicians still face a challenge. Current diagnostic tools are not sensitive enough to reliably detect the earliest signs of microvascular dysfunction, which limits opportunities for early intervention.

This is where Dr Sampson’s project steps in.

Building a harmonised imaging dataset for Western Australia

Modern imaging known as optical coherence tomography angiography (OCTA) has transformed eye care. OCTA allows clinicians and researchers to see the smallest blood vessels in incredible detail without the need for invasive dyes or lengthy procedures. It is quick, safe and has become increasingly common in eye clinics across the country.

However, there is a major barrier to fully realising the potential of OCTA.

Different clinics use different OCTA instruments and these devices do not always produce comparable images. The variations are technical rather than biological, yet they make it impossible to reliably combine data across sites. Without harmonisation, it is difficult to build the large datasets required to discover early biomarkers of diabetic eye disease.

Dr Sampson’s project, Harmonisation of Western Australia multi site OCTA datasets for new biomarker discovery and application in diabetic retinopathy, is designed to overcome this barrier. The aim is to develop and validate a data analysis framework that removes these technical differences so that OCTA images collected across Western Australia can be analysed as one.

Progress so far

The team has made significant progress. In the first half of the project they have:

• Reviewed more than 1,000 OCTA images collected from Lions Eye Institute (Perth) and Lions Outback Vision (Broome)
• Built a dataset of 400 high quality images of Western Australians with and without diabetic retinopathy to test and refine harmonisation models.
• Recruited 70 healthy volunteers, imaging each of them with three different OCTA instruments. This volunteer dataset is crucial for validating the harmonisation approach.
• Begun analysing early differences in vascular parameters across metropolitan and regional WA, including preliminary comparisons between Indigenous and non Indigenous participants.

During her recent presentation at the DRWA Grant Award Breakfast, Dr Sampson shared that the team is now preparing to implement and refine the computer models that will harmonise OCTA images across different devices. These models are based on an established statistical method known as ComBat, which has been used for more than twenty years to harmonise large medical imaging datasets in other fields. Applying this method to OCTA is a significant and innovative step forward.

The early results are promising. The team has already demonstrated that harmonisation reduces instrument related differences in vascular measurements. Once complete, this will allow data from multiple clinics to be pooled into a single large dataset, giving researchers the statistical power needed to identify new early biomarkers of diabetic retinopathy.

What the early findings are beginning to show

Although full analysis is still underway, the preliminary findings have highlighted important patterns.

The team noted meaningful differences in the microvascular parameters of participants from metropolitan Perth compared with those from Broome. They also observed that the average age of participants with diabetic retinopathy differed considerably between the two regions. This has raised new research questions about how diabetes related vessel changes may vary between groups, including Indigenous and non Indigenous Australians.

Dr Sampson explained that understanding these differences is essential, saying that these early observations are an important reminder that diabetic retinopathy does not always follow the same pattern across populations. Larger and harmonised datasets will allow the team to explore this in a more rigorous and meaningful way.

Looking ahead

The next stage of the project will focus on refining the harmonisation models, generating pilot data and deepening the collaboration with the project’s Community and Consumer Involvement group. This group includes people with lived experience of diabetes who help ensure that the research remains grounded, relevant and aligned with community needs.

Dr Sampson shared her ambition for the future. She hopes that OCTA will eventually become a routine part of eye screening for people living with diabetes, especially once the technology is supported by clear diagnostic biomarkers.

A message of thanks

Dr Sampson expressed her gratitude to all collaborators who have contributed data, clinical expertise and volunteer support, including colleagues from Lions Eye Institute, Lions Outback Vision, The University of Western Australia, Fremantle Hospital and University College London. She also acknowledged the ongoing support provided by Diabetes Research WA and the donors who make this work possible.

Her commitment to improving early detection of diabetic retinopathy is clear. By building one of the first harmonised OCTA datasets in Australia, this project is creating new opportunities to detect vision threatening changes earlier and more accurately than ever before.

 

Diabetes related foot disease remains one of the most serious and costly complications of diabetes in Australia. It affects thousands of people every year and contributes to long hospital stays, reduced quality of life and, in severe cases, amputation. These outcomes weigh heavily on individuals, families and the health system. They also reinforce our commitment at Diabetes Research WA to invest in research that delivers real change.

At our annual Grant Award Breakfast on 19 November, we were proud to announce Dr Pamela Chen as the recipient of the 2026 Diabetes Research WA Grant. Dr Chen is a senior podiatrist at Fiona Stanley Hospital and part of a multidisciplinary team dedicated to preventing and treating diabetes related foot ulcers. Her pilot project explores a promising technique called autofluorescence imaging, which may improve healing rates for people with hard to heal foot ulcers.

Reflecting on the significance of the work, Dr Chen shared,

“Foot disease in diabetes is often overlooked, yet it affects so many people. If we can find ways to improve healing even slightly, it has the potential to change lives.”

Why this research matters

Diabetes related foot disease affects nearly half a million Australians. Each year, around one in ten people with diabetes experience a hospital admission due to foot complications. Sadly, more than 6,000 Australians will lose part of their foot or leg as a result of a diabetes related ulcer. The condition is complex, difficult to treat and costly. It takes an estimated 2.7 billion dollars out of the Australian health system each year. In Western Australia alone, the burden sits at roughly 280 million dollars.

Healing outcomes remain challenging. Fewer than 30 percent of diabetes related foot ulcers in Australia heal within twelve weeks under current standard care. These ulcers often carry a high bacterial load, which slows healing, increases the risk of infection and raises the likelihood of amputation.

This is where Dr Chen’s work offers genuine hope.

Img src: Diabetes Feet Australia

Understanding autofluorescence

Autofluorescence imaging is a relatively new technique that uses safe ultraviolet light to detect bacteria in a wound. Certain bacteria produce substances that glow red or cyan under this light, giving clinicians immediate information about bacterial activity.

At present, dressing choices for diabetes related foot ulcers are based on broad principles such as comfort, moisture control and cost. Silver based antimicrobial dressings are widely used, yet evidence supporting their effectiveness in diabetes related ulcers is limited. International guidelines often recommend avoiding them unless there are clear signs of infection.

Autofluorescence may help guide these decisions more precisely. Early studies suggest that using this imaging to direct cleaning and treatment could improve healing outcomes. By identifying bacterial activity quickly and visually, clinicians may be able to target antimicrobial dressings only when they are likely to help.

About the project

Dr Chen and her team will run a pilot randomised controlled trial known as the AURA study. It will involve people with diabetes related foot ulcers that have not improved with standard care. Participants will be screened using autofluorescence imaging.

• If the ulcer shows no autofluorescence signal, participants will receive a standard inert dressing.
• If the ulcer shows a positive signal, participants will be randomised to receive either a targeted antimicrobial dressing or an inert dressing.

The team will follow participants for twelve weeks and measure healing, changes in bacterial load, quality of life and cost effectiveness. The goal is to assess whether a larger, multisite clinical trial is feasible.

Dr Chen highlighted the broader ambition of the research, sharing,

“The goal is for this to be embedded in an MRFF or an NHMRC clinical trials grant. That thank you again to DRWA for making this possible. I’m very appreciative of your support of our work.”

What success could mean for Western Australians

If this pilot demonstrates that autofluorescence guided treatment improves healing, the benefits could be far reaching.

• More precise and effective wound care
• Reduced use of unnecessary antimicrobial dressings
• Lower treatment costs for health services
• A clearer path to preventing avoidable amputations
• Faster adoption in clinical practice due to the availability of the device in Australia

Autofluorescence devices are already used in some Australian clinical settings, so translation into everyday care could occur more quickly than with many emerging technologies.

Investing in research that creates change

Dr Chen’s project reflects the mission of Diabetes Research WA. We support research that is practical, innovative and grounded in improving outcomes for people living with diabetes. This pilot study has the potential to reshape how clinicians assess and treat diabetes related foot ulcers across Western Australia and beyond.

We congratulate Dr Chen and her team and look forward to following their progress. Research of this nature requires dedication, collaboration and a strong sense of purpose. It is made possible only through the generosity of our donors and the support of our community.

To learn more about our research program or to support our work, please contact our team.

 

Diabetes Research WA is pleased to announce the winner of our 2025 grant as Dr Kimberley Wang from the University of Western Australia. Her project, entitled “Impact of intrauterine growth restriction on skeletal muscle glucose metabolism – link to increase risk of diabetes?” aims to determine the effects of intrauterine growth restriction (IUGR) on fibre type, abundance of myogenesis, glucose and insulin signalling molecules and glycogen storage in the skeletal muscle, and whether it occurs in a sex-dependent manner.

The work could lead to more effective therapies for the prevention and treatment of diabetes and other metabolic diseases.

The Research Team

The project is led by Dr Kimberley Wang from The University of Western Australia and supported by co-investigators Dr Erin Lloyd (The University of Western Australia), Professor Robyn Murphy (La Trobe University).

 

Developmental origins of metabolic diseases

Epidemiological and experimental studies have demonstrated that IUGR and low birth weight increase the risk for metabolic disease in later life, including insulin resistance and type 2 diabetes. In 2021, 6.6% of babies were classified as low birth weight in Western Australia. A meta-analysis reported that low birth weight individuals experienced a 45% higher risk of type 2 diabetes compared with healthy birth weight individuals, with females having a greater risk than males. The underlying mechanism(s) however remains unknown.

Unique mouse model to investigate the association between IUGR and type 2 diabetes

Dr Wang has established a mid-gestation maternal hypoxia-induced IUGR mouse model whereby the hypoxic exposure for this mouse model was limited to the period of myogenesis, which is the formation of skeletal muscular tissue process. This specific exposure period allows us to assess what will happen to the metabolic health when skeletal muscle development is disrupted.

Our overarching hypothesis is that adaptations that occur within skeletal muscle in response to IUGR include changes to fibre type, protein abundance involved in myogenesis, glucose and insulin metabolism, and glycogen storage in adulthood, and these changes will subsequently increase the risk of metabolic disease. Outcomes will contribute to discovery knowledge by revealing potential mechanistic explanations for the development of metabolic syndrome in IUGR individuals.

 

The project Harmonisation of Western Australia multi-site optical coherence tomography angiography (OCTA) datasets for new biomarker discovery and application in diabetic retinopathy, funded by Diabetes Research WA, aims to introduce and validate a data analysis framework so datasets from multiple clinics in Western Australia can be combined and analysed to identify more sensitive biomarkers of diabetic retinopathy.

The Research Team

The project is led by Dr Danka Sampson from Lions Eye Institute and the University of Western Australia and supported by co-investigators A/Prof. Fred Chen (Lions Eye Institute), A/Prof. Angus Turner (Lions Outback Vision), Dr Jeremiah Lim (University of Western Australia) and Dr Mark Chia (University College London).

In Australia, diabetes affects more than 1.7 million (1 in 20). In Western Australia alone, there are more than 128,000 people now diagnosed with diabetes. For every person diagnosed, it is estimated that there is another person who has diabetes but does not know it yet.

 

What is Diabetic Retinopathy?

Diabetic retinopathy (DR) is a serious eye problem that can develop in people with diabetes. DR can damage the microvasculature (the smallest vessels in the internal layer of the eye) even before people experience a decline in their vision. The early detection of vessel damage can prevent severe vision loss. However, there is a lack of sensitive diagnostic tools and biomarkers (medical signs of disease) to detect the early onset of microvascular damage.

 

Creating Big OCTA Data sets

Optical coherence tomography angiography (OCTA) has been increasingly used to diagnose eye diseases as a safe and quick test for assessing the eye’s smallest blood vessels. Compared to other instruments in the eye clinic, OCTA images the blood vessels non-invasively and with high resolution. The technique is gaining momentum in the standard of care.

Critical barriers to widespread usage include the lack of a large normative dataset of OCTA parameters. Big datasets can be achieved by combining data from multiple clinics. However, this is not a trivial task due to non-biological variations introduced during data collection across multiple sites and differences in OCTA cameras.

To reduce variability, this study will first develop and validate a data analysis framework to harmonise OCTA datasets collected at different Western Australian clinics. The harmonised datasets will be used to generate preliminary data on OCTA-derived microvascular biomarkers in DR in Western Australians. This will enable the study, prevention, treatment and monitoring of this common eye disease.