Eyeworld

69 EW INTERNATIONAL April 2018 3. Grulkowski I, et al. Retinal, anterior segment and full eye imaging using ultrahigh speed swept source OCT with vertical-cavity surface emitting lasers. Biomed Opt Express. 2012;3:2733–51. Editors' note: Dr. Ehlers and Dr. Grulkowski have no financial interests related to their comments. Contact information Ehlers: justis.p.ehlers@gmail.com Grulkowski: igrulkowski@fizyka.umk.pl OCT can image the vitreous through to the sclera, map the macula and optic disc in one scan, and provide high resolution fundus images. EW References 1. Ehlers JP, et al. The DISCOVER study 3-year results: feasibility and usefulness of micro- scope-integrated intraoperative OCT during ophthalmic surgery. Ophthalmology. 2018 Feb. Epub ahead of print. 2. Grulkowski I, et al. Swept source optical coherence tomography and tunable lens tech- nology for comprehensive imaging and biome- try of the whole eye. Optica. 2018;5:52–59. "Generally, vitreous is a gel- like medium that is practically non-scattering; it is just transparent. Therefore, it is hard to show using optical methods. On the other hand, we think that the detection in OCT technology is mature and sensitive enough to address that challenge." Disadvantages of the electroni- cally tunable lens with the SS-OCT technology included "thermal in- stability, small aperture, and higher order aberrations," according to the investigators. These limitations will likely be overcome as the technolo- gy advances. Dr. Grulkowski and co-investi- gators have been working on such advanced capabilities for SS-OCT for several years, with their first paper on full eye imaging capabilities being published in 2012. 3 Technology with a similar capability recently received approv- al from the U.S. Food and Drug Administration. The DRI OCT Triton Series (Topcon, Oakland, New Jersey) incorporates a built-in retinal cam- era, giving it the ability to visualize both anterior segment and posterior segment structure. Considered the first commercially available multi- modal SS-OCT in the U.S., the DRI "The concepts of application of a tunable lens in OCT come from mobile phones that have cameras that enable auto-focus to sharpen the image. Therefore, except for employing mechanically adapted standard lens, it is possible to make the configuration simpler with a degree of tenability. We think this can make the systems simpler with a better functionality," he said. Overall, Grulkowski et al. found integrating a tunable lens with SS-OCT to be "a powerful tool for studying the impact of dynamic focus on OCT image quality." They were able to image the anterior segment, retinal structures, and the whole eye in seven people without ocular pathology. The measurements obtained using the instrument were similar to those obtained by an ocu- lar biometer. "The main application can be comprehensive diagnostics of eye diseases, especially in cases when the pathological changes occur in both segments of the eye," Dr. Grulkowski said. Glaucoma is a prime example of this as a disease that can impact structures in the anterior segment as well as the optic nerve. "Secondly, the device can establish a new approach to ocular biometry to measure the intraocular distances—the technique that is rou- tinely used before cataract surgery," Dr. Grulkowski said. Dr. Grulkowski said this paper was the first report to show features of the anterior vitreous, a capability that might be important in moni- toring opacifications after cataract surgery. The research team is going forward with refining imaging of the entire vitreous, not just its interface with the crystalline lens or with the retina. "Nowadays, OCT systems can visualize the vitreoretinal interface quite well. However, there are also cases of vitreous opacifications that require 3-D visualization of the vitre- ous," he said. "This will enable a bet- ter understanding of the morpholo- gy of the vitreous and its pathology, and it will give us information on the impact of vitreous opacifications in retinal image degradation in eyes with opacities. " The use of OCT in the operating room is still an emerging field, and the role for OCT for various procedures and indications may be quite different. " —Justis Ehlers, MD Intraoperative OCT for anterior segment surgery Francis Price, MD, discusses applications of intraoperative OCT technology for anterior segment surgery, such as lamellar cornea transplants. EWReplay.org

• Cover
• Blank Page
• Blank Page (1)