Reinventing the eye examination

Post date: 
Thursday, 20 August 2015

Olufunmi Majekodunmi and Glenys Trevor report on how one doctor is attempting to change the way eye examinations are performed in hospitals.

Imagine walking into an eye clinic at a hospital, putting on a pair of “eye binoculars” and then having a doctor saying that your eye examination is now complete.
 
Well it might not be that fast, but if Moorfields doctor Pearse Keane has his way, then the way hospitals undertake eye examinations could be set to dramatically change in the not too distant future. 

What is the game changer? 

The traditional method of eye examination is called slit-lamp biomicroscopy, but the potential of a new device could prove to be a game changer. Keane believes it will make eye examinations quicker, reduce waiting times for eye examinations in clinics and help clinics to be more efficient.
 
So what is it? Keane is helping to develop a new form of ocular imaging device called binocular optical coherence tomography (OCT).
 
His efforts so far are looking good, as Keane is now the first ophthalmologist in the UK to scoop the prestigious National Institute of Health Research (NIHR) Clinician Scientist award. The NIHR award, which is just under £1million, will fund research work in this area for the next five years.
 
Binocular OCT provides extremely high-resolution images of the eye in a completely non-invasive manner. The imaging provides a greater resolution than CT or MRI scans and is obtained in just a fraction of a second. 
 
It also allows the patient to acquire the images from their own eyes without any assistance from a doctor or nurse. The screens on the device are similar to those on a smartphone or tablet computer, allowing a range of information to be displayed to the patient. 
 
This means that, in addition to acquiring images of the eye, the device can perform a range of other eye tests – such as measuring visual acuity, eye movements or reactions of the pupils to light.

The benefits 

One of the longer-term benefits being mooted for the device is that it could allow patients to monitor the condition of their eyes from the comfort of their own home.
 
Keane believes the device has strong potential. He says: “It will allow a comprehensive eye examination to be performed in an automated manner and means that patients with less severe stable eye diseases of the retina can have all their preliminary testing done in one quick session before seeing the doctor for a consultation.
 
“Other benefits the device could introduce is the speeding up of patients’ hospital visits with less time spent in the waiting room and more time with the doctor. In the longer term, the device could allow patients to have their chronic eye diseases monitored from their own homes or from their local GP, pharmacy or opticians.”

Reinventing eye examinations for the 21st century 

Binocular OCT provides extremely high-resolution imaging of all structures within the eye – from the eyelashes to the lens, to the retina and optic nerve. This will allow consultants to diagnose and monitor eye disease with much greater detail and accuracy than before.
 
The idea for binocular OCT was first formulated by Dr Alexander Walsh, an ophthalmologist and engineer based in California. Pearse spent a number of years at the Doheny Eye Institute in Los Angeles under the mentorship of Dr Walsh. This year, Dr Walsh’s company, Envision Diagnostics Inc, aims to build a prototype binocular OCT system at Moorfields to begin clinical testing and validation. This device will be the first of its kind in the United Kingdom and Europe
.
Over the five-year funding of the NIHR award, Dr Keane will look at each of the diagnostic tests provided by the device to assess their accuracy, reliability and reproducibility. The initial focus of the clinical testing will be on patients with age-related macular degeneration (AMD) and diabetic retinopathy.
 
Later it is hoped that the device will be used in other areas, such as glaucoma and paediatric ophthalmology, and even in the assessment of neurological diseases such as Alzheimer’s disease, Parkinson’s disease and multiple sclerosis.
 
These research studies will be supported by Moorfields consultants Adnan Tufail, Prof David Garway-Heath, principal statistician Catey Bunce and clinical researcher Jennifer Burr.

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