OCULAR IMAGING

Whole-eye imaging of the anterior and posterior segments, using binocular OCT. Image courtesy of Dr Alex Walsh, Envision Diagnostics , Inc.

A new imaging device is aiming to reinvent the way eye examinations are currently performed. Pearse Keane MD, MSc, NIHR Clinician Scientist at UCL Institute of Ophthalmology, UK, described plans for the clinical testing and validation of binocular optical coherence tomography (OCT), a device capable of producing non-invasive high-resolution images of the eye in a fraction of a second and in greater detail than computerised axial tomography (CAT) or magnetic resonance imaging (MRI) scanning.

“The unique capability of this device is to provide comprehensive eye examination in an automated manner and reinvent the eye exam for the 21st Century. It certainly has the potential to replace the slit-lamp, a technology which is little changed since it was first developed more than 100 years ago by Gullstrand in 1911,” he told the 15th EURETINA Congress in Nice, France.

While the device provides “whole eye” OCT imaging of the anterior and posterior segments, Dr Keane told EuroTimes that there are three more important reasons why the device has the capability to reinvent the eye exam.

Display Content

“Firstly, it is binocular in design. This allows the user to align the device with his or her own eyes without the need for a third party. So in other words, patients can scan their own eyes without the need for a photographer or doctor to be present. Secondly, it is a ‘smart’ device, meaning that the screen of the device can act like that of a smartphone or tablet computer to display content to the user. For example, the screens can be used to display letters on a visual acuity (VA) chart to the user. The device can then use voice recognition technology to measure their VA level.

“Finally, the device allows for simultaneous imaging of both eyes. This means that, unlike other OCT devices, it can assess features such as pupils and extraocular movements,” he said.

As Dr Keane sees it, these three features taken together mean that binocular OCT goes far beyond structural imaging of the eye, allowing for a range of diagnostic tests – from VA measurements, to visual field assessments, to pupillometry, among others – to be performed in a fully automated and quantitative manner.

Private Practices

The device will probably be used initially in hospital eye clinic settings before making its way into private practices, said Dr Keane.

“We believe, for instance, that it will greatly increase the efficiency and reduce the costs of retinal therapy clinics in the National Health Service (NHS). As such, we plan to conduct most of the initial testing in patients with chronic retinal diseases such as age-related macular degeneration (AMD) and diabetic retinopathy (DR),” he said.

Clinical tests in the UK will be funded by the National Institute of Health Research (NIHR) and will consist of a progressive framework of diagnostic accuracy studies. As the first ophthalmologist to receive the NIHR research award, Dr Keane’s award of just under £1million will fund the research for the next five years.

Gold standard

“The clinical tests will begin with studies to test the accuracy and reproducibility of each of the diagnostic features offered by the device as compared to gold standard examinations. In later studies we will look at real-world diagnostic accuracy studies – for example, evaluating whether the device is accurate for clinical decision-making in retinal clinics. We will also perform health economic analyses to determine what the potential cost savings and efficiency benefits of the device would likely be,”
he said.

After the initial clinical studies are completed, Dr Keane sees potential for the device in other applications outside the hospital setting such as screening, telemedicine applications or even home monitoring of eye diseases.

The idea for binocular OCT was first formulated by Dr Alexander Walsh, an ophthalmologist and engineer based in California, USA. The device is currently being developed in Los Angeles by his company, Envision Diagnostics, Inc. Dr Keane spent a number of years at the Doheny Eye Institute in Los Angeles under the mentorship of Dr Walsh.

Pearse Keane:

pearse.keane@moorfields.nhs.uk