Eyeworld

SUMMER 2026 | EYEWORLD | 57 C DIGITAL MOMENTUM by Ellen Stodola Editorial Co-Director About the physicians Karolinne Rocha, MD, PhD Professor of Ophthalmology Medical University of South Carolina Storm Eye Institute Charleston, South Carolina Nandini Venkateswaran, MD Cornea and Refractive Surgery Service Massachusetts Eye and Ear Lexington, Massachusetts Mitchell Weikert, MD Professor, Cullen Eye Institute Baylor College of Medicine Houston, Texas Advancing options in corneal imaging T here are many available technologies in the ophthalmologist's toolkit for the corneal practice, according to Nandini Venkateswaran, MD. She mentioned the importance of having a topogra- pher, adding that there are many great topogra- phers on the market that help you really assess the anterior cornea. "You also need a good tomographer, which is going to help you assess the posterior cornea, especially if you're diagnosing corneal irregular- ities like ectasia or keratoconus," she said. She added that epithelial thickness mapping and anterior segment OCT are useful. Dr. Venkateswaran said anterior segment OCT has become a nice tool for a variety of reasons, whether it's looking at the depth of a corneal scar, the attachment of an endothelial kerato- plasty graft (DMEK or DSAEK), or the degree of corneal thinning noted in a corneal ulcer. "Those are all the tools that I'm using in my practice that help me better diagnose and treat corneal diseases, and I use them often together." Dr. Venkateswaran said advanced corneal diagnostics and imaging devices can help paint a story. For example, if the topographer detects anterior corneal steepening, the tomographer and epithelial thickness mapping can be used together to confirm the diagnosis of keratoconus versus contact lens corneal warpage. Or if there are areas of flattening on topography, anterior segment OCT could potentially help character- ize corneal lesions causing such flattening, such as Salzmann's nodules or pterygia. In terms of how frequently she's using these technologies and if it's for every patient diagno- sis, Dr. Venkateswaran noted that often in her practice, a patient comes in already diagnosed with a condition, and she uses these technolo- gies to confirm the diagnosis. She will have certain diagnostic images taken before meeting with the patient so she can look at them clinically and assess what the imaging shows. Other times, she might suspect something and want additional tests. In terms of a learning curve with anterior segment OCT, Dr. Venkateswaran said that all of these corneal technologies are easy to incor- porate into practice. It can be helpful to speak to colleagues who use them to get a sense of certain layouts or printouts and which maps/ displays to look at, as well as parameters that might be most helpful. In general, Dr. Venkateswaran thinks the best approach to new technology is first to learn about it, then to see where it can play a role in your practice. It's also a good idea to make sure your staff understands how to use the machines and to work with the company to get appropri- ate training. While Dr. Venkateswaran is not using intraoperative OCT, she noted its utility when performing corneal transplants to check that an endothelial transplant is attached or to help understand corneal depth to achieve a success- ful big bubble for DALK. When incorporating corneal imaging technologies into practice, Dr. Venkateswaran recommended starting with a tomographer and topographer and building up to adding more options. Dr. Venkateswaran said it's also nice to be able to hear about these technologies at meet- ings and from colleagues to really explore the best options for a physician and their practice before committing to implementing a new technology. It's important to weigh if the return on investment is worth it, she said, adding that implementation can vary in different practice settings, for example from private practice to an academic setting. Many of these OCT capabilities are incorpo- rated into machines with other functionalities, so it's not a huge footprint, but may require updating your machines. Karolinne Rocha, MD, PhD, and Mitchell Weikert, MD, also discussed advanced imaging options in cornea, focusing on some of the new- er technologies. Dr. Rocha mentioned the OPMI LUMERA 700 (Zeiss), a surgical microscope with integrat- ed intraoperative OCT imaging. She uses this technology for corneal transplants, lamellar and endothelial keratoplasty, and called it a "game changer." It helps to show all the layers of the corneal graft in real time, so you can see if there are any folds or interface fluid. She added that there wasn't much of a learning curve, it's possible to adjust the focus, and you can turn continued on page 58

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