Eyeworld

DECEMBER 2022 | EYEWORLD | 59 R About the physicians Arjan Hura, MD Maloney-Shamie Vision Institute Los Angeles, California Dan Reinstein, MD, MA(Cantab) London Vision Clinic EuroEyes Group London, United Kingdom Neda Shamie, MD Maloney-Shamie Vision Institute Los Angeles, California William Trattler, MD Center for Excellence in Eye Care Miami, Florida by Liz Hillman Editorial Co-Director Reinstein is considered to be the "father" of this new diagnostic field of layered corneal diagnostics. "Having developed and worked with VHF digital ultrasound for 20 years prior, I was excited to help Optovue develop the first OCT prototype device to map the cor- neal epithelium in 2012, which commercial- ly launched in 2015. Most anterior segment S till a relatively new technology that is being incorporated into more and more devices, epithelial mapping use continues to become more widespread among refractive surgeons. From an availability standpoint, Dan Reinstein, MD, who pioneered mapping the epithelium, said "every OCT company is developing or has developed this functionality into their machines: Avanti OCT [Optovue], MS39 OCT [CSO Italia], Cirrus OCT [Carl Zeiss Meditec], and Anterion OCT [Heidelberg]. This is in addition to the Insight 100 [ArcScan], which uses the Artemis very high-frequency [VHF] digital ultrasound tech- nology, and the Precisio [iVis] ultra-thin blue scanning laser slit tomography." "As more doctors get routine access to epi- thelial thickness maps, there are an increasing number of publications," Prof. Reinstein said. William Trattler, MD, said that while epithe- lial thickness mapping has been on everyone's radar for a while, like Prof. Reinstein, he thinks that more physicians are incorporating it into their diagnostic practice. "We're still trying to understand a bit better how it will help us clinically," Dr. Trattler said. In March 2021, EyeWorld spoke with Prof. Reinstein and others about the utility of epi- thelial mapping in their practice. At the time, Prof. Reinstein shared the history of developing epithelial mapping and where it has come since then: Prof. Reinstein developed epithelial mapping and applications as a bioengineer- ing research fellow working in D. Jackson Coleman's lab with Ronald Silverman, PhD. Prof. Reinstein was the first to measure the epithelium of the cornea in vivo in 1991 using VHF digital ultrasound and the first to produce a 3-mm map of the epithelium in 1993. 1 He went on to develop the first method of mapping the full 10-mm epithe- lial profile of the cornea by 1997 2 when he began scanning and elucidating the epitheli- al changes in LASIK and analyzing the com- plications of corneal refractive surgery. With this work and the commercialization of the first epithelial mapping device (ArcScan Insight 100 VHF and other anterior segment OCT devices with this capability), Prof. Word on the street about epithelial mapping continued on page 60 Mean epithelial thickness profile for a population of 110 normal eyes (A) and a population of 54 keratoconic eyes (B). The epithelial thickness profiles for all eyes in each population were averaged using mirrored left eye symmetry. The color scale represents epithelial thickness in microns. A Cartesian 1-mm grid is superimposed with the origin at the corneal vertex. Source: Reprinted with permission from SLACK Incorporated. Reinstein DZ, et al. Epithelial, stromal, and total corneal thickness in keratoconus: three- dimensional display with Artemis very-high frequency digital ultrasound. J Refract Surg. 2010;26:259–271. HOT TOPICS IN OPHTHALMOLOGY

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