May 4, 2018
Disruption is frequently given a negative connotation but in the eye care industry disruption has led to improvements in earlier detection of sight threatening conditions, better treatment options and overall improved visual outcomes. Visualizing the structures of the eye in the past was challenging. Starting in the late 1800s newer technologies pushed the ophthalmologic industry forward.
The ophthalmoscope is an instrument for examining the interior structures of the eye, especially the retina by reflecting light through a mirrored lens into the eye. It was invented by Hermann von Helmholtz in the 1850s. The invention revolutionized the ability to view the retina (fundus) of the eye. This breakthrough technology for its time was not immediately accepted or adopted by the ophthalmology community. Gradually, the benefits of viewing the retina with a hand-held instrument became apparent and now the instrument is standard in every eye care practice and primary care physician’s offices around the world. The technology spawned sub specialization in diseases of the eye affecting the retina.
The Goldman Perimeter is a subjective visual field testing device that measures an individual’s scope of vision including central and peripheral (side) vision. The instrument maps the visual fields of each eye individually. It is useful in diagnosing and determining the severity of conditions such as glaucoma, stroke, pituitary diseases, brain tumors and neurological deficits. Hans Goldman developed the modern perimeter in 1945. His innovation expanded field testing by standardizing the illumination and optical projection system within a bowl-shaped instrument. The Goldman perimeter advanced visual field testing by varying the presented target, its size, brightness (luminance) and color with either a static or moving target. His innovation helped researchers to document and describe the relationship between visual field losses (defects) and conditions affecting vision.
OPTICAL COHERENCE TOMOGRAPHER (OCT)
Optical coherence tomography (OCT) is a non-invasive (non-contact) imaging test and a close optical analog to ultrasound imaging. Using light waves the OCT creates high resolution cross-sectional images of the tissue layers within the eye. The resultant image is a 3D representation. The concepts behind development of the OCT began over 40 years ago and were described by Michel Duguay in his pioneering study. He suggested that one could “see inside” biological tissues through using pulses of light. Researchers at MIT developed a prototype based on Duguay’s suggestions and founded a startup company Advanced Ophthalmic Diagnostics to commercially develop the OCT. By 1996, the first OCT became commercially available. However, clinical adoption was slow until 2004 when the OCT image resolution improved through ongoing innovation. OCT has revolutionized the clinical practice of ophthalmology and currently is used to image the macula, optic nerve, anterior chamber of the eye and aids in analyzing the effects of various diseases on the retina including diabetes, macular degeneration, inherited retinal disease, glaucoma and intraocular tumors.
The advent of improved visualization of the eye whether functional or structural enhances detection and aids the practitioner in treating eye disorders. In contrast, another type of disruptive technology currently under development in the eye care sphere aims to aid the consumer to track and check the accuracy of their vision from the comfort of their home. For example, EyeQue corporation beginning in 2015, using MIT licensed technology, developed and patented the Personal Vision Tracker (PVT). The PVT device harnesses the capabilities of the smartphone allowing consumers to measure their refractive status including near-and-far-sightedness and astigmatism. Previously, these measurements were only attainable from an eye exam with an optometrist or ophthalmologist. This vision technological advancement is disrupting the eye care industry and faces similar challenges to adoption as seen with other new innovations. The PVT is transforming and modernizing refractive vision technologies enabling consumers to interactively measure their refractive status and report changes to their eye care provider.