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Purpose: Retinal signatures of systemic disease ('oculomics') are increasingly being revealed through a combination of high-resolution ophthalmic imaging and sophisticated modelling strategies. Progress is currently limited not mainly by technical issues, but by the lack of large labelled datasets, a sine qua non for deep learning. Such data are derived from prospective epidemiological studies, in which retinal imaging is typically unimodal, cross-sectional, of modest number and relates to cohorts, which are not enriched with subpopulations of interest, such as those with systemic disease. We thus linked longitudinal multimodal retinal imaging from routinely collected National Health Service (NHS) data with systemic disease data from hospital admissions using a privacy-by-design third-party linkage approach., Participants: Between 1 January 2008 and 1 April 2018, 353 157 participants aged 40 years or older, who attended Moorfields Eye Hospital NHS Foundation Trust, a tertiary ophthalmic institution incorporating a principal central site, four district hubs and five satellite clinics in and around London, UK serving a catchment population of approximately six million people., Findings to Date: Among the 353 157 individuals, 186 651 had a total of 1 337 711 Hospital Episode Statistics admitted patient care episodes. Systemic diagnoses recorded at these episodes include 12 022 patients with myocardial infarction, 11 735 with all-cause stroke and 13 363 with all-cause dementia. A total of 6 261 931 retinal images of seven different modalities and across three manufacturers were acquired from 1 54 830 patients. The majority of retinal images were retinal photographs (n=1 874 175) followed by optical coherence tomography (n=1 567 358)., Future Plans: AlzEye combines the world's largest single institution retinal imaging database with nationally collected systemic data to create an exceptional large-scale, enriched cohort that reflects the diversity of the population served. First analyses will address cardiovascular diseases and dementia, with a view to identifying hidden retinal signatures that may lead to earlier detection and risk management of these life-threatening conditions., Competing Interests: Competing interests: SKW is funded through a Medical Research Council Clinical Research Training Fellowship (MR/TR000953/1). NP is funded by a Moorfields Eye Charity Career Development Award (R190031A). HM is supported by the National Institute for Health Research’s (NIHR) Comprehensive Biomedical Research Centre (BRC) at University College London Hospitals. SEP receives support from the NIHR BRC at Barts. KB has received speaker fees from Novartis, Bayer, Alimera, Allergan, Roche and Heidelberg; meeting or travel fees from Novartis and Bayer; compensation for being on an advisory board from Novartis and Bayer; consulting fees from Novartis and Roche and research support from Apellis, Novartis and Bayer. AP receives financial support from the NIHR BRC based at Moorfields Eye Hospital (MEH) NHS Foundation Trust and UCL Institute of Ophthalmology; is part of the Steering Committee of the Advanced Nerve and Glaucoma Imaging (ANGI) network which is sponsored by ZEISS and Steering Committee of the OCTiMS Study which is sponsored by Novartis and reports speaker fees from Heidelberg Engineering. JSR receives support from the NIHR as a senior investigator and via the NIHR BRCs at MEH and Great Ormond Street Hospital. AKD is director of INSIGHT, the HDRUK Health Data Research Hub for Eye Health. PAK is supported by a Moorfields Eye Charity Career Development Award (R190028A) and a UK Research & Innovation Future Leaders Fellowship (MR/T019050/1); receives research support from Apellis; is a consultant for DeepMind, Roche, Novartis, Apellis and Bitfount; is an equity owner in Big Picture Medical and has received speaker fees from Heidelberg Engineering, Topcon, Allergan, Roche and Bayer, meeting or travel fees from Novartis and Bayer and compensation for being on an advisory board from Novartis and Bayer., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Management of age-related macular degeneration (AMD) places a high demand on already constrained hospital-based eye services. This study aims to assess the safety and quality of follow-up within the community led by suitably trained non-medical practitioners for the management of quiescent neovascular AMD (QnAMD)., Methods/design: This is a prospective, multisite, randomised clinical trial. 742 participants with QnAMD will be recruited and randomised to either continue hospital-based secondary care or to receive follow-up within a community setting. Participants in both groups will be monitored for disease reactivation over the course of 12 months and referred for treatment as necessary. Outcomes measures will assess the non-inferiority of primary care follow-up accounting for accuracy of the identification of disease reactivation, patient loss to follow-up and accrued costs and the budget impact to the National Health Service., Ethics and Dissemination: Research ethics approval was obtained from the London Bloomsbury Ethics Committee. The results of this study will be disseminated through academic peer-reviewed publications, conferences and collaborations with eye charities to insure the findings reach the appropriate patient populations., Trial Registration Number: NCT03893474., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)