Eyeworld

EW NEWS & OPINION 26 March 2016 by Matt Young and Gloria Gamat EyeWorld Contributing Writers identifying the extent of the injury and the resulting impairment. For example, in a 2013 case series re- ported by Kolomeyer and colleagues in the Oman Journal of Ophthalmol- ogy, digital filters, color and fundus autofluorescence (FAF), OCT and microperimetry were technologies that seemed to complement each other in providing direct observa- tion and correlation of structure and function in cases of ocular trauma secondary to projectile objects. Other studies also explore the use of retinal imaging biomarkers for early diagnosis of Alzheimer's disease. This is another application of ophthalmic diagnostic imaging that is constantly evolving. "As our ability to measure ultrastructural changes in the retinal cells continues to improve, I predict we will be able to detect changes in many diseases including neurologic disease," Dr. Khouri said. As ophthalmic diagnostic imaging continues to evolve, the advancements are creating opportu- nities for clinicians to work together with other specialties in a multi- disciplinary approach of managing related pathologies in patients. "We already collaborate with colleagues from internal medicine, endocrinology, neurology, and other specialties in many areas; I think this is the future in medicine," he concluded. EW References 1. Mendez N, et al. Structural changes by spectral domain optical coherence tomogra- phy in patients with type 1 diabetes mellitus. J Diabetes Sci Technol. 2015 Aug 31. [Epub ahead of print] 2. Kolomeyer AM, et al. Complimentary imag- ing technologies in blunt ocular trauma. Oman J Ophthalmol. 2013;6(2):108–111. Editors' note: Dr. Khouri has no finan- cial interest related to this article. Contact information Khouri: khourias@njms.rutgers.edu of children and young adults mostly affected by type 1 diabetes. "This is a good thing, as many children do not enjoy the stinging sensation of dilating drops; media opacities can preclude the use of imaging as well," Dr. Khouri said. Of course, the child needs to remain still for a few seconds while the image is acquired. However, some children are incapable of sitting through the test. But unlike other ophthalmic diagnostic imaging procedures that have been used in practice such as photographic imaging of the fundus (a procedure that requires a bright flash) and intravenous fluorescein angiography (an invasive, difficult procedure to perform in children that has adverse effects), OCT, according to Dr. Khouri, is probably the most kid-friendly imaging tech- nology that is currently available. With the possible increase in the occurrence of type 1 diabetes, which is linked to obesity, young patients will benefit from earlier detection of diabetic retinopathy. "In our study, OCT was able to pick up structural changes in the retina before they were apparent on conventional examination," Dr. Khouri said. "The exact implica- tions of these changes are not fully understood at this time. We still recommended strict diabetic control in patients to prevent progression of these changes. I think results of our work lay the foundation for future research in this very important area." Further, ophthalmic diagnostic imaging technologies, particularly OCT, are instrumental in the diagno- sis of other retinal pathologies and glaucoma. "In glaucoma, OCT is used to measure the retinal nerve fiber layer and ganglion cell layers; those can be followed over time and compared to a reference database to detect changes," Dr. Khouri said. Even in cases of blunt ocular trauma, OCT complementary to other imaging technologies has been found helpful to clinicians in fully and Technology, Mendez and col- leagues reported the correlation of structural changes seen in the retina of a pediatric patient population to known diabetes risk factors. The investigators conducted a compre- hensive screening of type 1 diabetes patients using non-mydriatic fundus imaging and SD-OCT scans under the direction of Ben Szirth, PhD, director, ophthalmology screening program, Rutgers University. The scans, showing macular, paramac- ular, and perimacular thickness, correlated to poor glycemic control (HbA1C) and body mass index (BMI) using simple linear regressions. "A general trend of thickening of the macula, paramacula, and peri- macula was observed with increasing HbA1C (>7.5%) and increasing BMI; SD-OCT with retinal imaging was feasible in young individuals with DM1 and revealed ultrastructural macular and perimacular changes prior to manifest clinical disease," the researchers reported. In this prospective pilot imaging study, noted Dr. Khouri (co-author and co-investigator), the research team detected changes in the retinal layers with OCT even in patients who did not show visible retinopa- thy changes. "This means we can detect the earliest changes with OCT even be- fore they are visible to the examin- er's eye," he explained. Impact on disease management Because SD-OCT was successful in detecting abnormalities that would otherwise threaten vision prior to the onset of vision loss, patients can immediately be provided with preventative measures, and the response to selected therapies can be monitored accordingly. "As other groups corroborate those findings, I think recommen- dations regarding detection and screening will change in the future," Dr. Khouri said. More importantly, OCT does not require pupil dilation, and therefore, there is no need for eye drops to be administered in the eyes The device is paving the way in predicting who gets what disease, in ophthalmology and other fields I n ophthalmology, given that advanced imaging systems such as the spectral domain optical coherence tomography (SD- OCT) have resolutions close to 5 um, ophthalmologists are now able to detect pathologies that were very elusive in the past. For example, during the pre- OCT era, the American Academy of Ophthalmology (AAO) recommend- ed annual screenings start between 3 to 5 years after the onset of diabetes in type 1 patients less than 30 years of age. Today, based on the known abilities of OCT, it has become a standard of care test procedure in patients with diabetes, glaucoma, and other diseases. With the use of fundus exam- ination, diabetic retinopathy can now be detected by observing vascu- lar changes, hemorrhages, and fluid accumulation in the retina; these can all be documented today with photographic imaging of the retina. Role of SD-OCT in detecting pathologies "I think SD-OCT has changed the way we practice ophthalmology, particularly in glaucoma and retina," said Albert Khouri, MD, ophthal- mology residency program director, and associate director, glaucoma division, Rutgers New Jersey Medical School, Newark, N.J. With SD-OCT, according to Dr. Khouri, a large number of scans are captured in a very short period of time. "This fast imaging capability has the advantage of avoiding any eye motion artifact. With the available high resolution, it allows the detec- tion of ultra-structural changes in the retinal layers," he said. Published in the August 2015 issue of the Journal of Diabetes Science Using SD-OCT to predict pathology before it happens

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