Richard Rosen, MD, Vice Chair of the Department of Ophthalmology at New York Eye and Ear Infirmary, and a team of researchers in the Shelley and Steven Einhorn Clinical Research Center, are pioneering an imaging technology that enables them to see microscopic details of the retina and its finest blood vessels at a level not previously possible in patients with sight–threatening disease.
Their work, being conducted in the David E. Marrus Adaptive Optics Laboratory, incorporates adaptive optics (AO) technology with fluorescein angiography, the traditional procedure for visualizing abnormal blood vessels in the eye. AO was originally developed by astronomers to view objects in space without distortions caused by the atmosphere, whereas fluorescein angiography involves injection of dye into a patient’s arm, which is then recorded digitally as it moves through the bloodstream into the eye.
Dr. Rosen says AO combined with flourescein angiography will make it possible for physicians to study how diseases unfold on a cellular level so they can devise more effective treatments. “With this approach, we can appreciate very early changes and potentially intervene with treatment when the disease could be at a reversible stage,” he explains. “It can take over ten years for some patients to lose vision, with no visible changes seen with currently available imaging modalities. With AO, we can detect minute changes much earlier and hope to improve the standard of care and prevent blindness.”
Diabetic retinopathy, for example—a progressive disease in patients with diabetes that can lead to blindness—is typically diagnosed and treated with laser surgery or intraocular injections at a later stage, says Dr. Rosen. If the disease were detected earlier, physicians might be able to prevent vision loss with milder, less-invasive treatments.
In a recent study involving ten healthy volunteers that was funded, in part, by the National Eye Institute, Dr. Rosen and his colleague Alfredo Dubra, PhD, Assistant Professor and Co-Director of the Advanced Ocular Imaging Program at the Medical College of Wisconsin, found that combining AO technology and an oral form of the dye mixed with orange juice provided a stronger, longer-lasting signal than the dye administered intravenously. It was tolerated by all of the volunteers, whereas one volunteer who received an intravenous injection became nauseous.
Going forward, Dr. Rosen says one of the biggest challenges will be to make AO technology accessible to all ophthalmologists. Once the technology becomes more cost-effective, it can be incorporated into clinical trials and patient care.