Will intraoperative OCT be a game-changing technology in ophthalmology?

Issue: August 10, 2017

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Useful technology, but future unknown

We were involved with intraoperative OCT technology from the very beginning of its development. We have worked with it on a routine basis for several years, and it is a technology that can be helpful for a number of ophthalmic procedures.

However, do people need it? It is very helpful in some situations and we have used it with great outcomes for corneal transplants and for vitreoretinal surgery where membrane peeling is necessary, and I feel more confident using the technology for these surgeries before I leave the eye than without having it at my disposal. Using the technology while removing an epiretinal membrane, for example, it is very nice to be able to grasp the membrane without the use of a membrane micropick. It gives me a more secure feeling when I am using intraoperative OCT technology for this procedure.

Intraoperative OCT technology is useful for these basic procedures, but will it impact the future of ophthalmology? Nobody knows for sure if the technology will offer groundbreaking results in our field.

Oliver Findl, MD, MBA, is chair and associate professor of ophthalmology at Hanusch Hospital, Vienna, Austria. Disclosure: Findl reports he is a consultant to Carl Zeiss Meditec.

A game-changer

I currently find it to be a game-changer in my more challenging surgeries such as pediatric retinal cases, submacular surgeries involving gene therapy or stem cell delivery, retinal prosthesis implantation and any cases involving membrane peeling. It really guides my surgery in these cases and allows me to be more precise, leading to better surgical outcomes — for example, precision is the key in subretinal stem cell therapy delivery, and intraoperative OCT allows me to judge the depth of the delivery needle and location in targeted subretinal space. In my pediatric cases where preoperative and postoperative OCT is challenging and often impossible to obtain, it allows for better disease assessment and rapid pathology localization, guides my surgery and my instrument-tissue interactions and often eliminates unnecessary surgical steps where pathology or anatomy is not as apparent. In retinal prosthesis implantation, it allows me to determine more precise surgical location of the implant and distance from the retina, and it allows for immediate intraoperative adjustments of the implant if distance or location are inadequate vs. assessing these postoperatively in the clinic.

Initially, we were slow in the adoption of OCT technology in the clinic, and we did not realize what we were not seeing on our retinal exams, but now it has become the standard of care in retinal disease in the outpatient setting. Similarly, we are slow in adoption of this technology intraoperatively, and we are not aware of what we are not seeing intraoperatively such as microscopic pathology or our surgical instrument-tissue interactions, but as intraoperative OCT machines, software analysis programs and ease of intraoperative OCT machine use improve, intraoperative OCT will become the standard of care in anterior and posterior segment ocular surgery. It will provide significant improvement in our surgical outcomes.

Lejla Vajzovic, MD, is assistant professor of ophthalmology, adult and pediatric vitreoretinal surgery and diseases, and co-director of Duke Pediatric Retina and Optic Nerve Center at Duke University Eye Center. Disclosure: Vajzovic reports no relevant financial disclosures. She reports that she operates with Duke microscope-integrated swept-source OCT prototype research system developed by Duke Biomedical Engineering Department (Joseph A. Izatt laboratory) and Duke Advanced Research in Spectral/Swept Source OCT Imaging Laboratory (DARSI, Cynthia A. Toth laboratory). Use of this system in human subjects is performed with prior consent and under Duke IRB-approved protocols.