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Using Real-time OCT, AEVR Educates Capitol Hill on Visual Imaging Technologies Revolutionizing the Diagnosis and Treatment of Eye Disease

Attendees view real-time OCT images
Attendees view real-time OCT images

The next generation of Optical Coherence Tomography (OCT), a powerful diagnostic imaging technology that has emerged from collaborative research between the National Eye Institute (NEI) and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) within the National Institutes of Health (NIH), is already revolutionizing an eye care practitioner’s ability to diagnose and monitor treatment of major eye diseases faster, more accurately, at lower cost, and with less discomfort for the patient than ever before, Alexander Walsh, M.D., told members of Congress and staffers in a February 26 Capitol Hill briefing.

Topcon Medical Systems’ Aaron Graham performs a retinal scan
Topcon Medical Systems’ Aaron Graham performs a retinal scan

"OCT has changed everything we do in ophthalmology," said Walsh, an assistant professor of ophthalmology at the University of Southern California and director of the Doheny Eye Institute’s Imaging Exploration and Software Engineering Laboratory. "It represents an objective, standardized method for making a diagnosis and a quantitative way to monitor treatment progress and outcomes." Walsh spoke at this briefing sponsored by the Alliance for Eye and Vision Research (AEVR) and held in conjunction with the Coalition for Imaging and Bioengineering Research (CIBR), the American Institute for Medical and Biological Engineering (AIMBE), the Association for Research in Vision and Ophthalmology (ARVO), and the Ad Hoc Group for Medical Research.




Normal vs. Diabetic Retinopathy (traditional fundus photography images)
Early diagnosis is critical in patients with diabetic retinopathy since patients with healthy retinas (left) that receive timely laser treatments have a better chance of visual preservation than patients with diagnoses that are missed (right) and who often become legally blind

Normal vs. Diabetic Retinopathy (OCT images)
Retinal swelling (right) is a common cause of visual blurring in patients with diabetic retinopathy. The quantitative measurement of retinal thickness by OCT can improve management of therapies and decrease unnecessary or costly treatments.

OCT is a non-invasive, high-speed, high-resolution imaging technology that can now display a three-dimensional, cross-sectional view of the retina, not just the superficial view of its surface provided by conventional imaging technologies. OCT systems—no bigger than many instruments already in an ophthalmologist’s office—can capture an image painlessly in just seconds. Layers of the retina can then be separated on the computer screen to visualize and diagnose eye diseases, such as age-related macular degeneration (AMD, the leading cause of blindness in older Americans), diabetic retinopathy (the leading cause of blindness among working-age Americans), and glaucoma (the leading cause of vision loss in African Americans and Hispanics). “With OCT, we can now see minute tissue layers deep inside the eye to determine what might well have been missed before,” said Walsh, who demonstrated the speed and simplicity of an OCT scan with a live demonstration using a next-generation system provided by Topcon Medical Systems.

Unlike earlier tools, OCT creates color-coded numerical thickness maps of the retina that resemble topographic maps of mountainous terrain. These numbers allow practitioners to document changes in disease progression or the effects of treatment from visit to visit, which facilitates earlier diagnosis and better management of therapies and can mitigate both the risks and costs of over- or under-treatment. In fact, numbers are an essential advantage of OCT, said Walsh, who likened it to when individuals know their cholesterol levels or blood pressure readings and can compare them to benchmarks and take steps to reduce them. "Quantifying the state of the eye’s interior leaves less to subjective judgment and helps both practitioners and patients understand the disease and measure treatment progress," he stated.

The clinical applications of OCT that have been investigated and proven by federally-funded research demonstrate the cost-effectiveness of this research. For example:
  • OCT provides unparalleled visualization and measurement of retinal changes that can be coupled with a functional measurement of vision, maximizing the use of evidence-based medicine in eye care.

  • The Food and Drug Administration (FDA) is increasingly considering OCT as an outcomes measure in clinical trials for new treatment's, reducing costs by requiring fewer patients and taking less time, thus speeding new diagnostic tests or treatments to patients.

  • CT can save money as well as eye sight, as diagnoses and therapies based on this technology can delay, save, and prevent expenditures to the Medicare program, especially with the epidemic of age-related eye diseases due to an aging population.

"The need for OCT grows all the time," said Walsh, who added that ongoing collaborations among the NEI, NIBIB, academic researchers, and industry are leading to further refinements in the technology. "Although currently used primarily in a retinal specialist’s office, OCT has widespread potential as a cost-effective tool to screen for AMD, diabetic retinopathy, and glaucoma," he said, while also acknowledging that the technology is just beginning to expand into other medical fields, such as cardiology, dermatology, and gastroenterology.

Cong. David Hobson (R-OH, left), a House Appropriator, shares his family’s experience with vision loss with AEVR Executive Director<br> James Jorkasky
Cong. David Hobson (R-OH, left), a House Appropriator, shares his family’s experience with vision loss with AEVR Executive Director
James Jorkasky
CIBR President Renee Cruea offered a welcome and commented that, with respect to medical imaging, “We can be proud of the state of the science now, but we also have to be aware of how much further we have to go.”
CIBR President Renee Cruea offered a welcome and commented that, with respect to medical imaging, “We can be proud of the state of the science now, but we also have to be aware of how much further we have to go.”
Prior to the briefing, Dr. Walsh met with Melissa Bez in the office of Cong. Henry Waxman (D-CA) of the House Energy and Commerce Committee, with authorization jurisdiction over the NIH
Prior to the briefing, Dr. Walsh met with Melissa Bez in the office of Cong. Henry Waxman (D-CA) of the House Energy and Commerce Committee, with authorization jurisdiction over the NIH
James Jorkasky and Dr. Walsh also met with Sean McCluskie (right) in the office of Cong. Xavier Becerra (D-CA), whose district includes the USC campus.
James Jorkasky and Dr. Walsh also met with Sean McCluskie (right) in the office of Cong. Xavier Becerra (D-CA), whose district includes the USC campus.