By Troy Patterson

Eyecare diagnostic equipment companies are responding to trends in health care by branching out into technologies that are advancing toward mainstream usage.

Innova

Innova’s Wayne Stobie, director of marketing, says initially ophthalmology and eventually optometry, will benefit from the advances that are coming down the pipe.

Advances in Optical Coherence Tomography (OCT) show a common trend across companies like Innova, Zeiss and Topcon, which continue to innovate and, with some introducing technologies that were newly approved in late 2016.

There continues to be a lot of interest in the OCT technologies for diagnostics, and we’re seeing more of that,” Stobie said. “So we’re going to continue attending events and training people on how to use OCTs for diagnostics.”

Stobie said there’s some new OCT technology, like Innova’s OCT angiography machine Nidek OCT RS3000 Angioscan, that has yet to find a mainstream place in the optometric world.

Stobie says the technology will be a “distraction” to medical professionals because of the promise it shows in its diagnosis of growing conditions like glaucoma, macular degeneration and dry eye.

The technology shows the vasculature in the eye and with some diseases, it’s starting to look good for seeing things before they happen, like glaucoma for example,” he says. “It’ll be an ophthalmology thing to start off with until they figure it out, and professionals pass down the technological know-how. And then it will become an optometry thing to be able to do as early of diagnostics as possible.”

Stobie says the challenge currently is the technology can show blood vessels non-invasively, without the use of injections, right down to eight micron capillaries, but the use of that information isn’t able to be widely utilized yet.

“The immediate need is in the ophthalmology world where they’re doing injections for macular degeneration and some diabetic retinopathy,” Stobie said. “In those cases, to be able to confirm that it’s working and to follow the vascular changes without requiring additional conventional angiograms, which often require a hospital visit because there’s potential anaphylactic reaction, there is a real benefit to OCT angiography. It is something that can be done anywhere, to anybody in 30 seconds without an injection and without any problems and it provides similar information. That’s really exciting and a lot of people are very excited about it.

Research is starting to show there are very early changes in some of the disease progressions that can be seen within the eye’s vasculature. Stobie said once they validate the OCT angiography scans and make it clear what eyecare professionals need to look for and where to look, its usage could see more mainstream usage.

So going into 2017, that will be for lack of a better word, a distraction, because it’s very cool and very exciting, but really it’s not going to be something to change what people do in practice right now,” he says. “But I can see it as something that can be incorporated into offices in the coming years.”

Stobie says the OCT also allows a lot of insight into glaucoma and macular degeneration, which gives eyecare professionals a lot better idea of what’s actually happening within the eye and a better diagnostic ability.

In terms of macular degeneration’s two types – the most prevalent dry versus the more sight-threatening wet macular degeneration, “the OCT allows more insight into when it’s becoming wet and so that you can identify that and send the patient to a specialist to get it dealt with.”

Stobie also mentions a new technology called autofluorescence imaging, which looks at the health of the eye.

While the OCT method shows the structural changes in the eye, autofluorescence imaging takes a picture of a level of a chemical called lipofuscin, a metabolic byproduct that is always present within the retina.

But when the retina becomes sick, or stressed, it can accumulate because the retina is unable to keep up with managing the level of it,” Stobie says. The image shows ‘hot spots’ of where lipofuscin is accumulating more than normal, “so you can identify where there’s a problem before it presents itself as a change that you’d see with the OCT. We have a lot of people who are very interested in that.”

Stobie said there’s also increased interest and awareness of dry eyes and how they impact vision and a number of other aspects of the eyes.

In the past, similar to macular degeneration, it’s not something that an awful lot of things could be done about,” Stobie says. “Now there are more treatment options. But in some cases, when your eye becomes really dry it initiates a tear response, so it’s tough to explain to patients that they have dry eye when their eyes are all teary.”

So once eyecare professionals are able to use the technology to take an image of what’s causing dry eye, document it for the patient and demonstrate it to them and the things that can help alleviate it, autofluorescence imaging will have a regular role to play.

I think that’s going to be another important change we see going forward.”

ZEISS

The medical technology group ZEISS received its US FDA Clearance for its new Swept-Source OCT imaging machine, the PLEX Elite 9000 in late 2016.

This powerful, cutting-edge Swept-Source OCT and OCT Angiography platform was designed for advanced retina research and is at the core of the Advanced Retina Imaging (ARI) Network,” ZEISS said in a media release.

The ARI Network is focused on exploring new clinical applications for the diagnosis and treatment of eye disease and advancing OCT innovation to benefit patients in the coming years

ARI Network, a unique global consortium of clinicians and scientists from around the world, are working at the forefront of retinal disease research. The company says the US FDA approval will allow the ARI Network to more easily enroll patients and may facilitate faster research approval.

The wide-field, high-resolution visualization provided by the new ZEISS technology “expands clinicians’ ability to examine the critical microstructures and microvasculature of the posterior segment at any depth of interest from vitreous to sclera.”

The company said the new piece of equipment is a breakthrough it their quest to achieve better and faster imaging of the retina and choroid.

By imaging deeper and in greater detail than ever before, we will further our understanding of the retina and choroid, and greatly facilitate clinical trial investigations into different diseases,” says Dr. Rosenfeld, Chairman of the A R I Network. “This collaboration between the retina experts in the A R I Network and the engineers and scientists at ZEISS is vital to the advancement of retinal and choroidal imaging and scientific discovery.”

TOPCON

Topcon announced the delivery of its 10,000th OCT device in late 2016, and saw the FDA approval of its new 3D OCT-1 Maestro System.

A new standard of clinical utility by combining a high resolution colour non-mydriatic retinal camera with the latest Spectral Domain OCT technology,” Topcon detailed in a release. “The rotating touch panel and fully automated (alignment, focus and capture) operation make the 3D OCT-1 Maestro the perfect diagnostic solution for even the smallest clinical practice.”

The company held its first international Swept Source OCT & Angiography Conference in Madrid Spain on Feb. 10-11, 2017, as the inaugural event dedicated to Swept Source OCT & Swept Source OCT Angiography.

The event featured presentations from leading ophthalmologists on a variety of topics, including recent advances in the field of Swept Source OCT, as well as its diagnostic uses for diabetic retinopathy, macular degeneration, glaucoma, tumours and more.

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