SECOND DAY, I WOULD LIKE TO
INTRODUCE DR. CHANG FOR OUR KEY
NOTE SPEAKER FOR THIS MORNING.
THANK YOU.
>> I'M DR. HUANG AND CAN I GET
THE SLIDES PLEASE.
THIS IS A PRIVILEGE FOR ME TO
BRUCE OUR SECOND KEY NOTE WHO IS
DAVID HUANG, OKAY, AND I WILL
LET YOU DRIVE THIS.
THANKS.
SO, DAVID--YOU KNOW ALL OF--YOU
KNOW THE BASICS ABOUT DAVID BUT
LET ME JUST GO THROUGH SOME OF
THIS BIOGRAPHY, DAVID WAS BORN
IN TAIWAN, CAME TO THE U.S. AT
AGE 13 WHERE HIS FAMILY MOVED TO
UP STATE NEW YORK THAT'S WHERE
HE WENT TO HIGH SCHOOL, JOINED
THE WRESTLING TEAM, YOU KNOW
JUST GRADUATED AND END ENDED UP
GOING TO M. I.T. AND GOT A
BACHELORS AND A MASTERS THERE
AND THEN WENT TO HARVARD MEDICAL
SCHOOL THAT WAS AFFILIATED WITH
M. I.T. CALLED DIVISION OF
HEALTH SCIENCES AND TECHNOLOGY.
KNOWS THIS ABOUT DAVID, I
THOUGHT WE HAD SOME SIMILARITIES
BECAUSE LIKE DAVID MY FAMILY
CAME TO THE U.S. IN TAIWAN, I
STUDIED ELECTRICAL ENGINEERING
IN COLLEGE AND I GRADUATED FROM
THE SAME PROGRAM, OKAY, BUT QUH
WE STARTED TO LOOK DEEPER, I
STARTED TO FEEL LIKE MAYBE
THAT'S WHERE THE SIMILARITIES,
WE STARTED TO DIVERGE A LITTLE
BIT SO I TRIED TO FIND SOME
PICTURE JUST TO ILLUSTRATE
MEDICAL SCHOOL, FROM MYSELF, AND
ALL I COULD FIND WAS THINGS LIKE
THIS, YOU KNOW WHERE APPARENTLY
I WAS LEARNING TO PLAY BEACH
VOLLEYBALL AND YOU KNOW GO TO
AMUSEMENT PARKS IN WEST
MASSACHUSETTS.
WHEREAS DAVID ON THE OTHER HAND
WAS GETTING HIS Ph.D. AT
MEDICAL PHYSICS AT M. I.T. AND
WORKING ON THIS SEMINOLE PAPER
WITH YOU KNOW, THIS PAPER'S BEEN
SHOWN HERE, SO MANY TIMES, YOU
KNOW ERIC, JOEL, YOU KNOW CARMEN
[INDISCERNIBLE] AND OBVIOUSLY
JIM AND YOU KNOW TO STATE THE
OBVIOUS, THIS PAPER HAS BECOME
SUCH A CLASSIC THAT EVEN THOUGH
IT'S GOT 18,000 CITATIONS,
PEOPLE DON'T NEED TO CITE IT
ANYMORE.
IT'S JUST BECOME PART OF EVERY
DAY KNOWLEDGE, THAT TRANSCENDS
CITATION, EVEN AND AFTER THAT
DAVID BECAME A RESIDENT IN
OPHTHALMOLOGY AT THE EYE
INSTITUTE AND DID A FELLOWSHIP
IN CORNEA AT EMORY AND THAT WAS
JUST THE BEGENERATEDDING FOR
HIM.
HE STARTED HIS CLEAR AT
CLEVELAND CLINIC IN REFRACTIVE
SURGERY AND BIOMEDICAL
EMERGENCYING AND MOVED TO USC.
AND THEN MOVED TO OREGON HEALTH
AND SCIENCE UNIVERSITY IN 2010
WHERE HE BECAME PROFESSOR AND
BIOMEDICAL ENGINEERING, BECAME
DIRECTOR OF THE CENTER FOR
OPHTHALMIC, OPTICS AND LASERS,
THE COOL LAB WHICH HAS OVER 30
FACULTY, STAFF AND TRAINEES AND
IT WAS DURING THAT TIME THAT HE
RECEIVED MAJOR AWARDS, WITH A
NUMBER OF THE PEOPLE IN THE
AUDIENCE HERE, HE WAS ELECTED TO
THE NATIONAL ARK CAD ME OF
ENGINEERING AND RECEIVED THE
STANFORD AND GREEN BERG PRIZE TO
END PLIENDNESS VISIONARY AWARD
AND YOU KNOW NUMBER OF YEARS
AGO, HE BECAME ASSOCIATE
DIRECTOR AT THE OHHSU EYE
INSTITUTE AND IT WAS DURING THIS
PERIOD WHERE HE RECEIVED ALL
THE--THE LASKER AWARD, NATIONAL
MEDAL OF TECHNOLOGY AND
INNOVATION, NOW IN EMERGING ITS
OF THESE PARALLEL ANDS HOW I GOT
TO KNOW DAVID, I TARTED WORKING
AT HEALTH AND OREGON SCIENCE
UNIVERSITY ABOUT 6 MONTHS AFTER
DAVID DID AND THAT'S WHERE I
FELT LIKE I GOT TO KNOW HIM AS A
COLLEAGUE AND AS A FRIEND.
AND SO THAT'S MY LAST SLIDE OF
THE INTRODUCTION.
THAT ON A PERSONAL NOTE JUST
FROM WORKING WITH HIM ON A
COUPLE PROJECTS, AND I'VE GOTTEN
TO UNDERSTAND THE WAY THAT HIS
MIND WORKS.
DAVID IS SO CREATIVE, HE HAS
THIS UNUSUAL ABILITY TO ELECTRIC
AT A PROJECT ON A VERY, VERY
BROAD NOTE.
LIKE WHAT'S THE IMPACT OF HIS
WORK GOING TO BE IN OTHER AREAS.
AND ALSO DELVE REALLY DEEPLY AND
KIND OF UNDERSTAND EVERY NUANCE
OF A PROBLEM AND IF YOU COULD
POST THAT UP AND SO, DAVE I ALSO
HAS 1 DAUGHTER, [INDISCERNIBLE]
WHO WE GOT TO KNOW A LITTLE BIT
BECAUSE I HAPPEN TO HAVE 2
DAUGHTERS AND THEY'VE DONE A FEW
THINGS TOGETHER OVER THE YEARS
AND JUST MEETING HIS CHILD, SHE
WAS SMART, SPUNKY, CREATIVE AND
YOU KNOW THESE KIDS ARE ALL IN
COLLEGE RIGHT NOW.
AND YOU KNOW WHEN I LOOK AT
PICTURES OF MY KIDS IN COLLEGE
WHICH THEY SEND FROM TIME TO
TIME, THEY'RE DOING THINGS LIKE
HANGING OUT IN THE DORM WHEREAS
WHEN I LOOK AT PICTURES OF HER,
SHE'S HINGING OUT IN THE
WHITE HOUSE, AND SO BUT THE
REASON I PUT THIS UP ISN'T TO
TALK ABOUT THE WHITE HOUSE OR
SKIING, BUT TO SAY THAT, YOU
KNOW THIS IS REALLY GIIVE ME A
CHANCE TO SEE DAVID ON A MORE
PERSONAL LEVEL AS A FATHER AND
TO SEE HOW HE'S RAISED A
DAUGHTER YOU KNOW WHO'S BECOME
REALLY, REALLY SMART AND SHE
TRIED TO--SHE CAME TO ATTEND THE
LASKER AWARDS SYMPOSIUM BUT YOU
KNOW THEY DIDN'T LET HER OUT OF
ORGANIC CHEMISTRY EXAM EVEN
THOUGH HER FATHER WAS WINNING
THE LASKER AWARD AND A RECEPTION
SO IT WAS A RUSH FOR HER HAD GET
THERE BUT THIS HAS BEEN A REAL
PRIVILEGE FOR ME TO WATCH DAVID
BOTH AS AN ACADEMIC AND AS A
PERSON AND WITH THAT, DAVID
WE'RE REALLY EXCITED TO HAVE YOU
HERE, CONGRATULATIONS FOR ALL
YOUR ACCOMPLISHMENTS AND LOOK
FORWARD TO YOUR TALK TODAY.
[ APPLAUSE ]
>> WOW, THANK YOU MIKE, THAT WAS
A WONDERFUL INTRODUCTION I LOVE
ALL YOUR PERSONAL TOUCHES, I
DIDN'T KNOW YOU SAVED ALL THOSE
PICTURES WITH OUR DAUGHTERS
TOGETHER FROM THE HAWAII AND THE
SKI TRIP.
THAT'S REALLY WONDERFUL.
SO I WANT TO THANK NATIONAL EYE
INSTITUTE, DR. MIKE CHANG AND
DR. [INDISCERNIBLE] TO ORGANIZE
THIS SYMPOSIUM.
I'VE BEEN SAVING UP LITTLE
STORIES AND SNIPITS FOR THIS
PRESENTATION AND I HOPE YOU WILL
FIND IT AMAZING ALSO.
SO I WILL TALK ABOUT SEEING
SMALL AND AIMING BIG AT TWEPMENT
AND CLINICAL IMPACT OF OCT AND I
DO HAVE A FINANCIAL INTEREST IN
SOME ASPECTS OF OCT, IT'S LISTED
HERE.
SO 2023 OF COURSE FERS A BANNER
YEAR FOR OCT AND I FOUND
ESPECIALLY GOING TO THE
WHITE HOUSE TO BE QUITE
THRILLING.
PRESIDENT BIDEN WAS VERY QUICK
WITTED AND OBVIOUSLY ENJOYED
BOSSING EVERYONE AROUND, SO I
THINK RUMORS THAT HE'S SLOWING
DOWN IS GREATLY EXAGGERATED AND
I REALLY CREDIT HIM FOR REVIVING
THE NATIONAL MEDALS, AFTER A 6
YEAR HIATUS, I THINK IT SHOWED A
LOT OF RESPECT FOR SCIENCE AND
TECHNOLOGY.
WE CAN THINK OF OCT AS THE
CULMINATION OF MORE THAN A
HUNDRED YEARS OF RESEARCH INTO
USING LIGHT TO MEASURE THE TIME
OF FLIGHT OF LIGHT.
I THINK JIM IN HIS TALK TALKED
ABOUT [INDISCERNIBLE].
BUT MORE RECENTLY WE CAN TRACE
IT TO THE MICHELSON MORALLY
WHERE HE DEVELOPED THIS SPEED OF
LIGHT RELATIVE TO THE MOTION OF
EARTH AND OF COURSE HE FOUND
THAT THE SPEED OF LIGHT DID NOT
CHANGE RELATIVE TO EARTH MOTION
AND THAT SET THE STAGE FOR THE
THEORY OF RELATIVITY AND FOR HIS
NOBEL PRIZE IN 1907.
AND WE USED THE SAME MICHELSON
INTERROMETER BUT NOW WITH SHORT
COHERENCE LENGTH OF LIGHT AND
THAT ALLOWS US TO MEASURE THE
TIME OF LIGHT REFLECTED FROM
TISSUE SAMPLES.
THESE DAYS OFTEN DOWN TO LEVEL
.03 MICROMETERS WHICH WAS EQUIV
LEAPT TO 30 FS ROUND TRIP, AND
OF COURSE TIME CANNOT BE WORTH A
CLOCK OF ANY TYPE SO REALLY ONLY
THE LIGHT IS THE ONLY THING THAT
IS FAST ENOUGH TO MEASURE TIME
OF FLIGHT AT THIS LEVEL.
OCT TARTED IN PROFESSOR
FUJI MOTO'S LAB IN 1990.
SO PROFESSOR FUJIMOTO, GAVE ME
THE INSTRUCTION OF MEASURING THE
THICKNESS OF CORNEA AND RETINA
AND THIS WAS A FS SECOND LASER
LAB SO WE CLEARED A SMALL SPACE
IN THE OPTICS TABLE AND THIS
PHOTOGRAPH SHOWS MY FATHER
VISITING BOSTON AND I WAS
SHOWING HIM MY EXPERIMENTAL SET
UP FOR OCT AND I'M NOT SURE HE
UNDERSTOOD HOW IT WORKED BUT HE
CANNED ME, YOU KNOW WHEN I'M
GOING TO GRADUATE FROM MEDICAL
SCHOOL BECAUSE I WAS TAKING A
VERY LONG TIME.
[LAUGHTER]
AND YOU KNOW I DID NOT HAVE ANY
GOOD ANSWERS.
NEITHER OF US WERE SURE IT WAS
WORTH TAKING EXTRA 4 RESEARCH
YEARS.
BEYOND THE ALREADY LONG SCHOOL
MEDICAL CURRICULUM.
BUT I KNEW I WAS ENJOYING MY
TIME IN THE ULTRA FAST OPTICS
GROUP BECAUSE I WAS LEARNING
FROM VERY SMART PEOPLE AND THEY
WERE TEACHING ME HOW TO NAVIGATE
THIS UNEXPLORED TERRITORY THAT I
WONDERED INTO AND I WAS HAVING A
LOT OF IDEAS AND I WAS IMAGINING
ALL KIND OF THINGS THAT THIS
COULD LEAD TO AND WHAT 1 OF THE
IDEAS WAS OPTIC O ADHERENCE
TOMOGRAPHY.
AND THE IDEA CAME TO ME WHEN I
WAS LOOKING AT THE INTERFERA
METRIC SIGNAL FROM A RETINAL
SAMPLE AND BECAUSE WE HAD VERY
HIGH SENSITIVITY, HUNDRED
DECIBEL, AND RELATIVELY HIGH
RESOLUTION COMPARED TO OTHER
EFFORTS THEN, 10-MICRONS AND
BECAUSE WE WERE PLOTTING THINGS
ON LOGO RHYTHMIC SCALE, I SAW
NOT JUST THE FRONT AND BACK
RETINAL REFLECTIONS WHICH I WAS
KIND OF EXPECTING IN THE
BEGINNING BUT I WAS ALSO SEEING
QUITE A NUMBER OF SIGNAL PEAKS
FROM INSIDE THE RETINA AND OF
COURSE UNDER THE RETINA AND IT
BECOME AN ISSUE LIKE--AT 50 I
THOUGHT OF IT AS A PROBLEM, LIKE
WHICH 2 PEAKS WOULD I PICK TO
MEASURE THE RETINAL THICKNESS
AND THEN MY SECOND THOUGHT WAS,
WELL, IF WE SCAN THE BEAM ACROSS
THE RETINA, THEN I WOULD GET A
PICTURE AND THAT WOULD REVEAL
THAT LAYER STRUCTURE OF THE
RETINA AND THEN MAYBE I COULD
MEASURE THE RETINAL THICKNESS
THAT WAY AND THEN THE THIRD
THOUGHT WAS, IF I COULD GET A
PICTURE OF THE INTERNAL
STRUCTURE OF THE RETINA, THAT
WOULD BE A FREIGHTER DISCOVERY
THAN SIMPLY MEASURING THE
THICKNESS.
SO I WAS VERY EXCITED, I RENTED
JIM'S OFFICE AND BEFORE I GOT
DATA, ASKED FOR SOME
PERMISSION TO BUY A DATA
VISUALIZATION SOFTWARE, IMAGE
RENDERING SOFTWARE SPYGLASS, AND
JIM GRACIOUSLY AGREED TO DO THAT
EVEN THOUGH I DIDN'T HAVE ANY
DATA YET.
AND THAT LED TO THE COLOR SCALE
THAT GAVE OCT IMAGES MORE
PIZAZZ, THAT WAS I STANDARD
SPYDPLASES VISUALIZATION SCHEME
AND OF COURSE IT WORKED OUT, YOU
KNOW WE COULD SEE LAYER
STRUCTURE IN THE RETINA AND THAT
LED TO OUR EFFORT TO DEVELOP OCT
SAY CLINICAL STRUMENT BUT THE
IPT GREATER I SHALL RESULTS
INVITRO WERE PUBLISHED IN
SCIENCE AND DESPITE WHAT
DR. CHANG SAID, I WOULD
ENCOURAGE YOU TO CONTINUE CITING
IT.
[LAUGHTER]
18,000 IS NOT ENOUGH, YOU KNOW,
LET'S SHOOT FOR A BIGGER NUMBER.
BUT I ALSO WANT TO MENTION THAT
DR. JOE SHYOUMAN WERE THERE AT
THE VERY BEGINNING, WHEN WE WERE
DOING ALL THE RETINAL MEASURE
AMS, HE WOULD BRING OVER CALF
EYES AND THEN LATER ON HUMAN
CATAVERRIC EYES AND HE SHOWED ME
HOW TO CUT THE EYEBALL IN HALF
SO WE BEING IMAGE THE RETINA
WITHOUT THE INTERFERENCE OF THE
CO CATARACTS THOO THESE EYES GET
ANDS HE TOLL ME THAT THE RETINAL
STRUCTURES AND HOW TO INTERPRET
THIS INITIAL IMAGE.
AS YOU KNOW, THERE ARE ARTIFACTS
FROM CUTTING THE EYEBALL IN
HALF, YOU GET A RETINAL
DETACHMENT AND YOU KNOW WHAT ALL
THESE STRUCTURES ARE, RETINA,
OPTIC, ET CETERA, SO I OWE JOE A
LOT IN TEACHING ME HOW TO DO THE
EXPERIMENT AND THE EYE
STRUCTURES AND OF COURSE, A LOT
OF OTHER PEOPLE WERE ALSO
INVOLVED.
I DID NOT KNOW THEN, BUT I KNOW
NOW THAT THERE WERE PARALLEL
DEVELOPMENTS IN VIENNA AND THEY
ALSO WERE USING AN INFRANCIS
COLLINS TOM TERTO LOOK AT EYE
STRUCTURES BUT THEIR INITIAL
GOAL WERE DIFFERENT.
THEY WERE MEASURING ACTUAL EYE
LENGTH SO THEY USED A FABRY-PRO
INTERPROMULGATE TERAND THE
HETERODETECTION WHICH I WAS
USING THEY WERE USING AN
INFRARED SCOPE TO VISUALIZE
INTERFERENCE PATTERN BETWEEN THE
CORNEA AND RETINA AND I WOULD
IMAGINE THEY WOULD JUST SEE THIS
IRPT FER ENSEL PATTERN WHEN THE
LIGHT--INTERFERENCE PATTERN WHEN
THE LIGHT FROM THE CORN RAAND
LET WITH THE RETINA INTERFERE.
SO IT'S MORE DIFFICULT THAT YOU
CAN SEE INTURNOVERRAL STRUCTURES
THAT WAY, AND THAT'S WHY THEY
DIDN'T GO TOWARD IMAGING UNTIL
LATER.
SO, YOUR IMPLEMENTATION OF THE
INTERFROM TERDETECTION SYSTEM
AND INITIAL GOAL DOES MATTER.
AND OF YOU COURSE RCT WAS
POSSIBLE ONLY BECAUSE OF
ADVANCES IN OPTICAL TECHNOLOGIES
THAT WERE DEVELOPED FOR OPTIMAL
CHIEWNICATIONS WHICH WAS VERY
HOT THEN IN THE 1980 ANDS THESE
INCLUDED SEMICONDUCTOR
DISCIPLINARIAL, LIGHT SOURCES
AND OPTICAL FIBERS AND I LEARNED
A LOT OF THESE TECHNOLOGIES FROM
ERIC SWANSEN WHO WAS MY GURU IN
THIS AREA.
COME SO ERIC WAS RESPONSIBLE FOR
A LOT OF THE DESIGN MUCH THE
OCT.
HE WAS THE FIRST INVENTOR LISTS
IN OUR PATENT, THE FIRST PATENT
ON OCT, THE 501 PEN WHICH
DESCRIBED THE TIME DOMAIN OCT
THAT BECAME THE BLUEPRINT FOR
THE FIRST 10 YEARS OF OCT, AS
WELL AS WEB-SOURCED OCT ACTUALLY
WHICH WE REALIZED WHEN WE WERE
LOOKING AT THE SPECTRAL PATTERNS
OF THE FIBER OPTIC INIA
FROM--INTEGRATION TOM TERAND
ERIC OF COURSE WAS ALSO
IMPORTANT IN STARTING A ON
COUPLE OF THE IMPORTANT
COMPANIES IN OCT, EVENTS
OPHTHALMIC DEVICES THAT FIRST
TWEPPED COMMERCIAL OPHTHALMIC
OCT AND LIGHT LAB IMAGES THAT
DEVELOPED CARDIOVASCULAR OCT, HE
ALSO CONFOUNDED SYCAMORE AND
ACACIA, WHICH WERE MAJOR PLAYERS
IN HIGH CAPACITY FIBER OPTIC
COMMUNICATIONS.
SO ERIC WAS A VERY PROLIFIC
ENGINEER OF THE FIRST ORDER.
IN THE BEGINNING OCT, WAS A
SOLUTION IN SEARCH OF A PROBLEM
AND WE KNEW THAT IT HAD BETTER
RESOLUTION, 10 TO A HUNDRED
TIMES BETTER THAN EXISTING
TOMOGRAPHIC IMAGING MODALITIES
LIKE ULTRASOUND, MRI, AND CT.
SO NATURALLY, WE THOUGHT THAT WE
SHOULD FOCUS THE INITIAL
RESEARCH AND ALSO
COMMERCIALIZATION EFFORTS ON
SMALL CRITICAL TISSUE STRUCTURES
AND OUR BEST GUESSES WERE THE
RETINA IN THE EYE, AND ALSO,
CORONARY ARTERY PLAQUES, BOTH OF
WHICH WERE PUBLISHED IN OUR
INITIAL SCIENCE PAPER AND THAT
TURNED OUT TO BE A VERY GOOD
GUESS, WHEN WE WERE INVITED TO
WRITE A REVIEW PAPER, 25 YEARS
LATER IN 2016, WE LOOK AT THE
UTILIZATION OF OCT AND INDEED
THOSE WERE THE 2 BIGGEST
APPLICATIONS OPHTHALMIC OCT WAS
BEING PERFORMED THEN, ABOUT
30 MILLION PROCEDURES WORLD WIDE
AND CARDIOVASCULAR, INTRA
VASCULAR OCT, ABOUT A HUNDRED
THOUSAND PROCEDURES PER YEAR, I
THINK EXTRAPOLATING FROM
MEDICAID AND MEDICARE, I THINK
IT'S ABOUT 40 MILLION PROCEDURES
PER YEAR NOW IN THE EYE AND
PROBABLY MUCH HIGHER IN
CARDIOLOGY WHICH HAS SEEN A LOT
OF RECENT GROWTH.
I ALSO WANT TO MENTION JOE
ISWROD AND MICHAEL HEE, WHO PLAY
IMPORTANT ROADS IN DWTMENT OF
THE FIRST OCT SYSTEMS FOR
CLINICAL TODAYS AND AS WE WERE
DISCUSSING YESTERDAY, IT WAS
REALLY IMPORTANT FOR PEOPLE IN
INDUSTRY TO BECOME INTERESTED
AND ENGAGED AND INVEST IN A
TECHNOLOGY FOR IT TO BECOME
AVAILABLE TO CLINICIANS AND I
ESPECIALLY WANT TO THANK JOHN
MOORE, WHO WAS THE PRESIDENT OF
HUMPHREY INSTRUMENT THEN AND
WOULD LATER ON BOTTOM
ZEISS HUMPRY WHEN IT COMBINED
TOGETHER, AND I WANT TO REMEMBER
JOHN CAME OVER AT THE 4 SEASONS
HOTEL FOR A CELEBRATION AND
SOMEHOW I ENDED UP AT A HOT TUB
AT THE 4 SEASONS TALKS TO JOHN
MOORE AND HE WAS EXPRESSING HIS
ENTHUSIASM AND VISION, HE
THOUGHT THAT OCT WAS GOING TO BE
REALLY BIG IN OPHTHALMOLOGY AND
OF COURSE HE WAS CORRECT
ALTHOUGH IT TOOK 10 YEARS AND IT
PROBABLY WASN'T VERY GOOD FOR
HIM.
BUT I THINK THAT HIS VISION
REALLY PLAYED A KEY ROLE IN HOW
FAST OCT WAS ABLE TO GAIN GROUND
IN THE CLINIC.
AND JAY WEI WAS THE FIRST
ENGINEER TO LEAD COMMERCIAL
DEVELOPMENT AND ZEISS HUMPHREY
AND LATER ON HE BECAME THE VEO
OF OPTAVIEW, HIS OWN COMPANY, E
FOUNDED IT.
I WORKED WITH HIM FOR MANY YEARS
AND I ALSO REALLY APPRECIATED
HIS ROLE AND ORIGINAL
CONTRIBUTIONS TO THE
COMMERCIALIZATION AND CLINICAL
USE OF OCT.
THE FIRST OCT SYSTEMS, OCT 1 AND
OCT 2, WERE COME OUT OF HUMPHREY
AND LATER KARL ZEISS METATECH
AND THESE WERE ONLY USED IN
MAJOR EYE CENTERS BECAUSE ONLY A
FEW HUNDRED UNITS WERE SOLD AND
IT--THERE WERE KIND OF PRODUCED
GRAINY SMEARED OUT IMAGES AND I
THINK IT WAS POLARIZING EVEN
AMONG ACADEMIC MEDICINE.
THERE WERE EARLY ADAPTORS WHO
SAW GREAT POTENTIAL OF THIS
TECHNOLOGY AND WORK TO USE IT
AND WRITE ORIGINAL TRANSLATIONAL
ARTICLES IN A NUMBER OF DISEASES
THAT BECAME VERY IMPORTANT.
THAT INCLUDED THE OCT, THAT CAME
OUT IN 1999, AND I WANT TO
MENTION COLLEAGUES HERE, THIS
WAS IMPORTANT IN POPULARIZING
THE KNOWLEDGE OF OCT, TO
CLINICIANS AND THERE ARE OTHER
CLINICIANS WHO SAW THESE IMAGES
AND WERE NOT IMPRESSED BY THEIR
QUALITY AND THOUGHT IT WAS PART
OF AN EVIL SCHEME TO DEMOTOIVATE
YOUNG RESIDENTS, CORRUPT THEM SO
THEY DON'T LEARN THE FINE ART OF
RETINAL EXAM NATION AND OF
COURSE THEY WERE--THEY WERE
RIGHT, ALSO, YOU KNOW, LIKE
DR. MIKE CHANG MENTIONED,
RESIDENTS PROBABLY DON'T DO
NEARLY AS MUCH NOW TO LEARN
DETAILED RETINAL EXAMINATION
WITH A CONTACT LENS AND RELY ON
OCT AND THEY'RE MAKING BETTER
DIAGNOSIS THAN EVER WITH ALL
THESE DIGITAL IMAGING
TECHNOLOGIES BUT I WAS PRES
ABTLY SURPRISED IN 1999 WHEN I
WAS IN FELLOWSHIP TRAINING THERE
WHEN I WENT TO SEE A MOVIE
CALLED ENTRAPMENT WITH SEAN
CONNERY AND KATHRYN ZETA-JONES,
AND THE MOVIE WENT TONIGHT
KUALA LIMPUR, WHERE THERE'S SOME
TOP SECURITY INVOLVED AND
THERE'S AN EYE SCANNER AND SEAN
CONRY SCANS HIS EYE AND OUT POPS
THIS IMAGE OF MACKULAR HOLE, AN
OCT IMAGE WHY WOULD HE HAVE A
MACULAR HOLE, IT DIDN'T MAKE ANY
SENSE BUT I DON'T THINK ANYONE
ELSE IN THE AUDIENCE HAD THE
SAME THOUGHT.
[
[LAUGHTER]
SO WHAT I LEARNED FROM THAT IS
THAT THE TRANSLATIONAL RESEARCH
TAKES A LOT OF EFFORT AND
PERSEVERANCE BUT IS NECESSARY
AND CLINICAL ACCEPTANCE TAKES
TIME AND YOU KNOW IN THE BIG
SCHEME OF THINGS, PROBABLY 10
YEARS WASN'T VERY LONG.
AND NEVER MIND THE DOUBTERS.
AND FOR THE NEXT PART OF THE
STORY, I WANT TO TELL, I WANT TO
GOVERN A HISTORICAL PARALLEL,
120 MILLION YEARS AGO SOME
KARNIVEEROUS WASPS LEARNED TO GO
VEGETARIAN BY SIPPING NECTAR AND
EATING POLLENS AND THESE
PROTOBEES HAD COLOR VISION IN
THE VISIBLE AND UV, AND BECAUSE
OF THAT FLOWERS WHICH NEED BEES
TO POLLENATE WILL BENEFIT FROM
POLLENNATION, DEVELOP DISTINCT
COLORS AND SHAPES TO, ATTRACT
BEES AND THAT LED TO THE
COLORFUL WORLD WE LIVE IN THAT
WE ENJOY AND TOGETHER BEING AND
FLOWERS, FLOWERING PLANTS WERE A
BIG SUCCESS AND THEY SPREAD
THROUGHOUT THE TERRESTRIAL
WORLD.
SO A PARALLEL.
MORE RECENTLY CLEVER RETINA
CLINICIANS, CLINICIAN SCIENTISTS
LEARNED THAT IN NEOVASCULAR AMD
WHEN YOU LOOK AT OCT IMAGING,
YOU CAN SEE NEOVASCULAR MEMBRANE
AND RETINAL FLUID AND THAT IF
YOU INJECT ANTIVASCULAR
ENDOTHELIAL GROWTH FACTOR OR
ANTIVEGF YOU CAN MAKE THIS GO
AWAY.
AND THIS INSIGHT LED TO REALLY A
REVOLUTION IN THE TREATMENT OF
WET AMD WHICH USED TO BE A 1 WAY
STREET TO BLINDNESS BUT NOW CAN
BE MANAGED SUCCESSFULLY FOR A
LONG TIME.
AND THIS SYNERGY AND SUCCESS LED
TO BOTH OCT AND ANTIVEG F
INTROVITRAL TECHNOLOGY WITH
ANTIVEIMRKS F INJECTIONS AND
WITH ABOUT 2 AND HALF MILLION
INYEKSES AND 40 MILLION OCT
PROCEDURES PERFORMED EVERY
YEAR.
SO NOT QUITE AS SUCCESSFUL AS
THE BEES BUT PRETTY GOOD FOR A
HUMAN EFFORT.
AND JUST FOR A SANITY CHECK, I
WASN'T SURE IF I WAS TAKING THIS
UP, IT'S STILL POSSIBLE, I WAS
MAKING IT UP, THATORY BUT I
LOOKED UP THE DEVELOPMENT OF
ANTIVEG F FOR AMD MD AND I FOUNN
THE LITERATURE THEORESOURCESSEN
FELLED, WHICH IS 1 OF THE CLEVER
RETINAL SPECIALISTS WHO PLAYED A
ROLE IN THE DEVELOPMENT OF THIS
NEW TREATMENT, HE SAID IN A 2009
RETINA TODAY BREW, THAT TO FULLY
UNDERSTAND HOW WE ARRIVE AT
INYEKSS BEVACIZUMAB, A TYPE OF
VEGF, TO TREAT WET AMD, 1 MUST
GO BACK TO 2001 WHEN THE
STRATEGIC PLANUS OCT WAS FIRST
INTRODUCED SO HE ATTRIBUTED THE
DEVELOPMENT OF ANTIVEG F WITH
THE INSIGHT AND CLINICAL
VISUALIZATION THAT OCT OFFERED
AND THE STRATEGIC PLANUS OF
COURSE WAS THE OCT SYSTEM THAT
MADE THIS TECHNOLOGY MAIN
STREAM, IT HAD 400 A-SCANS PER
SECOND WHICH IS ENOUGH TO GIVE
US A MEDIUM DEFINITION IMAGE AND
IT'S SO SIMPLE, I THINK JIM SAID
6000 UNIT WHICH IS ENOUGH TO
MAKE IT AVAILABLE TO MOST
OPHTHALMOLOGISTS IN THE U.S. AND
MADE IT A CLINICAL SUCCESS
EMPLOY WE'VE ESTIMATED THAT OCT
GUIDANCE OF THOSE NEEDED ANTIVEG
F INJECTIONS INSTEAD OF REGULAR
MONTHLY INYEKS, SAVE MEDICARE
MORE THAN A BILLION DOLLAR PER
YEAR IN AN ARTICLE THAT WAS
PUBLISHED IN 2018 AND THAT
DWARFS THE AMOUNT OF INVESTMENT
THAT NIH AND OTHER FUNDING
AGENCIES PUT INTO OCT RESEARCH
WHICH WAS ESTIMATED AT 0.4
BILLION.
BUT THAT'S OF COURSE MUCH
APPRECIATED.
OCT IS THE MOST COMMONLY USED
AND COST EFFECTIVE IMAGING
MODALITY IN OPHTHALMOLOGY NOW
EXCEEDING [INDISCERNIBLE]
PHOTOGRAPH SINCE 2002 AND IT'S
ALSO A VERY ECONOMICAL COSTING
$40 FOR BOTH EYES, LESS THAN
EVEN FUNDUS PHOTOGRAPHY, SO BY
2005 OCT WAS MAIN STREAM AND I
WAS AGAIN PRES PLEASANTLY
SURPRISED IN WHEN I WALK INTO
THE PRESIDENT OF OPHTHALMOLOGY
MEETING AND SAW OF ALL THINGS
CORNEAL OCT IMAGES EVERYWHERE,
AND SO I KNEW THAT WE HAD MADE
IT BY THAT TIME.
FOR THE DPLAW COMA SPECIALIST
OUT THERE, OCT IS ALSO USED TO
DETECT AND MANAGE GLAUCOMA BY
IMAGES THE ANTERIOR CHAMBER
ANGLE AND THE OPTICAL IMAGES MIC
NERVE IN THE RETINA BOTH FOR
EARLY DETECTION AND ALSO FOR
MONITORING OVER TIME ANDOSH CT
OVERTOOK VISUAL FIELD AS THE
MOST COMMONLY USED DIAGNOSTIC
MODALITY IN THE FLAW COMA CLINIC
ACCORDING TO THE AMERICAN
ACADEMY OF OPHTHALMOLOGY IRIS
DATABASE, SOMETIMES IN THE
2010S.
AND OF COURSE OCT WAS USED IN
DETERMINING CORNEA THICKNESS AND
MAPS, AND THAT CAN HELP US
RECOGNIZE MANY DISEASES AND OCT
CAN NOW BE USED FOR TOPOGRAPHY
IN ATIGER DATABASE TO PLACEBO
AND [INDISCERNIBLE].
I THINK IT WILL BE USED A LOT
MORE.
WE DEVELOPED OUR OWN TOPOGRAPHY
GROUP IN OUR OWN GROUP AND WE
FOUND IT TO WORK VERY WELL AND
SO HAVE A NUMBER OF COMPANIES
WORLD WIDE AND A COUPLE OF THEM,
AFTER SEVERAL YEARS, DELAY
OBTAIN F, DA CLEARANCE JUST LAST
YEAR SO I EXPECT IT IS USED TO
GROW RAPIDLY IN THE U.S.
OCT ALSO ENABLES VERY PREICIZE
SURGERY.
RETINAL SURGEONS CAN USE THEIR
HAND TO MANIPULATE NEEDLES DOWN
TO THE MICROMETER LEVEL, BUT OF
COURSE THEIR STEREO VISION
DOESN'T HAVE TO PRECISION AND
OCT GIVES SURGEONS THAT
PRECISION SO THAT THEY CAN MAKE
MANEUVERS LIKE SUBRETINAL
LOCATION FLAL INYEKS OF GENE
THERAPY VECTORS.
THIS IS A VIDEO PROVIDED TO ME
BY DR. ANDY LAWER THE DIRECTOR
OF KC INSTITUTE WHO IS ALSO A
GENERAL SURGEON.
HE CAN ALSO DO THIS TYPE IN THE
CORNEA AND THIS IS AN INJECTION
OF AIR BUBBLE IN THE DEEP STROMA
AND DEEP ANTERIOR OF THE
[INDISCERNIBLE] PROVIDED TO ME
AT DR. ANTHONY KUO AT DUKE.
ONE THING THAT DROVE THE
EVOLUTION OF OCT TECHNOLOGY IS
THE GROWTH IN IMAGING SPEED.
THERE'S MOORE'S LAW OF OCT
SPEED, IT DOUBLES ABOUT EVERY 2
AND HALF YEARS AND OF COURSE THE
MOVE TO FOURIER DOMAIN WAS A BIG
PART OF THAT AND THAT ALLOWED US
TO EXTEND OCT TO VOLUMETRIC
IMAGING, A LOT OF PRECISION
MEASUREMENTS AND MOST EXCITINGLY
NOVEL CONTRASTS WHICH I WILL
TALK ABOUT BRIEFLY.
SO THIS VIDEO MADE BY
DR. [INDISCERNIBLE] BEAUTIFULLY
ILTRAITED THE 3 DIMENSIONAL
NATURE OF OCT AT HIGH SPEED.
AND THIS VOLUMEET RICK OCT CAN
BE EXTENDED TO THE PERIPHERAL
RETINA.
WE CAN SEE THE WHOLE RETINA NOW
WITH CUSTOM SYSTEMS AND THESE
ARE IMAGES PRODUCED BY 1 OF OUR
FACULTY IN OUR RESEARCH GROUP,
DR. YIFAN JIAN XTHIS IMAGE CAN
IMAGE OUT TO THE [INDISCERNIBLE]
IN NEONATAL EXAM NATION OF R. O.
P. AND HAD IS A VIDEO SHOWING
DR. P. CAMPBELL PERFORMING
THIS IMAGING PROCEDURE.
AND THIS WAS DONE IN THE NICU,
NEONATAL INTENSIVE CARE UNIT AND
OF COURSE HE AN NONSPECIFIC SIDE
EFFECTS THEY--THEITIZED THE EYE
AND THIS CAN BE--THIS IS DONE
WITH DILATION BUT WOULD ACTUALLY
FIT INTO A SMALL PUPIL AND SINCE
THIS IS AN INFANT RED, IT
DOESN'T FRAZZLE THE INFANT, IT
ONLY TAKES SEVERAL SECONDS, THE
WAY PETE DOES IT SO HE ACTUALLY
DOES THIS CLINICALLY INSTEAD OF
IN DIRECT.
OCT ANG YOAGRAPHY IS PROBABLY
THE MOST IMPORTANT EXTENSION OF
OCT IN THE PAST 10 YEARS.
IT'S ALSO 3 DIMENSIONAL AND IT
MAPS PLUS CELL MOTION IN THE
RETINA WHICH PRODUCES
FLUCTUATION, CHANGES IN THE OCT
SIGNATURES --SIGNAL THAT CAN BE
DETECTED WITH VARIOUS AG GOR
RHYTHMS.
AGAIN, A BEAUTIFUL VIEDMAN YE
MADE BY DR. JIA, OUR
CONTRIBUTION TO OCT ANGIOGRAPHY
INCLUDED THE DEVELOPMENT OF A
ALGORITHM CALLED SPLIT SPECTRUM
AMP LIAISONITUTE DECORALATION
ANGIOGRAPHY OR SSADA, AND IT'S
BASED ON THE INSIGHT THAT OCT
ANGIOGRAPHY CAN BE MADE BY
DETECTING SPECKLES DECORALATION
AND SPECKLED PATTERNS CHANGE AT
DIFFERENT WAVE LENGTH SO BY
SPLITTING THE SPECTRUM, YOU CAN
INCREASE THE NUMBER OF EFFECTIVE
IMAGE FRAMES SEVERAL TIMES AFTER
11 FOLD, WITHOUT INCREASE IN
SKIN TIMES SO IT'S VERY
EFFICIENT AND YOU ONLY NEED A
COUPLE OF THESE SCANS TO COMPUTE
A REASONABLE ANGIOGRAPHY WITH
SSADA AND IT REPRESENTS A 4 FOLD
INCREASE IN FLOW SIGNAL TO NOISE
RATIO.
WE ALSO DEVELOPED A WAY TO--AN
ALGORITHM TO RESULT AMBIGUITY
BETWEEN PROJECTIVE FLOW AND
INSITU FLOW AND THE PROJECTION
FLOW OF AN GIVING--YOUOGRAPHY
ALLOWS US TO VISUALIZE FOR
PLEXUSS IN THE RETINA, WHICH IS
AMAZING WHEN YOU THINK ABOUT IT,
IT'S ONLY A COUPLE HUNDRED
MICRON THICK STRUCTURE AND
PLEXUS SPECIFIC PATHOLOGIES CAN
BE VISUALIZED THIS WAY.
SO, IF YOU FOCUS ON THE NERVE
FIBER OF PLEXUS, YOU CAN DETECT
OPTICAL IMAGES MIC NERVE DISEASE
LIKE GLAUCOMA WITH HIGH
ACCURACY.
OT OTHER SIDE OF THE SPECTRUM,
RETINAL LOCATION NIGHTIS
PIGMENTOSA ASHING THE DEEP
RETINAL STRUCTURES AND THAT
LEADS TO DEEP CAPILLARY FLEXUS
ATROPHY WITHOUT AFFECTING THE
OTHER PLEXUS AS MUCH.
RETINAL VASCULAR DISEASE IS LIKE
DIABETIC RETINAL LOCATION NUMBER
OF PATIENTSATHY AFFECTS ALL
RETINAL PLEXUSS AND OF COURSE WE
CAN ALSO DETECT AND CLASSIFY
CORNEAL VASCULARIZATION VERY
WELL WITH OCT AND GEOGRAPHY.
SO IN THE INTEREST OF TIME, I
WILL SKIP OVER THIS.
OCT CAN ALSO SEE GREAT DETAIL AS
WE'VE SEEN YESTERDAY.
IN MY RESEARCH DPROWP WE HAVE
TRIED--GROUP, WE HAVE TRIED BLUE
LIGHT OCT MICROSCOPY THAT CAN
VISUALIZE CELLS IN THE CORNEA AS
WELL AS MICROBES AND I'M HOPEFUL
THAT THIS WILL ALLOW US TO SEE
INFECT YOWZ KEROTIGHT ISOTOPE IN
THE CLINIC IN A NONEVASIVE,
NONCONTACT FASHION.
IESM ALSO VERY EXCITED ABOUT I
OPTICAL IMAGES O RETINAL
LOCATION NOGRAPHY, EXTENDING
AGAIN FROM STRUCTURE TO
FUNCTION.
WE ARE ALSO INVESTIGATING THIS
BASED ON ULTRA HIGH RESOLUTION
OCT WITHOUT AO TO LOOK AT
CHANGES IN THE PHOTO RECEPTOR SO
THAT WHEN WE STIMULATE THE
RETINA, WE CAN SEE, THE MAP, THE
PHOTO AREY SEPTORSOR, LIGHT
RESPONSE, WE TURN TO OUR OLD
TRICK, SPLIT SPECTRUM AND WE
HAVE AN EFFICIENT ALGORITHM THAT
WILL IMPROVE THE SIGNAL TO NOISE
RATIO OF OPTICAL IMAGES O
RETINAL LOCATION NOGRAPHY AND
THIS ALLOWS US TO IMAGE A LARGER
AREA, LIKE 3 BY 3 AREA IN A
MONTAGE OF 3, 2.5 SECOND SCANS
AND ALLOWS US TO AMRI TO
CLINICAL DISEASES SUCH AS
RETINAL DEGENERATIONS AND AMD.
SO WE CAN SEE A LOT OF THINGS
WITH OCT IMAGING NOW, NOT JUST A
CLASSIC STRUCTURE, STRUCTURAL
MEASURES, LIKE THICKNESS, EDEMA
AND ATROPHY, BUT ALL PRORIFFERAL
RETINA, MICROBES,
NEOVASCULARRIZATION, ISCHEMIA,
AND PHOTO REPRESENT ISOR
FUNCTION, AND I TRULY BELIEVE IF
WE SEE THE DEC, WE CAN TREAT IT
WITH VEG F AND WE CAN DO THAT
WITHIN OUR LIFETIME, WE DON'T
HAVE TO WAIT MILLIONS OF YEARS
LIKE THE BEES TO AFFECT THE
WORLD.
AND I'M VERY EXCITED BY THE
POSSIBILITY OF OCUE LOAMICS AND
2 THINGS THEY THINK WILL MAKE
IMPACT, 1 IS DOPPLER OCT TO LOOK
AT RETINAL BLOOD FLOW AND THE
WAVE FORM THAT WOULD REVEAL
HEMODYNAMICS IN THE CAROTID AND
AORTIC VALVE, AND ALSO OCT
ANGIOGRAPHY, WE PERFORMED SOME
PRELIMINARY TODAYS WITH
NEUROLOGY COLLEAGUES AND FOUND
THAT THE PROFUSION LOSS HAVE
CHARACTERISTIC PATTERNS IN TBRAW
COMA, MULTIPLE SCLEROSIS,
ALZHEIMERS DEMENTIA AND THESE
COULD BEING DIFFERENTIATED OR
DETECTED WITH HIGH SPECIFICITY
WITH THIS TYPE OF ANALYSIS, AND
OF COURSE, WE CAN GO BEYOND THE
EYE NOW THAT WEB CONNECTED HAVE
HIGH SPEED, VERY HIGH SPEED OCT,
WE CAN EXTEND THE RESOLUTION TO
MUCH WIDER AREA SUITABLE FOR
IMAGING HEART, SKIN, DIGESTIVE
TRACT, MIDDLE EAR, BRAIN, TEETH
AND A LOT OF OTHER STRUCTURES.
SO I WOULD LIKE TO ACKNOWLEDGE
THE SUPPORT OF NEI, RPB, AND
THIS IS OUR RESEARCH GROUP, THE
CENTER FOR OPHTHALMIC OPTICS AND
LASERS AT OREGON HEALTH AND
SCIENCE UNIVERSITY AND PLEASE
VISITING THE OUR WEBSITE
COOLLAB.NET.
THANK YOU.
[ APPLAUSE ]
>> IN THE INTEREST OF TIME, CAN
WE HAVE 1 QUICK QUESTION.
WE HAVE TO BE OUT OF THIS ROOM
BY NOON.
>> SORRY ABOUT THAT.
>> [INDISCERNIBLE]
>> YES, WITH OCT ANGIOGRAPHY, WE
CAN SEE CAPILLARIES VERY WELL
AND LOOK AT THE CHANGE IN
CAPILLARY DENSITY AND ALSO IN
SOME DISEASES, IT'S BETTER, EVEN
BETTER AT DETECTING PATCHES
WHERE THERE CAPILLARY DROP OUT
AND THAT'S A POWERFUL
DIAGNOSTIC.
>> [INDISCERNIBLE]
>> YES, WE CAN MONITOR THAT.
>> HOW MANY?
>> YES.
>> WELL, I THINK YOU WOULD HAVE
TO LOOK AT SPECIFIC DEC IN
PUBLICATIONS, BUT YOU CAN
MEASURE AREA DENSITY OR LINE
DENSITY AND WE CAN DISCUSS THAT
OFFLINE SINCE IT'S A COMPLICATED
TOPIC.
THANKS.
[ APPLAUSE ]
>> OKAY, WE WILL GET ON WITH THE
FIRST SESSION OF THE MORPING
CLINICAL APPLICATIONS AND THIS
SESSION WILL BE MODERATED BY
DR. AMANI, FAWZI FROM
NORTHWESTERN UNIVERSITY.
>> THANK YOU DAVID AND THANK TO
YOU THE ORGANIZERS AND DAVID AND
PROFESSOR FUJIMOTOFOR BRINGING
THIS ALL HERE.
THIS SESSION IS REALLY WHO'S WHO
IN PIONEERING CLINICAL
APPLICATIONS SO THEY'RE ALL
CLINICIAN SCIENTISTS, THEY'RE
ALL SURGEONS, THEY'RE ALL
AMAZING, FIERCE, BRILLIANT AND
EACH OF THEM PYONORRED AN
INTEREST IN THEIR FIELD AND THEY
PUSHED THE BOUNDARIES FOR ALL OF
US CLINICIANS ISSUES THE FIRST
OF SUCH PIONEERS AND DR. CYNTHIA
TOTH, WORKS AT DUKE.
SHE BROUGHT THE FIRST OCT TO
DUKE, STARTED THE READING CENTER
AND HAS BEEN WORKING WITH JOE
IZAT, IN BRINGING APPLICATIONS
LIKE INTEROPERATIVE OCT AND
PERFIRST BABY AND BRINGING OCT
TO BABIES WHO CAN'T SIT UP AT
THE [INDISCERNIBLE] AND I LOOK
FORWARD TO YOUR TALK CYNTHIA,
THANK YOU.
>> THANK YOU AMANI.
I THINK THIS IS 1 OF THE MOST
SPECIAL PLACES OR SITUATIONS IN
WHICH I'VE I'VE BEEN ABLE TO
TALK AND TO REALLY TALK ABOUT
BEING ABLE TO BE AROUND BEFORE
OCT AND TO ACTUALLY SEE THE
IMPACT IT HAD AS OPPOSE TO THOSE
WHO'VE GROWN UP WITH OCT
AVAILABLE AT OUR FINGERTIPS IN
CLINICS.
WITH A WAY TO APPLY IT IN HOW WE
TREAT HUMAN ANDS SALVAGE VISION
EMPLOY SO I WILL TALK ABOUT
APPLICATIONS IN BREAKING
BARRIERS IN OCT.
DUKE UNIVERSITY HAS GIVEN ME
TIME AWAY FROM DUKE SO I SPENT
TIME WORKING WITH THE IMAGING,
DEVELOPINGNYONATAL OCT IMAGING,
AND I ALSO HAVE GRANTS AND
ROYALTIES AND STUFF, I'M GOING
TO TALK ABOUT INVESTIGATIONAL
DEVICES.
ALL OF THESE ARE NOT FDA CLEARED
THE INVESTIGATIONAL 1S WILL BE
IDENTIFIED AS SUCH, THESE ARE
USED UNDER IRB PROTOCOL ANDS
PATIENTS AND PAMLYS HAVE GIVEN
WRITTEN APPROVAL OF ANY IMAGES
IN THIS TALK EMPLOY I FIRST WANT
TO ACKNOWLEDGE THE BABY STEPS
TEAM, WE TARTED 8 YEARS AGO WITH
THE STUDY OF EYE BRAIN
DEVELOPMENT IN PRETERM INFANTS.
THIS IS MY RO-1 THAT IS
CONTINUING ON IN A GROUP.
I STARTED IT WITH MAURI
OSHEROFFINE MC GUIRE, DURING THE
CAT TRIAL, I WAS THE OCT GRADER
FOR THAT AND SHE HELPED US GET
OFF THE GROUND BUT IT WAS
REALLYIO IZAT AND THE ENGINEERS
THAT DEVELOPED THE SYSTEMS THAT
ALLOWED US TO DO IT.
I'VE HAD OTHER RESEARCH SUPPORT
OUT OF NIH AS WELL, BUT I WANT
TO THANK CHRISTIAN VEELAN, AND
[INDISCERNIBLE] THESE 2
BIOMEDICAL ENGINEER WHOG BOTH
TRAINED AT DUKE BUT WHO HAVE
GONE ON AND MADE THE INSTRUMENT
OF MY DREAMS A SWEPT SOURCE HAND
HELD OCT FOR HUMAN USE AND I
WANT TO RECOGNIZE NIH WHO
THROUGH SBIR HAS HELPED US
TRANSLATE FROM THE RESEARCH LAB
INTO HUMANS.
SO I WAS FORTUNATE TO BE
STANDING AROUND IN A SECOND
LASER ACT AND WE WERE LOOKING AT
LASER WITH TISSUE AND JIM
FUJIMOTOSHOWED UP WITH
COLLEAGUES, AND PAT ROACH WAS
RUNNING THE PROJECT, WE WERE
LOOKINGA THE LASER INTERACTION
IN THE RETINA TRYING TO DEVELOP
SAFETY PROTOCOLS.
I WAS FORTUNATE ENOUGH, I WAS
THE OPHTHALMOLOGIST ON THE TEAM
SO WE WROTE UP OUR STUDIES OF
OCT MORPHOLOGY AND LIVING
TISSUES ISSUES THIS WAS IN
LIVING PRIMATE EYE, NOT IN DEAD
EYE, BUT I WAS HOOKED BECAUSE MY
FIRST EXPOSURE TO OCT WAS INTRA
OPERATIVE USE.
SO THERE WE WERE SHOOTING A
LASER AT THE RETINA AND WATCHING
FROM BASE LINE 13-SECONDS LATER,
THE AND 18 MINUTES LATER, THE
LASER LESION PLOOMING IN LIVING
TISSUE AS WE WERE TREATING.
AND THAT WAS LIKE--THAT CHANGED
MY LIFE.
I HAVE NO ENGINEERING
BACKGROUND.
I AM JUST A VERY FORTUNATE
PURPOSE WHO RECOGNIZES AND LOVES
THIS TECHNOLOGY THAT WE'VE BEEN
HANDED.
SO WE HAD JOE IZAT CAME TO DUKE
IN 2001, HE DEVELOPED A HANDLE
OCT AND THIS WAS BEING USED FOR
ANIMAL RESEARCH.
THEY ALSO HAD A TABLE TOP UNIT
THAT GAVE US ACCESS TO THE RAW
OCT DATA SO I COULDN'T GO TO ANY
OF THE OTHER INDUSTRIAL SYSTEMS
AND GET OUT THE RAW OCT SCANS,
WE COULD WITH THIS AND WE USED
IT IN THE ANCILLARY STUDY, EMILY
[INDISCERNIBLE] ALLOWED US TO
PARTNER AT 4 OF THE SITES AND
GENENTECH AND OPTICAL IMAGES GEN
ALLOWED US TO DO THIS.
SO HERE WE WERE EXAMINING THE
[INDISCERNIBLE] AND YOU HEARD
ABOUT A LOT OF THIS YESTERDAY,
THAT LED UP TO DEEP LEARNING
ALGORITHMS, ET CETERA AND OUR
LAB IS CONTINUING THAT WORK.
AT THE SAME TIMEIO WAS
DEVELOPING WITH US HIGH SPEED
OCT, SO THE SPECTRAL DOMAIN AND
SWEPT SOURCE ALOUD US TO BRING
OCT 3D IN THE O. R. IN REALTIME
AND THIS WAS 4 D.
THIS WAS 1 OF OUR PET PROGECS
FROM THE BEGINNING WAS TRYING TO
DO INTERRAOPERATIVE OCT, MANY
FAILURES EARLY ON BUT IT HASS
BEEN A FANTASTIC RIDE.
BUT I'M NOT TALKING ABOUT
INTEROPERATIVE OCT TODAY, I'M
GOING TO TALK ABOUT GOING BACK
TO THE NURSERY AND THERE WE WERE
USING THE TECHNIQUES OF HAND
HELDS AND SCAPENS WITH THE
INDIRECT LIGHT SHINING INTO THE
CHILD'S LIGHT, ANYONE WHO'S HAD
AN EYE EXAMINE KNOWS.
AND IN FACT, RECEIPTLY A TBROWP
OF PEOPLE DID ROP EXAMS ON EACH
OTHER LIKE THEY WOULD DO ON THE
INFANTS WHILE THEY SAID THE LID
SPEC LUMAND THE LENS IS MILD,
THE RETINAL PHOTOGRAPHY IS
INTENSE AND AMPLIFIES THE IMPACT
OF THE DEPRESSION EMPLOY IT WAS
THAT SAME SPEED THAT ALLOWED US
TO DO INTEROPERATIVE OCT THAT
ALLOWED US TO GO TO SKIDS
BECAUSE A SINGLE SLICE WOULD NOT
TELL US WHETHER WE HAD AN
INHERITED DEC, THIS WAS A KID
WITH HER MANS SKI SIN TROAM OR
WHETHER YOU COULD DO A STRAIGHT
LINE SCAN.
I LOVE THE NIH LOGO WITH THE ARK
ASK IMAGES AND IT SHOWS THE HEAD
AND THE CHIN WITH THE CHIN REST,
THERE ARE A LOT OF PEOPLE WHO
CAN'T, INFANTS, CHILDREN AND
THOSE THAT CAN'T COOPERATE, MY
GOAL IS TO GET THEM ACCESS THAT
WE USE IN PATE WHO IS CAPTAIN
COOPERATE.
SO WE STARTED USING THE ARMATURE
SYSTEM, GOT RID OF QUICKLY AND
BY 2012 THE FDA APPROVED BI
OPTICAL IMAGES GEN IN KIDS AND
NEOINATES AND WE WENT ON TOIO
AND HIS STUDENTS, DEVELOPED
MULTIPLE SWEPT SOURCE SYSTEMS
THAT WENT FROM 100 UP TO 400
KILOHERTZ AND WE NOW HAVE A 1.6
KILOHERTZ SYSTEM.
WE'VE BEEN USING THIS THEN IN
THE BABY STEP STUDY AND THIS IS
SHOWING THE 400 KILOHERTZ
SYSTEM, AND BABY STEPS TARTED 8
YEARS AGO TO CHARACTERIZE FROM
BEDSIDE OCT IMAGING, EARLY
INDICATORS OF ON R. O. P., POOR
BRAIN VISION, ABNORMALITIES AND
POOR NEUROLOGICAL DEVELOP AM AND
SO WEB CONNECTED ENROLLED, WE
GOT HEALTH DATA, OCT, THE EXAM,
MRI IN A SELECT GROUP, VISUAL
ACUITY AND NEURAL DEVELOPMENT.
THEN IN BABY STEPS 2, NOT ONLY
ARE WE ENROLLING A SECOND
COHORT, SO WE HAVE ENOUGH TO GO
ON TO R. O. P., WE'RE ALSO
FOLLOWING THEM UP TO 5 YEARS.
SO 118 INFANTS ENROLLED IN THE
FIRST GROUP.
102 IMAGED FOVIA SUCCESSFULLY
CAPTURED, RETINAL THICKNESS
CAPTURED.
WHY DO I THINK THIS WILL BE A
BREAK THROUGH IN PEDIATRICS,
BECAUSE THE STRESS IN THE
NURSERY AND THE CHILDREN EXPOSED
TO THE FREIGHTEST LEVEL OF PAIN
AND STRESS HAVE HIGH CORTISOL
LEVELS AND AIVETTED HYPER
THALAMIC PITUE TARY ADRENAL
ACCESS THAT RELATES TO THEIR
BEHAVIOR.
SO WE DID A STRESS STUDY, WE
COMPARED OCT TO THE INDIRECT
OPERATING GLOBALLY THAT WILL MA
SCOPE EARLY, LATE, THE WHITE
BARS ARE THE OCT, NO CHANGE IN
STRESS BEHAVIOR.
THE RED BARS ARE FACIAL
EXPRESSION CHANGE AND CRYING
SEVERITY CHANGE IN A SERIES AND
THIS WAS CAPTURED BY A SEPARATE
INDIVIDUAL, NOT THE PEOPLE DOING
THE OCT OR INCORRECT EXAMS, WE
HAVE NURSES DOING THAT NOW FOR
OCT AND RETCAM STUDY EMPLOY AS
HAS BEEN SHOWN WITH THE EYE CROP
TBROWP, ET CETERA, OCT HELPS US
IDENTIFY IS IT A 4 YEAR, 5 YEAR,
IS THERE A PHOBIA, BUT CHEN HAS
REALLY LOOKED AT WORKING ON
NEUROVASCULAR DEVELOP AM, WE CAN
VISUALIZE THE VASCULAR,
AVASCULAR JUNCTION OTHERS
CATEGORIZE IT AND BECAUSE OF
OTA, WITH OUR SPEED WERE ABLE TO
OBTAIN WITH THE SYSTEM, WE CAN
SEE THE SHEETS OFNY O
VASCULARIZATION BUT AS SHE JUST
REPORTED THIS YEAR, WE CAN SEE
THE SPLITTING OF CAP NORMAL
VASCULAR DEVELOPMENT SPLIT
BETWEEN THE NERVE FIBER MEMBRANE
AND LIMITING BEFORE IN THE TOP
MIDDLE WHERE THE PHOBIA AND THEN
AFTER AND HAD IS FOLLOWING THE
SAME CHILD SEQUENTIALLY WEEK TO
WEEK AS THESE BUDS DEVELOP.
WE CAN SEE RESPONSE TO ANTIVEG F
THR ACTIVITIES ACTIVITIES AND
PROJECTS--THERAPY AND THE DEC
EMPLOY WITH THE WAY OF SHADOWING
THE VIEW, A WAY OF PROCESSING
THE OCT, WE CAN EXTRACT A HIGH
CONTRAST RETINAL VASCULAR VIEW
WHICH IS USEFUL BY CLINICIANS,
COMPARING 1 TO ANOTHER THAT THEY
CAN DETERMINE THE RELATIVE
SEVERITY RANKING OF THE R. O. P.
WITH GOOD AGREEMENT AND R. O. P.
TOOL, 1 OF THE EARLY COMPUTER
ASSISTED ANALYSIS TOOLINGS IS
ALSO APPLICABLE TO OCT IMAGES.
PETE CAMPBELL AND MICHAEL CHANG
AND THE IROP TBROWP --GROUP HAVE
SHOWN WITH THE COLOR PHOTO, YOU
WILL HAVE THE CHALLENGE OF THE
HAYES AND PERIPHERY AND
PREDICTIONS AND IT DOESN'T HAVE
THE COLORING IN THE WINDOW HAS
THAT REMOVES THESE REFLECTIONS.
SO WITH COLOR PHOTO THEY CAN
SKELETONIZE AND BIENARRIZE AND
EXTRACT THE VESSEL TRACINGS,
FEATURES AND IDENTIFY A SEVERITY
SCORE, OCT ADDS THE THIRD
DIMENSION, SO NOT ONLY DO WE
HAVE THE VESSEL INFORMATION ON
FOS, WE HAVE THE THICKNESS AND
NOTE THAT PLUS DEC, RETINAL
VESSEL IS NOT JUST LATERAL,
IT'SAXIAL SO WE CAN SEE THE
VESSELS BULGING OUT OF THE
RETINA IN ADDITION TO THE
NEOVASCULARRIZATION THAT WE SEE
UP IN THE CORNER, SO OCT IS
LIKELY TO BE USEFUL IN THE
FUTURE OF R. O. P. KREENING.
LOW INFANT STRESS, INFRAREDS THE
CHILD DOESN'T SEE THE LIGHT,
FUNGUS INDEPENDENT, IT RECORDS
RECORDING FOR SCREENING AND
MANAGE AM, THERE'S HIGH POSITION
AGREEMENT ON VASCULAR SEVERE
MITRAL IRITY AND IT CAN FEED
INTO AI ANALYSIS FOR SESEVERE
MITRAL ERITY.
BUT I FEEL LIKE A GINSU KNIVES
COMMERCIAL, BECAUSE I'M INTO
THIS IF YOU VBT GOTTEN IT.
THERE'S MORE EMPLOY SO AT SCHOOL
INCAS WHEN WE EXAMINE PEOPLE WHO
WERE BORN PRETERM THAT THEIR
PHOBIAS ARE OFTEN ABNORMAL.
THEY HAVE PERSISTENCE OF THE
RETINAL VASCULAR LAYERS AND
INE-PRESCRIBING LAYERS, WHEN
DOES THAT OCCUR?
WE FOUND THAT AT 36 WEEKS,
POORER FOVEALL DEVELOPMENT WITH
LOWER GA.
THEY SAW HA AND RECOGNIZED THAT
FOVEALL WAS ARRESTED EARLIER IN
THE KIDS BORN PRETERM.
NOT ONLY THAT BUT IT IS EXISTING
WITH R. O. P. STAGE, BUT NOT
WITH THE + DEC, WITH OCT,
REMEMBER WE WERE TALKING ABOUT
THIS OXYGEN SINK AND SUPPLY, SO
NOW WE'RE NOT JUST LOOKING AT
RETINAL VASCULATURE, NOW WOE
FOLLOW THE CHOROID IN THESE
CHILDREN, THIS IS ACROSS THE
CENTRAL MACULAR, DON'T ASK ME
ABOUT MACULAR EDEMA, WE DIDN'T
KNOW WHAT'S GOING ON, THINKING
IT'S AN IMBALANCE THE RETINA IS
TWEPPING NOT RELATE OFFICE OF
DIVERSITY R. O. P.
OF THE INFANTS YOU CAN SEE THE
TRANSITION ZONE AT 39 WEEKS, SO
CHOROID INCREASES IN THICKNESS
AND STABILIZES OFF LATER IN LIFE
AND IT'S DELAYED AND LOWER IN
FROAGHT IN KIDS THAT ARE XREAMLY
LOW BIRTH WAY AND AGE, CORROIDAL
CHANGES THERE'S THINNING IS
ASSOCIATE WIDE PLUS DEC BUT NOT
WITH STAGE OF R. O. P. WITH
MACULAR EDEMA.
SO UNRELATED BUT NOW WE STARTED
LOOKING AT STEROIDAL FACTORS AND
THE FIBROID, UNLIKE WHAT I WAS
TALKING ABOUT AND OTHER RETINAL
CHANGES, THE CHOROID PULL MONEY
LINKED TO THE DECS IN THE KIDS.
YOU CAN SEE IN THE BLUE, THAT'S
DISPLASSIA, PIE, ONOXIEN AT 36
WEEKS OR AT THE TIME OF THE OCT
IMAGING.
AND WITH LOWER GROWTH VELOCITY,
SO ALL OF THESE ARE LINKED TO
THE THINNER CHOROID.
SO NOW WE SWITCH FROM CHOROID,
THAT'S JUST THE BEGINNING.
BIRTH WAY IS PREDICTIVE OF NERVE
FIBER LAYER ON THE LEFT, EVERY
250-GRAM INCREASE IN A CHILD'S
BIRTH WAY IS SOCIETIED WITH A
LITTLE OVER A 5-MICRON INCREASE
IN THE RML THICKNESS SO THIS MAY
BE REFRECTING INUTERO
DEVELOPMENT AND POSSIBLY INJURY,
REMEMBER WE'RE NOT LOOKING AT
THESE KIDS IMMEDIATELY AFTER
BIRTH, WE SEE THEM AFTER THEY
REACH ABOUT 30 WEEKS
GUESTATIONAL OF POST MENSTRUAL
AGE.
MANY OF THEM ARE BORN A MONTH,
TO A MONTH AND A HALF BEFORE.
WE ALSO CAN FOLLOW INTERESTING
BI PHASIC CHANGE IN THE BIRTH
AND UP SLOPE AND DOWN SLOPE
WHICH WE OFTEN LEARNED ABOUT AS
THERE'S QUOTE PRUNING GOING ON
IN THE RNFL AND SO WE CAN SEE
THESE CHANGES IN OUR KIDS AS WE
FOLLOW THROUGH A LARGE COHORT.
THE KIDS THAT HAVE SEPSIS AND
NECK ROUGH ATOMITIZING
INTERCOLITIS, THIS IS
INDEPENDENTLY SOC WIDE THE
THINNER RETINAL NERVE FIBER
LAYER EMPLOY SO WE HAVE A LOT OF
CONFOUNDING FACERS.
WE HAVE THE LOW BIRTH RATE, R.
O. P. HAS AN IMPACT AND THEN
ESPECIALLY WE HAVE SEPSIS
INTERCOLITIS WITH RNFL.
SO IN STUDIES IN SWEDEN, KOREA
AND LOS ANGELES, THESE ARE ALL
2018 AND AFTERWARDS THEY HAVE
ALL SHOWN THAT THE
NEURODEVELOPMENT FOR INFANT
SCREEN IS LOW, THAT IS LOWER
THAN THE OTHER PRETERM
POPULATION AND LOWER CERTAINLY
THAN TERM.
SO THESE TESTS OF
NEURODEVELOPMENT ARE NORMALIZED
AT 100 AND SO YOU CAN SEE THE
LOW SCORES ACROSS THE BOARD FOR
THESE.
SO WE STUDIED 2 YEAR
NEURODEVELOPMENTAL OUTCOME ANDS
FOUND THAT THEIR TBRAITER NERVE
FIBER LAYER THICKNESS, EVERY
10-MICRON OF INCREASE IS
ASSOCIATE WIDE A 7-POINT OR
GREATER HIGHER MOTOR SCORE AND
HIGHER COGNITIVE SCORES.
IN ADDITION WE FOUND, ALTHOUGH
IT WAS A SMALL NUMBER OF
PATIENTS, A LOWER AUTISM RISK
SCORE.
WE ALSO CORRECTED FOR
GESTATIONAL AGE AND MOTHERS
EDUCATIONAL LEVEL, TRYING TO PUT
IN SOME FACTOR THAT ALLOWS FOR
SOCIOECONOMIC AND IT STILL ENDS
UP HOLDING UP AS A PREDICTER
EMPLOY SO NOW WE'RE LOOKING IN
THE NURSERY BEFORE THE TIME THE
CHILD SHOULD HAVE BEEN BORN, I
CAN LOOK AT THE NERVE FIBER
LAYER AND GIVE YOU A FACTOR THAT
YOU CAN NOW FOLLOW IN THIS
CHILD, AND THAT RELATES TO THEIR
NEURODEVELOPMENT.
IN ADDITION IT ALSO RELATES
GREATER RNFL THICKNESS WITH
BETTER VISUAL ACUITY OUT COMES
BY THE VISUAL CUITY AT 9 MONTHS.
FIVE YEAR DATA YET TO COME.
WHY DOES THIS MATTER IN I WAS
EXCITED ABOUT THE FINDING WE
FOWBD WITH ROTHMAN IN 2015, WE
USED A DEFICIENT HANDLE OCT
SYSTEM, AND IT WAS IN A
DIFFERENT GROUP OF INFANTS SO WE
ALSO FOUND INCREASED COGNITIVE
AND MOTOR WITH INCREASED RNFL
THICKNESS.
WE WENT TO LOOK FOR THEM, SINCE
WE HAVE A SYSTEM THAT'S USE
INDEED INFRARED, IT DOESN'T
CONFRICT THE PUPIL, THERE'S NO
VISIBLE LIGHT.
WE TOOK IT TO INFANTS WITH
HIPOXIC ISOTOPE CHEEMIC INSEVERE
MITRAL LOP RAGHTY.
TO LOOK AT IS THERE RETINAL
LOCATION NUMBER OF PATIENTSATHY
IN MOST PEOPLE DON'T DILATE THE
PUPILS BECAUSE THESE KID ARE IN
SEIZURE WATCH, AND WHAT DID WE
FIND THAT WAS PRESENT?
RNFL WAS PRESENT 1 AND HALF DAYS
AFTER BIRTH, SO IS SOME OF THIS
MORE CHRONIC IN UTERO IN
CHILDREN, RATHER THAN ACUTE RIKE
AN UMBILLICICAL CHORD AROUND THE
NECK.
SO WE ALSO FOUND ACUTE RETINAL
LOCATION NUMBER OF PATIENTSATHY
WITH A CHILD WITH SMALL CHANGES
IN THE BRAIN.
SO HANDLE OCT GIVES INSIGHT BO
DEPRIVATIONMENT, MALDEVELOPMENT
DISEASE AND INJURY OF THE
RETINAL LOCATION MA AND SOME OF
IT IS ASSOCIATE WIDE
NEURODEVELOPMENT.
THE WORLD OF R. O. P. HAS
CHANGED SINCE 2007 SINCE WE
STARRED ANTIVEG F ECTENDED THE
RISK PERIOD FOR RECURRENCE AND
THIS HAS INCREASED THE BURDEN
AND DURATION OF MONITORING AND
THERE ARE MULTIPLE THERAPIES
UNDER EVALUATION, I THINK A
PERIPHERAL VIEW MAY BE NEEDED,
RETINAL LOCATION CAM I SHOWED
YOU HAS THE PROBLEM, OCT CAN GET
AROUND THAT SO THEA IMAGING
STARTED BY CHRISTIAN VELAND,
[INDISCERNIBLE] AND MYSELF, OUR
KNOLL IS TO MAKE IMAGING
DISCIPLINARY NAG NUMBER OF
THETICS TO POPULATIONS UNABLE TO
ACCESS THE CONVENGAL TABLE TOP
IMAGING.
THE CHALLENGES IS THE HANDLE OCT
THAT WAS OUT THERE THEY STOPPED
PRODUCING SO IT'S NO LONGER
AVAILABLE.
WE HAVE A NONCONTACT SYSTEM FOR
THOSE UNABLE TO PARTICIPATE IN
TABLE ON TOP CAN WE HAVE A WIDE
FIELD CONTEXT SYSTEM AND THAT'S
FOR KID FIST THE NURSERY TO GIVE
US THE WIDE FIELD OF VIEW.
IT'S GREATER THAN THE RETINAL
LOCATION CAM FIELD OF VIEW AND
IT HAS A MORE USEFUL FIELD OF
VIEW AS CAN YOU SEE IN THE SAME
EYE IMAGES WITH BOTH SYSTEMS.
PETE CAMPBELL AND HIS GROUP HAVE
ALSO BEEN STRONG PROPONENTS OF
WIDE FIELD OCT IMAGING AS YOU
SAW EARLIER AND WE'VE SEGMENTED
THE VOLUMES TO ISOLATE THE
CORROIDAL VASCULAR PATTERN WHICH
CAN BE CONFUSING FROM THE
RETINAL VASCULAR PATTERN, IN
THIS SLIDE WITH RETINAL VASCULAR
DISEASE AND NORMAL RETINA.
SO I THINK THE FUTURE IS STRONG.
DIGITAL CAMERA AND OCT ARE GREAT
FOR STUDYING OCT, BUT HANDLE IS
BETTER FOR MONITORING THIS WIDE
RANGE I TOLD BUT I WON'T REPEAT
AGAIN.
AND I THINK WE NEED TO REMEMBER
THAT KIDS ARE PEOPLE TOO AND
THEY DESERVE ACCESS TO THE SAME
TECHNOLOGIES WE PROVIDE FOR
ADULT PATESENTIOUS SPECIALLY FOR
SENIOR PATIENTS.
I WANT TO ACKNOWLEDGE MY TEAM
AND THOSE WHO HAVE SUPPORTED US
AND THANK YOU FOR THE
OPPORTUNITY TO CELEBRATE THIS
TECHNOLOGY THAT'S BEEN A GIFT TO
ALL OF US IN OPHTHALMOLOGY.
[ APPLAUSE ]
>> THANK YOU SO MUCH CYNTHIA AND
THE NEXT SPEAKER NEEDS NO
EMERGENCY, HE IS A PROFESSOR OF
OPHTHALMOLOGY AND BIOMECHANICAL
ENGINEERING.
HE'S BEEN PUSHING THE BOUNDARIES
HE'S DEVELOPED THE CIRCULAR RNFL
SCAN WHICH CONTINUES TO BE THE
CORNER TONE OF DPLAW COMA
MONITORING AND HE WILL TELL US
ABOUT HOW HE'S PUSHING THE
BOUNDARIES FURTHER.
THANK YOU JOEL.
>> THANKS AMANI, AND EVERYBODY,
THANKS FOR HAVING LASKER-FEST,
AND CONGRATTULESS, I DIDN'T MEAN
AND DAVID.
THIS IS A FANTASTIC CONFERENCE
AND I'VE LEARNED SO MUCH BEING
HERE AND ENJOYED MEETING SO MANY
PEOPLE INTERESTED IN THE FIELD.
I'M GOING TO TALK ABOUT CLINICAL
APPLICATIONS OF OCT AND DPLAW
COMA DETECTION, IDENTIFICATION
OF CHANGE AND PREDICTING
PROGRESSION.
THESE ARE MY FINANCIAL
DISCLOSURES EMPLOY SO I'M GOING
TO TALK ABOUT AS I SAID FLAW
COMA DETECTION, I'M ALSO GOING
TO TALK ABOUT VISIBLE LIGHT OCT,
WHICH YOU'VE HEARD ABOUT
YESTERDAY, IT'S AN INNOVATION IN
DPLAW COMA DETECTION, ADDING A
COUPLE OF POTENTIAL NEW
BIOMARKERS FOR DPLAW COMA, WE
WILL TALK ABOUT PROGRESSION
DETECTION AND PROGRESSION
PREDICTION.
SO I GOT INTERESTED IN FINDING A
WAY TO DO OBJECTIVE QUANTITATIVE
ASSESSMENT OF PEOPLE WITH
GLAUCOMA.
--TO LOOK AT THE OPTIC NERVE AND
IF AN EXPERT SAID THAT THERE WAS
AN ABNORMALITY DAMAGE TO THE
OPTIC NERVE, THEN THAT PERSON
MIGHT HAVE GLAUCOMA.
BUT IT WAS A VERY SUBJECTIVE
ASSESSMENT RIGHT FROM THE
BEGENERATEDDING TO THE END
EXCEPT FOR THE INTRA OCULAR
PRESSURE MEASUREMENT WHICH TURNS
OUT IS NOT A DPRAIT WAY OF
DETECTING DISEAZ.
AND THE ARK ASSESSESMENT OF THE
OPTIC NERVE HEAD WAS SORT OF THE
CORNERSTONE OF GLAUCOMA
DIAGNOSIS AND YET THIS
SUBJECTIVE ASSESSMENT WAS VERY
VARIABLE, NOT ONLY FROM OBSERVER
TO OBLIGATIONS OBSERVER BUT
WITHIN A GIIVE OBSERVER TRUSTEES
TIME TO TIME.
AND WHAT I'M SHOWING IS A PAPER
FROM VICTOR WHICH WAS FROM THE
AMERICAN OPERATING GLOBALLY THAT
WILL MODEL CITIZEN LOGICAL
SOCIETY THESIS SHOWING THERE'S
VERY HIGH VARIABILITY AND KISS
AGREEMENT WITHIN AND BETWEEN
OBSERVERS.
A NUMBER OF TECHNOLOGIES WERE
DEVELOPED DURING THE MEAN 80S
THAT WERE DESIGNED TO DO THIS
SORT OF OBJECTIVE ASSESSMENT OF
THE OPTIC NERVE HEAD.
THERE WASSTERIOGRAPHY, THERE WAS
THE CONFOCAL SCANNING LASER AND
LASER POLARIZEDDER
IMPEDIMENTSAGERIE, OUR C-CURVE
WAS TYPICAL OF THE KIND OF
THINGS WIEW WOULD SEE DURING
THAT TIME OR ACTUALLY A LITTLE
LATER IN THE 90S WAS FROM THE
ADVANCED IMAGING FLAW COMA STUDY
THAT WAS LED BY DAVID WONG WHERE
WE LOOKED AT DIFFERENT
TECHNOLOGIES FOR ASSESSING
GLAUCOMA AND IN THIS CASE WE'RE
COMPARING OCT VERSUS THE SCANNER
LASER POLAR IMPEDIMENTS TERAND A
COUPLE DIFFERENT ITERERATIONS
AND YOU CAN SEE THAT OCT HAS A
DIFFERENT AREA UNDER THE
OPERATOR CURVE THAN SKIN AND
LASER POLAR IMAGERY AT .91.
O THIS IS PRETTY MUCH WHAT WE
HAVE NOW IN DOING CLINICAL OCT.
WE HEARD A TREMENDOUS AMOUNT
ABOUT WHAT'S GOING ON IN THE LAB
RATOREXPE IT'S INCREDIBLE
LOAMACYY EXCITING AND IT CAN'T
WAIT FOR IT TO BE TRANSLATED TO
CLINICAL PRACTICE BUT THIS IS
WHAT WE HAVE NOW AND SO THESE
ARE PROBABLY THE MOST COMMONLY
USED DEVICES IN CLINICAL
PRACTICE IN THE U.S., AND SO
THAT INCLUDES THE
ZEICIRCUMSTANCE CIRCUMSTANCE AND
NOW THE VISITINGIONICS AND THE
TRITON FROM TOP CON, THERE'S
ALSO THE MAESTRO FROM TOP CON.
THIS THESE ARE DOMAIN, TRITON IS
SWEPT SOURCE AND WE GET A PRINT
OUT THAT SHOWS US--OFTEN SHOWS
THE THUMB NAILINGS OF THE OCT,
CAPILLARY SCAN AND ALSO CROSS
SECTIONS OF THE OPTIC NERVE AND
THE CERTAIN PAPILLARY SCAN IS
BEING SHOWN ON EEP OF THESE
UNITS--EACH OF THESE UNITS.
THE WAY WE CAME UP WITH THE WAY
OF DOING CERTAIN CIRRUS APPLIED
ILLEGALSARY SCAN WAS INITIALLY
BEFORE DAVID EVENT CAME UP WITH
THE IDEA OF SCANNING THE OCT
BEAM WHICH IT WAS STILL OPTICAL
IMAGES COCO HERE ENSEL REFLECT
O--METABOLIZEDETRY, WE THOUGHT
MAYBE WE COULD DO A A-KAN--KANA
AT EACH CLOCK HOUR AROUND THE
OPTIC NERVE AND IT TOOK A LONG
TIME EVEN THEN TO DO ANY SCAN.
AND WE WOULD CATCH THE AXONS
THEY WERE COMING IN TO MAKE UP
THE OPTIC NERVE, AND WE GOT 48
SCANS PER SECOND OF THE
PROTOTYPE AUTOPSY SERIES SO 2
AND HALF SECONDS TO DO A HUNDRED
A-SCANS WHICH IS WHAT MADE UP
THE CIRCLE.
WE FIGURED WELL, WITH THE CIRCLE
WE WILL CATCH ALL THE AXONS
PRETTY MUCH THAT ARE GOING TO
MAKE UP THE OPTIC NERVE AND THEN
WE WERE TRYING TO FIGURE OUT,
WELL, YOU KNOW, HOW BIG SHOULD
THE CIRCLE BE?
AND I THOUGHT OF THE OPTIC NERVE
HEAD AS A POINT SOURCE SO I
THOUGHT WE SHOULD HAVE THE
STANDARD SIZED CIRCLE AS OPPOSE
TO MAKING THE CIRCLE RELATIVE TO
THE DIAMETER OF THE OPTIC NERVE,
BUT BIG ENOUGH SO THAT YOU WOULD
BE OUTSIDE THE AREA OF
PERIAPPLIED ILLEGALSARY ATROPHY
AND ALMOST ALL OPTIC NERVES AND
SO WE DIDN'T EXPERIMENT WITHIO
IZATT, AND WE LOOKED AT
DIFFERENT VOLTAGES, BECAUSE THE
VOWEL VOLTAGE CONTROLLED THE
CIRCLE SIZE AND SO IT TURNED OUT
THAT RELATIVELY EVEN VOLTAGE
GAVE US A VARIETY OF USEFUL
CIRCLE SIZES AND THAT
3.4-MILLIMETER CIRCLE WAS
OPTIMAL.
THREE PBT 37 ACTUALLY AND WE
LOOKED AT LATER, WHY IS THIS
TURNING OUT TO BE OPTIMAL, LEAST
VARIABLE AND GIVE US GOOD DATA
AND IT TURNS OUT THAT IT'S AT A
PLATEAU IN THE RETINAL NERVE
FIEBILE LAYER AS IT GOES INTO
THE OPTIC NERVE, SO THAT
EXPLAINS THE LOWER VARIABILITY
OF THAT CIRCLE DIAMETER EMPLOY
IN ANY EVENT, THE SCANNING
CIRCLE GIVES YOU DATA AND YOU
CAN PRESENT THAT IN A NUMBER OF
WAYS, THERE'S A CHART, AN RNFL
THICKNESS PROFILE AND QUARANT
AND CLOCK HOURS AND THEN THERE
ARE THESE THUMB NAILS THAT ALLOW
THE USER, CLINICIAN TO LOOK AT
THE QUALITY OF THE SCAN AND YOU
CAN SEE THAT ON THE SPECTRALIS
AND OTHERS, SO THEY ALL GIVE YOU
QUANTITATIVE DATA THAT YOU CAN
USE, AND THAT--THOSE 4 IMAGES
WERE ALL IN SINGLE HEALTHY
PATIENT'S EYES, THE SCAN ON THE
SAME DAY ON THE EACH OF THE
DIFFERENT UNITS SO HERE'S A
GLAUCOMA PATIENT WHO SCAN OFFICE
OF DIVERSITY EACH OF THOSE
DIFFERENT UNITS ON THE SAME DAY,
AND YOU CAN SEE THAT THERE ARE
DIFFERENCES HERE BETWEEN THE
NORMALS THAT I SHOWED YOU, THE
HEALTHYS AND THE GLAUCOMA AND SO
HERE YOU HAVE A DIFFERENT FROM
THE EXPECTED SO THAT'S BASED ON
ENORMATIVE DATABASE, EACH OF
THESE DEVICES HAVE DIFFERENT
NORMATIVE DATABASES AND IF YOU
WANT TO GET TO THE DATA, THE RAW
DATA ON EACH OF THESE DEVICES,
WELL THAT'S DARN NEAR
IMPOSSIBLE.
SO HA IS 1 OF THE AREAS THAT I
THINK WE NEED TO FOCUS ON AS
BOTH THOSE RESEARCHERS AND AS
CLINICIANS IN TERMS OF BEING
ABLE TO ACCESS THE DATA THAT
WE'RE RETRIEVING FROM OUR
PATIENTS AND THEN USE IT EITHER
FOR GIVEN PATIENT OR FOR THE
POPULATION IN RESEARCH.
SO WHAT YOU SEE IS A THINNING OR
DECREASED THICKNESS IN THE
RETINAL NERVE FIEB RILE AREA
WITH GLAUCOMA DISPLAYED IN
VARIOUS WAYS AND WE CAN ALSO
LOOK AT THE MACKULA AND MEASURE
GLAUCOMA AND THAT WAS AN IDEA
THAT RON ZEIMER HAD AND RON RON
IS RETIRED BUT HE'S A FIZZIST
THAT YOU CAN MEASURE THE
GLAUCOMA WHICH WAS HERETICAL AT
THE TIME BECAUSE YOU KNOW,
BECAUSE GLAUCOMA DOESN'T AFFECT
THE RETINA RIGHT?
AND THAT'S WHAT WE THOUGHT WHEN
THE ONLY TOOL WE HAD WAS TELLING
US THAT THE MACK LA WASN'T
REALLY AFFECTED IN GLAUCOMA BUT
RON SHOWED USING A DEVICE THAT
HE CREATED THAT MACULAR
THICKNESS IN FACT WAS REDUCED IN
PEOPLE WITH GLAUCOMA, AND HE
REASONED THAT SINCE THE CELL
BODIES ARE 20 TIMES THE DIAMETER
OF THEIRAXONS THAT IT WOULD
ACTUALLY BE EASIER TO PICK UP
GLAUCOMA IN THE MACK LA THAN IN
THE RETINAL NERVE FIEB RILE
LAYER AND THAT TURNS OUT TO BE
SORT OF TRUE IN SOME CASES, BUT
YOU CAN CERTAINLY PICK UP FLAW
COMA'S DAMAGE IN THE MACK LAS.
YOU SEE HERE IN THIS PERSON'S
LEFT EYE ON THE DEVIATION MAP
WHICH IS SHOWING AN ABNORMALITY
AND IN THE THICKNESS MAP WHERE
YOU CAN SEE THIS TEMPORAL DEFET
WHICH IS SHOWS IN THE FIELD.
THIS IS RTVIEW, AND THEN THE
TRITEON YOU HAVE THE HOOD REPORT
AND THEN THE HOOD REPORT IS FOR
DON HOOD WHICH DEVELOPED THIS
CONCEPT OF MAPPING THE THINNESS
OR THE RETINAL FIEB RILE LAYER
TO THE RECEPTIVE FIELD IN THE
AND THEN TO WHAT WOULD BE
EXPECTED ON THE VISUAL FIELD
TEST SO SHOWING A CLINICIAN
VISUALLY, WHAT THAT STRUCTURAL
ABNORMALITY WOULD LOOK LIKEOT
FUNCTIONAL EXAMINATION AND IN
FACT, AS YOU CAN SEE IN THIS
PATIENT, THERE'S VERY GOOD
STRUCTURE FUNCTION
CORRESPONDENCE.
THIS IS CO TRANSACTIVATOR WAY OF
LOOKING AT THE DATA FROM THE OCT
THIS, IS DEVELOPED BY CHRISTEN
HUNG, IT'S CALLED ROTA,
RNFL OPTICAL TEXTURE ANALYSIS,
THESE ARE DEFECTS IN THE RETINAL
LAYER, THESE ARE OCT IMAGES THAT
HAVE BEEN PROCESSED WITH THE
ROTA ALGORITHM AND THEN YOU CAN
SEE THE STANDARD STRUCTURAL OCT
PRIBT OUTS AND VISUAL FIELDS
THAT CORRESPOND WITH THESE EYES
AND SO ROTA AGAIN VISUALLY TELLS
THE CLINICIAN WHERE THE
ABNORMALITIES ARE AND TO SOME
EXTENT THE DENSITY OR THE
SEVERITY YOU DPETOT MAP, THE
DEVIATION IS TELLING YOU NORMAL
BORDER LINE OR ABNORMAL IN THE
KACCTA SET THAT'S USED FOR THE
NORMATIVE DATA.
THIS IS A PATIENT OF MINE AND
WHAT YOU SLEEP APNEA AND
SLEEP APNEA AND
OBESITY--SEE IS A PROGRESSION OF
TIME IN THE VISUAL, AND THIS
PERSON'S GLAUCOMA IS GETTING
WORSE AND IF YOU DO A TREND
ANALYSIS, YOU CAN SEE THAT THE
VISUAL FIELD INDEX WHICH IS 1 OF
THE MEASURES THAT WE CAN USE TO
MEASURE GLAUCOMA IS GETTING
WORSE AND THIS IS THE GPA, THE
EVENT,INAL SIS, AND HERE THAT
CORRESPONDS TO THIS ABNORMALITY
ON THE PROGRESSION MAP AND IT
ALSO CORRESPONDS HERE BUT WE
DON'T REALLY SEE A CHANGE IN THE
RETINAL NERVE FIBER LAYER
BECAUSE THIS PERSON REACHED THE
FLOOR OF WHAT THE OCT IS ABLE TO
MEASURE IN THE RETINAL FIBER
LAYER, SO EVEN THOUGH THEY'RE
WORSE IN THAT EYE, YOU'RE NOT
DETECTING IT.
THIS PERSON ALSO HAS WORSE
GLAUCOMA IN THE OTHER EYE, AND
HERE CAN YOU SEE THE
CORRESPONDING ABNORMALITIES IN
THE MAP, AND HERE IS THE
ABNORMALITY SHOWING UP AS
GETTING WORSE.
AND SO BECAUSE OF THAT
FLOUR EFFECT, THIS IS AN AREA
WHERE OCT GPA MIGHT BE HELPFUL
IN PEOPLE WHO HAVE FLAW COMA
EMPLOY I WANT TO TALK ABOUT
VISUALIZE OCT, YOU HEARD ABOUT
THE TECHNOLOGY YESTERDAY, WE CAN
USE IT TO GET HIGH RESOLUTION
OCT IMAGING AND WE CAN ALSO LOOK
AT OXYGENATION IN RETINAL
VESSELS SO HERE IS AN EXAMPLE OF
REPRODUCIBLE AND A MEASUREMENT
OF OXYGEN SATTURATION AND WE DID
A STUDY WHERE WE LOOKED AT
GLAUCOMA IN HEALTHY PATIENTS AND
IT TURNED OUT THERE WAS A HIGHER
VENUS SATURATION OF OXYGEN IN
PEOPLE WITH GLAUCOMA WHICH WAS
CONFUSING AT FETTER BUT WE
REASONED THAT IT'S LIKELY
THERE'S LESS TISSUE METABOLISM,
IN THESE PEOPLE WITH GLAUCOMA
AND THEREFORE LESSOXIEN
COMSUMPTION.
AND THAT'S WHAT WE THINK WE ARE
SEEING AND THERE WAS A GOOD
CORRESPONDENCE BETWEEN THE VNL 2
AND THE GIPC L, WE ALSO LOOK AT
SPECKLE, SO SPECKLE NOISE COULD
BE REDUCED USING US ON MODULATED
SCAN PATTERN AND YOU CAN SEE
IT'S LIKE AND NOT EXACTLY THIS
ALOOED US US TO REDUCE THE
SPECKLE AND THIS IS REALLY WORK
BY [INDISCERNIBLE] AND HIS
GROUP.
AND THEN WE LOOKED AT THE IRPT
FLEXY FORM LAYER WHICH LOOKS
LIKE A SINGLE LAYER ON STANDARD
CLINICAL OCT BUT WITH THE VERY
HIGH RESOLUTION YOU CAN GET WITH
THE VISIBLE LIGHT OCT, CAN YOU
SEE THERE ARE 5 LAYERS THAT ARE
DISCERNIBLE IN THE INTERPLEXUS
FORM LAYER AND WE LOOK AT THAT
IN RELATION TO TBLAW COMA AND IT
TURNED OUT THAT--GLAUCOMA AND IT
TURNED OUT YOU CAN MEASURE THAT
DAMAGE IN THE INNER FLEXUS FORM
LAYER SPECIFICALLY AND WE BEING
THAT THAT MIGHT BE A USEFUL
BIOMARKER FOR GLAUCOMA AS WELL.
AND THEN I JUST WANT TO TOUCH ON
ARTIFICIAL INTELLIGENCE, I KNOW
WE HAVE A SECTION COMING UP
THAT'S TALKING ABOUT THAT IN A
MOMENT BUT THE COLLABORATIVE,
AND PLEASE LOOK AT AI FLAW COMA
DETECTION AND THINGS LOAMACYIC
KREENING PROGRAMS AND WE THOUGHT
THAT--IT'S VERY HARD FOR
SPECIALISTS TO AGREE ON WHAT
FLAW COMA IS AND SOPHISTICATED
LOOKING FOR MANIFEST FLAW COMA
WITH OCT WOULD BE A REASONABLE
APPROACH FOR FLAW COMA KREENING.
IT TURNS OUT THAT YOU CAN DETECT
FLAW COMA USING AI WITH OOH CT
WELL, AND CAN YOU DO BETTER
USING DEEP LEARNING, THIS WHERE
THE CONVOLUTIONAL NEURAL NETWORK
AND WE FOUND THAT YOU COULD DO
SIGNIFICANTLY BETTER WITH DEEP
LEARNING THAN WITHSTAND ARD
SORTS OF TECHNIQUES AND MACHINE
LEARNING TECHNIQUES AND IN
ADDITION YOU COULD PREDICT
PROGRESSION OF THE DEC, SO FOR
INITANCE IN THIS STUDY, THE
AUTHORS WERE LOOKING AT WHO
WOULD GO ON TO HAVE SURGERY AND
YOU COULD PREDICT THAT USING
ARTIFICIAL INTELLIGENCE USING
OCT, IT'S ESTIMATED YOU COULD
PREDICT VISUAL FIELD LOSS UP TO
5 AND HALF YEARS IN ADVANCE FROM
A SINGLE STARTING POINT USING AI
WITH OCT AND THAT WOULD ALLOW
PEOPLE TO TREAT MORE OR LESS
INTENSIVELY BASED ON WHAT A
PATIENT IS LIKELY TO DO.
AND YOU CAN ALSO FORECAST
WHAT--AROUND THE RETINAL FIBER
LAYER WILL BE AND YOU CAN DO
THAT BETTER THAN THE STANDARD
METHODS LIKE THE GPA AND HERE
HERE LOOKING AT THE GROUP IN
GLAUCOMA GROUP USING DEEP
LEARNING VERSUS USING THE
STANDARD GPA EMPLOY FINAL 1 OF
THE MAJOR ISSUES AS I ALLUDED TO
IS DIFFERENCES IN THE OUTPUTS OF
THE DIFFERENT DEVICE ANDS IT HAS
TO DO WITH THE SIGNAL PROFILES
AS WELL AS A NUMBER OF OTHER OS
SPECS OF HOW THE DEVICES GATHER
THEIR DATA AND THE--WHAT WE NEED
REALLY IS A STANDARDIZATION THAT
WOULD ENABLE THE ABILITY OF SCAN
DATA ACROSS PLATFORMS BOTH FOR
RESEARCH AND CLINICAL USE FOR
ACCESS TO PROVIDERS AND
INSTITUTIONS.
AND THAT INFORMATION SHARING IS
REALLY FUNDAMENTAL TO RESEARCH
AND ALSO CLINICAL CARE DELIVERY.
THERE ARE A VARIETY OF DIFFERENT
SEGMENTATIONS METHODS USED BY
THE DIFFERENT MANUFACTURES OF
THESE DEVICES AND HAVING A
UNIFORM WAY OF SEGMENTING THE
IMAGES AND SHARED NORMATIVE
DATABASE WOULD ENHANCE THE DATA
SHARING, PARTICULARLY AT A
CLINICAL LEVEL.
AND YOU COULD DO SEGMENTATION
DRIVEN ASSESSMENT USING AI OR
MACHINE LEARNING, WHICH WOULD
REDUCE THE COST OF MANUEL
LABELING FOR INSTANCE AND
INCORPORATE ANATOMIC INFORMATION
OR YOU COULD DO FEATURE AGNOSTIC
ASSESSMENT LOOKING AT OCT
VOLUMES AND THAT ACTUALLY
CONTAINS A LOT MORE INFORMATION
THAN THE SEGMENT SCANNED.
SO BEING ABLE TO LOOK AT THE RAW
DATA AND DO THIS WITH AI I THINK
WOULD BE MORE ROBUST THAN
SEGMENTATION.
SO TO CONCLUDE I THINK WE SEE
ARTIFICIAL INTELIENCE AND FLAW
COMA IDENTIFICATION AND
PROGRESSION AS GREAT POTENTIAL,
THE DEFINITIONS OF THE
PARAMETERS REQUIRE CONSENSUS AND
THE UTILITY OF ARTIFICIAL
INTELIENCE AND MACHINE LEARNING
APPROACHES CAN BE ESPECIALLY
USEFUL IN UNDERSERVED AREAS, IT
DESKILLS THE DISEASE AND ITSELF
PROGRESSION AND THAT INCREASES
PATIENT ACCESS POTENTIALLY AND
REDUCES COST SO I THINK THAT WE
MAY HAVE THE OPPORTUNITY TO
REALLY FLATTEN THE FLOAB IN
TERMS OF ACCESS TO CARE EMPLOY I
WANT TO THANK MY COLLABORATORS
ESPECIALLY JIM FUYI MOTO AND
DAVID AND I ALSO WANT TO THANK
DAVID IN TERMS OF THE ADVANCED
IMAGING FLAW COMA GROUP AND I
WANT TO THANK--FLAW COMA GROUP
AND I WANT TO THANK MY OWN GROUP
WHO IS--WHO ARE GROWING AT MY
NEW HOME AT WILLS EYE HOSPITAL.
THANK YOU VERY MUCH.
[ APPLAUSE ]
>> THANK YOU VERY MUCH JOE, I AM
HAPPY KNOW THAT MACULAR
DEGENERATION AND ALSO A DEC, AND
I AM HAPPY TO LEARN THAT.
OUR NEXT SPEAKER IS PUSHING THE
BOWPPEDRIRYS TO AI, AND MACULAR
DEGENERATION FOR AMD, AND HER
SOFTWARE IS INCORPORATED IN A
COMMERCIAL PLATFORM.
I THINK SHE WAS FIRST TO SEE
THAT LOOKING AT FLUID COMPART
AMS IN THE RETINA IS VERY
IMPORTANT IN AMD AND SHE WILL
TELL US ABOUT AN APPLICATION FOR
GEOGRAPHIC ATROPHY WHICH IS
FUNDAMENTAL.
URULEA IS IN VIENNA WHERE
PROFESSOR [INDISCERNIBLE] WAS,
SHE WAS ALSO THERE WHERE ALL IT
ALL BEGAN IN A LAB THAT'S IN A
SORT OF IN A DEPARTMENT WHERE
OCT WAS ACTUALLY INVENTED AS
WELL.
WELCOME, URSULA.
>> SO THANK SO MUCH FOR THIS
MAGNIFICENT INVITATION TO JOIN
IN AND CELEBRATE THE AWARDEES,
VERY ENGAGED AND BRILLIANT
PEOPLE THAT WE ALL KNOW.
XI THINK THAT IT COMES WITH A
LOT OF OPTIMISM THAT THERE ARE
PEOPLE LIKE THAT WHO CAN BRUCE
PARADIGM SHIFTING SCIENCE.
PARADIGM SHIFTING MEDICINE AND
IT'S NOT THE ONLY THEIR
BRILLIANCE, IT'S ALSO THEIR
WILLINGNESS TO DEDICATE THEIR
WHOLE LIFETIME TO DO WHAT THEY
DO AND THEY DON'T DO IT JUST FOR
THEMSELVES, THEY DO IT FOR ALL
OF US.
AND THEY DO IT FOR THE PATIENTS
AND A LOT OF HUMAN BEINGS,
BENEFIT FROM IT.
SO IT'S ALSO GET TOGETHER, TOO,
AMONG LIKE MINDED PEOPLE LIKE US
WHO ARE A COMMUNITY THAT IS
ATTRACTED BY SUCH A MIND SET AND
THAT TRIES TO CONTRIBUTE IN
ADDITION AND IS INSPIRED AND
TAKEN AWAY AND ALSO TRIES TO DO
A LITTLE BIT OF WHAT THE
AWARDEES HAVE DONE.
AND THEN TO FIND A PLATFORM LIKE
THE NEI, WHO WAS MADE TO BRING
KNOWLEDGE, EXPERTISE AND
ADVANCES TO THE COMMUNITY, THIS
IS A MOST FANTASTIC AND MOST
INSPIRING REASON TO GET
TOGETHER.
SO LET ME ADD A LITTLE BIT FROM
MY SIDE TO--FOR SOME MORE
ENTERTAINMENT FOR YOU EMPLOY SO
MY TOPIC IS AI-BASED MANAGEMENT
OF GERIATRIC ATROPHY WHICH WOULD
INCLUDE SCREENING, MONITORING
AND PREDICTION EMPLOY THESE ARE
MY DISCLOSURES.
SO THE CHALLENGE IS HUGE AS WE
ALL KNOW BECAUSE THE WORLD
POPULATION IS AGING RELENTLESSLY
AND WE HAVE TO TAKE CARE OF
MILLION AND IN ILLEGALSION OF
PEOPLE WHO WERE SUFFER
AGE-RELATED DEC, PARTICULARLY
REGARDING THEIR VISION.
WE ARE TRYING TO DO OUR BEST,
NEVERTHELESS, WORLD WIDE VISION
WAS INCREASED BY 23% IN THE AGE
OF OCT AND IN THE AGE OF RETINAL
LOCATION NONAPOPTOTIC
PHARMACOTHERAPY, THAT'S A
WARNING.
SO GA STRONGLY AFFECTS
VISION-RELATED QUALITY OF LIFE
IN MANY ASSPECS WE KNOW THAT
ALREADY WE ALWAYS FEEL IT SLOW
AND WE HAVE A LOT OF TIME, BUT
THERE ISN'T SO MUCH TIME IF YOU
LOOK AT THE STATISTICS AND SEE
THAT 2/3RDS OF PATIENTS WITH
BILATERAL GA BECAME INELIGIBLE
TO DRIVE BY A MEDIAN TIME OF 1.6
YEARS.
THAT'S NOT A LOT OF TIME.
SO THE FIRST THING ALWAYS IS
BEFORE YOU DO SOMETHING, BEFORE
ACTIVITY COMES IN, UNDERSTANDING
MUST COME IN, SO UNDERSTANDING
GEOGRAPHIC ATROPHY MEANS THAT
THE MARKERS ARE SUBCLINICAL AND
THEY ARE HIDDEN UNDERNEATH THE
RETINA AND JUST TO LOOK ON AN F.
A. F., LIKE DEFECT DOESN'T
HELPITOUS UNDERSTAND WHAT
HAPPENS AT THE LEVEL OF THE RPE
AND THE PHOTO RECEPTORS WHICH
ARE THE MAJOR LAYERS HERE.
SO WE NEED TOOLS.
ONE TOOL IS CERTAINLY AN EYE
BASED RECOGNITION OF RPE LOSS,
AND THIS COMING FROM AN OCT
BECAUSE WE KNOW THAT THE
MANAGEMENT OF AMD, IS DRIVEN BY
OCT AND IT MAKES NO SENSE TO GET
OUT ANOTHER COMER FROM THE
POCKET WHICH IS CALLED F. A. F.
AND THEN TAKE PHOTOS AND THEN
SOMEHOW TRY TO INTEGRATE IT INTO
OUR DAILY ROUTINE WHICH IS ALL
OCT BASED EMPLOY SO THE FIRST
THING WE DID IS WE INTRODUCED
OCT BASED EYE ANALYSIS OF THE
RPE LAYER, THAT WAS RATHER
SIMPLY, WE SET UP A 3D, TO 2 D
SEMANTIC SEGMENTATION, AFTER 3
DIMENSION IN VOLUME.
IT'S A COMPLOAT LOSS SO THIS IS
WHAT CAN KEEP UP WITH FUNDERS
AUTOPLEUR ESTIMATE THAD ENSEL
NICELY, OF COURSE WE ARE TO
PROVE THIS.
WE HAD TO COME UP WITH GROUND
TOOLS, HUMANS GRADING THE RPE
LOSS AND ON OCT THIS, IS
COMPARED TO F. A. F. WHICH IS
COMPARED TO AUTOMATED AND MANUEL
AND WE FOUND THAT THIS IS TRULY
CONSISTENT.
SO YES, THE FIRST STEP HAD BEEN
DONE.
WE CAN USE OCT INSTEAD OF FAF
AND THAT ALLOWED US TO LOOK ON
THE DATA OF THE FIRST CLINICAL
PHASE 3 TRIAL THAT CAME THRU
POSITIVE AND THIS IS
[INDISCERNIBLE] AND DERBY SO WE
USE THIS ALGORITHM TO LOOK AT
THE LEVEL OF THE RPE, WHICH IS
THERE BUT IT'S RATHER MODERATE.
SO THE SECOND TOOL THAT WE
INTRODUCED EASE EZ-LOSS
MEASUREMENT WHICH IS CONSISTENT
WITH THE OUTER SEGMENT OF THE
PHOTO RECEPTORS ALSO PART OF THE
MITOCHONDRIA BODY.
SO THIS IS VERY TRICKY, SO THIS
A THIN LAYER, GROUND TOOLS NOT
SO EASILY PROVIDED.
A SIMPLE OLYMPIC GOR RHYTHM
WOULDN'T DO IT SO WE CAME UP
WITH A COMPOSITE OF 4 DIFFERENT
COMPUTATIONAL, CONVOLUTIONAL
NETWORKS AND THEY WERE BROUGHT
TOGETHER AND THEY WERE BROUGHT
IN TON TEXT, ALSO THE CONTEXT OF
THE RETINA, AND THAT IT ENABLING
US TO, BASED ON AN ASCAN LEVEL,
REACH PIXEL LEVEL PRECISION.
THAT IS VERY IMPORTANT BECAUSE
HERE, THE LAYER IS TINY, THE
BIOMARKER IS VERY SENSITIVE BUT
IT IS MOST IMPORTANT.
OF COURSE HIGH ACCURACY AND
RELIABLE REPRODUCIBILITY IS A
MUST ASK WEB CONNECTED WENT
THROUGH A LOT OF HARDWARE, HOME
WORK TO IDENTIFY WHETHER THIS
CAN BE PROVIDED EMPLOY WE
ACHIEVED A DICE SCORE OF .99
WHICH IS THE HIGHEST YOU CAN GET
REGARDING PRECISION AND
REPEATABILITY AND WE ALSO LOOKED
ON AGREEMENT BETWEEN DIFFERENT
READERS AND AGREEMENT BETWEEN
DIFFERENT IMAGES TAKEN IN
DIFFERENT TIME INTERVALS, THIS
IS ALL THE THINGS THAT YOU NEED
TO DO TO MAKE SURE THAT PEOPLE
BELIEVE YOU, THAT WHAT YOU DO IS
REALLY MEASURING WHAT IT IS
SUPPOSED TO BE TO MEASURE EMPLOY
AND IT IS ALSO MOST IMPORTANT TO
USE THIS IN A REALTIME MANNER.
THERE IS NO HELP FROM SUCH A
TOOL IF HUMAN EXPERTS FROM A
READING CENTER THEN HAVE TO
CONTROL AND SMOOTHEN AND POLISH
IT BECAUSE THIS HAS TO BE
DELIVERED TO THE CLINICIANS, THE
MOMENT THEY SEE THE PATIENT.
SO REALTIME IS MOST IMPORTANT.
AUTOMOST IMPORTANT FOR CLINICAL
TRIALS, BECAUSE IF CLINICAL
TRIALS, MOST OF THE IMAGES,
ASSERT ACTUALLY, CAN NOT BE USED
BECAUSE PATIENTS CANNOT FIXATE
WITH GA AND MOSTLY THE OPERATOR
DOESN'T SEE THE IMAGE BEFORE
IT'S SENT OUT TO A READING
CENTER, SO THEN THE PATIENT GOES
HOME, HE HAS TO WAIT, 3 OR 5
WORKING DAYS AND THEN THE
PATIENT COMES BACK, BUT HERE
NOW, AN IMAGE CAN BE TAKEN WITH
HIGHEST QUALITY FROM THE
BEGINNING.
AND THIS ALLOWS US TO NOW ADD
THE PHOTO RECEPTOR COMPONENT TO
THE ANALYSIS OF SUCH A HUGE AND
VERY IMPORTANT PHASE 3 TRIAL AND
THIS IS HERE AS YOU CAN SEE OAKS
AND DERBY AND THERE'S A HUGE
DIFFERENCE BETWEEN THE
THERAPEUTIC EFFECT AT THE LEVEL
OF THE PHOTO RECEPTORS AS
MEASURED BY THE EZ-LAYER, MUCH
BIGGER THAN SAVING ONLY THE
[INDISCERNIBLE] RPE AS I HAD
HEARD MANY TIMES FROM OTHER
COLLEAGUES BECAUSE THIS IS A
TRUE THERAPEUTIC BENEFIT THAT
CAN BE SEEN FROM THE FIRST
MONTHS ON.
SO IT MAKES NO SENSE TO SEND THE
PATIENTS HOME AND SAY, I WILL
WAIT FOR DECLINE IN VISION, THEN
I UPON THAT YOUR LESION IS
ADVANCING, YOU HAVE TO TREATMENT
IMMEDIATELY BECAUSE VISION LOSS
IS IRREVERSIBLE AND BY LOOKING
AT THIS FOR EZ-LOSS YOU CAN AND
YOU MA HAVE NOTED THE P-VALUE
HERE IS .0001.
SO THIS IS NOT JUST A BORDER
LINE RESULT.
THIS MADE US UNDERSTAND AND I
VISUALIZE THIS YEAR MAYBE
BECAUSE I'M A RETINA PERSON, I
LIKE VISION, I LIKE TO VISUALIZE
FEATURES TO UNDERSTAND THEM.
SO, BLUE IS RPE LOSS, IN GREEN
IS EZ LOSS, THIS IS A VISION WE
FOLLOWED OUT FOR 2 YEAR ANDS IT
SUCH A [INDISCERNIBLE] TYPE OF
LESION, IT IS SUCH A PROGRESS
NUMBER OF THETIC LESION GROWTH
INTO ATROPHY, THE PHOTOGRAPH
ALWAYS PRECEDES AND EXCEEDS THE
RPE LOSS AND THE RPE LOSS JUST
FILLS IN.
THIS HAS BEEN SEEN IN EVERY
SINGLE PATIENT WHETHER HERE OR
SHE CAME FROM A CLINICAL TRIAL
OR THE REAL WORLD AND THIS ALONE
IS A VERY IMPORTANT PIECE OF
EVIDENCE.
THEN OF COURSE, I HAVE TO ANSWER
THE QUESTION, YOU SHOW BEAUTIFUL
AREAS BUT DO THEY HAVE ANY
MEANING FOR THE PATIENT, MEANING
VISUAL ACUITY, WHEN WE DID A
POINT TO POINT EVALUATION OF
180,000 SPOTS THAT WERE TESTED
BY MICRO PERIMPEDIMENTSETRY AND
SUPER IMPOSE THEM ON TO THE
ADJACENT IMAGE ON THE OCT, WE
COULD CLEARLY SEE THERE'S A
LINEAR CORRELATION BETWEEN EZ
THICKNESS AND THE FUNCTION IN
TERMS OF THE DECIBEL, SO YES,
THE GREEN LAYER HAS AN
IMPORTANCE FOR FUNCTION.
SO NOW WE CAN START SCREENING,
MONITORING AND PREDICTION EMPLOY
SO KREENING MEANS GA MANAGEMENT,
HAS TO BE DONE IN A SINGLE
PATIENT OF COURSE, PATIENT COMES
IN, GETS AN OCT, THE OCT, IS
THEN SENT TO THE CLOUD AND
ANALYZED IN A STANDARDIZED
MANNER AND THEN THE DOCTOR CAN
MAKE AN EDCUEICATED DECISION
ABOUT TREATING ON OR NOT TO
TREAT.
THIS IS VERY CLEAR WHEN
INDIVIDUALS CAN AM IN THAT HAVE
A VISUAL OOH CUITY ISSUE,
HOWEVER MOST OF THE PEOPLE DON'T
COME IN BECAUSE THE LESIONS
START OUTSIDE OF THE PHOBIA
INISH PATIENTS DO NOT NOTICE,
THEY'RE NOT PATES, THEY'RE JUST
PEOPLE.
SO THERE IS A RISK GROUP IN
WHOSE EYES, IS THE DEC IS
BECOMING ESTABLISHED AND IS
PROGRESSING.
IT IS VERY, VERY ASSURING IN
GEOGRAPHIC ATROPHY THAT IT IS A
SLOW PROCESS BUT CAN BE CAPTURED
IN THE BEGINNING BEFORE THERE'S
ANY CLINICAL SIGNS SEEN.
SO, WE FOLLOWED THIS OUT OVER 3
YEARS AND WE COULD CLEARLY COME
UP WITH A SERIES OF EVENTS.
FIRST THERE'S OUTER NUCLEAR
LAYER THINNING, THEN THERE IS
PHOTO RECEPTOR THINNING, THEN
MUCH LATER COMES DRUSEN
RESOLUTION AND EVEN MUCHALATER
THE BAR CODE OF CHOROIDAL HYPER
TRANSMISSION.
AND WHEN YOU LOOK AT THE LOWER
RIGHT SIDE, YOU SEE HOW LUMPY,
BUMPY THE AREA IS AND HOW
PRECISE AN ALGORITHM EZ MEASURE
LINE IS TO BE.
THE POINT IS HERE, WE HAVE TIME
BUT WE ARE ALSO ABLE TO SEE THE
FIRST SIGNS THAT ARE
IRREVERSIBLE AND IT DEFINITELY
LEAD TO DISEASE MORE THAN A YEAR
BEFORE EMPLOY SO THIS COMES FROM
PINNACLE AND PINNACLE IN AN
OBSERVATION TRIAL THAT IS
SPONSORED BY THE WELCOME TRUST
WE ARE NOW IN HERE, IN NUMBER 4,
ALREADY, WE HAVE LOOKED AT 580
PATIENTS OVER TIME, NON
INTERVENTIONAL STUDY AND WE
COULD SEE THAT BI FAR THE
LEADING FEATURE IS OUTER NUCLEAR
LAYER AND PHOTO RECEPTOR LOSS.
AND THIS IS SEEN BEFORE A SINGLE
RPE CELL IS GOING ARK WIMBERLY,
YOU WILL ALSO SEE THIS UP HERE
IN THE MULTIFOCAL LESION WHICH
IS A VERY RELIABLE SIGN,
THEREFORE PREDICTION OF
CONVERSION.
CONVERSION AND PROGRESSION ARE
DIFFERENT THINGS SO WHEN WE LOOK
AT CONVERSION, THIS IS WHERE THE
FIRST STAGE OF DISEASE, WE SET
UP A SPATIAL TEMPORAL ATLAS OF
INTERMEDIATE AMD CONVERTING AND
WE TARTED WITH 1 FEATURE THAT
WAS CHOSEN HERE AND WE LOOK AT
THE DEVELOPMENT IN A FEW HUNDRED
PATIENTS OVER 3 YEARS AND WE
COULD SEE THAT PATIENTS THAT
DEVELOPED MNV OR GA AS COMPARED
TO NONCONVERTERS DID HAVE A LOT
OF BI MOW MARKER MOVEMENT AND
DRUSEN WERE INCREASE NOTHING
BOTH TYPES OF LATE AMD, MNV AND
GA.
THAT WAS EACH MORE ENHANCED AND
MORE LEANING TOWARDS THE
PREDICTION OF GA WHEN WE LOOKED
ON HYPER REFLECTIVE FOCI AS YOU
CAN SEE HERE, HYPER REFLECTIVE
FOCI REALLY INCREASED
SIGNIFICANTLY IN GA MORE SO THAN
IN MNV AND SIGNIFICANTLY MORE IN
NONCONVERTERS, SO HYPER
REFLECTIVE FOCI PLAY A ROLE.
WE USE MACHINE LEARNING FOR
EVALUATING THE PROGRESSION OF
INTERMEDIATE AMD BASED ON OCT
IMAGING AND FOUND VERY CLEARLY
THAT IT WAS CHARGED IN THE
SENSORY LAYERS MOSTLY STAINING,
DRUSEN TRAINING AND MIGRATION
THAT PREDICTED DISEASE
CONVERSION JUST LIKE THIS
WITHOUT ANY OTHER BIOMARKERS
ADDED, WE HAVE JUST NOW STARTED
A HUGE GRANT WHICH IS CALLED EYE
SCREEN WHERE WE'RE SCREENING ON
A COMMUNITY BASE TOGETHER WITH
OPTOMETRIST ANDS OPTICAL
IMAGESITITIONS THAT WERE SPREAD
INTERNATIONALLY THROUGH EUROPE.
WE WILL INCLUDE 5000 PATIENTS
AND LINGS A PAN-EUROPEAN GUIDED
OCT NETWORK FOR KREENING AND
RISK ASSESSMENT OF AMD, THIS IS
WELL ORGANIZED OF COURSE WE CAN
SEE HERE AND WE WILL CATCH A LOT
OF ORM GAs AND WHY WE ARE
DOING THIS AND THAT BRINGS ME
MONITORING.
AND MONITORING IS VERY IMPORTANT
BECAUSE WE ARE DOING VERY
INVASIVE EXPENSIVE TREATMENT TO
THOUSANDS AND THOUSANDS OF
INDIVIDUALS SO THERE MUST BE A
REASON TO DO THIS.
ALSO THINK OF US AS DOCTORS, WE
ARE GIVING MILLIONS OF INTER
VEAL INYEKSS THIS WILL INCREASE,
NOT ONLY SUBSTANCES NOT ONLY
COMPLEMENT INHIBITION WHICH WILL
INCREASE THAT NUMBER AND IT WILL
NOT INCREASE THE NUMBER OF EYE
DOCTORS AT THE SAME TOKEN SO WE
NEED TO EMPOWER THE HUMAN AND
HOW CAN YOU DO THIS OBVIOUSLY
WITH AI PARTICULARLY DEEP
LEARNING WHERE NO HUMAN BEING
NEEDS TO BE ABUSED AS A SLAVE
FOR IMAGE ANNOTATION.
BECAUSE THIS IS DONE BY A MOUSE
CLICK ON THE REGULAR OCT, THIS
IS THE SPECTRALIS, THIS IS THE
FIRST DEVICE WE STARTED WITH
BECAUSE SO MANY DATA WERE
AVAILABLE AND WE COULD TRAIN THE
ALGORITHM IMMEDIATELY.
SO WHAT DOES IT MEAN, YOU SELECT
THE IMAGE YOU WOULD LIKE TO KNOW
MORE ABOUT IT, YOU BRENG IT TO
THE CLOUD AND THIS IS THE REPORT
THAT YOU GET AFTER 1-2 MINUTES.
SO THIS IS DEFINITELY MORE THAN
YOU CAN SEE ON AN FAF IMAGE.
IT'S ALSO FULLY AUTOMATED, IT AM
CANS IN REALTIME BY THE CLOUD
FROM A STANDARD OCT, IT OFFERS
VISUALIZATION, THAT IS MOST
IMPORTANT SO YOU SEE THE BLUE
AREA, THIS IS RPE LOSS, YOU WILL
SEE THE GREEN AREA, THIS IS EZ
LOSS, PHOTO RECEPTOR DAMAGE, I
REMIND YOU THIS IS IRRERERSIBLE
AND THEN CAN YOU DO AN OVERLAY
AND THE VISUALIZATION IS NOT A
CALCULATION.
IT IS THE CONDITION AS IT IS AT
FIRST PRESENTATION WITH ANY
GIVEN PATIENT.
YOU KNOW IMMEDIATELY WHERE THE
LESION IS GOING TO.
THIS IS MDR APPROVED IN EUROPE,
IN THE U.S. YOU CAN USE IT ON AN
INVESTIGATION AND BASE, YOU HAVE
TO INFORM YOUR IRB, THAT'S IT.
SO THIS IS A FOLLOW UP OF A
PATIENT WHO WAS NOT TREATED AND
YOU SEE BASE LINE MONTH, 2
MONTHS, 12, A CLEAR PROGRESSION
AND VERY PREDICTABLE.
SO A NEW ERA HAS BEGUN WHEN THE
FDA RECOGNIZED THIS AND IT'S
EASY LOSS, FIRST OUTCOME MEASURE
FROM [INDISCERNIBLE], SO IT'S
THE NEW KIDOT PLOK AND IT RELYS
ON EZ LOSS AND OCT-BASED AI.
SO THIS IS THE BEST TOOL TO HELP
YOUR PATIENT BECAUSE YOU'RE
INTERVENING WHEN THERE IS NO
IRREVERSIBLE TISSUE CULTURE
MEDIA THAT ALREADY OCCURRED
EMPLOY SO WE DID THE PREDICTING
ALGORITHM ALREADY AT THIS STAGE
OF THE DATA THAT WAS THE PHASE 2
TRIAL AND WE LOOKED ON LOCAL
PROGRESSION RATE.
ONE HAS TO UNDERSTAND THAT
LESIONS DO NOT ENLARGE
EVERYWHERE, ABOUT THE SAME BUT
THAT THERE ARE HOT SPOTS, SO,
AND HERE THE LESION GROWS IN
OTHER SPOTS, IT DOESN'T GROW.
SO WHAT WE FOUND AFTER THE
METICULOUS WORK OF CORRELATING
MORE THAN 30,000 GA MARKER
LOCATIONS IS THAT IT WAS REALLY
EZ THINNING THAT WAS DRIVING THE
PROCESS AND HAD BY FAR THE
HIGHEST PREDICTIVE VALUE.
SO LET'S GET OUT THEN OF F. A.
F., EVERYBODY HEARD ABOUT THESE
PERILESIONONNAL PATTERNS THAT
HAD VERY FUNNY NAMES, POETIC,
WHENEVER IT BECOMES POET IN LIFE
SCIENCES YOU SHOULD RUN
AWIMBERLY AND SAY, I WANT
NUMBERS.
SO HERE ARE 2 DARK AREAS, THEY
LOOK EXACTLY THE SAME.
ON FAF, HOWEVER, YOU DO OCT SCAN
AND OCT ANALIS, YOU SEE THAT
THESE LESIONS ARE BY FAR NOT THE
SAME.
ONE HAS A LARGE ACTIVITY ZONE OF
EZ LOSS EMPLOY WE DID A
SYSTEMATIC CORRELATION OF FAF.
WITH PROGRESSION OF THE LESIONS
IN THE CENTER, THERE WAS NO
CORRELATION.
EVERYTHING WAS VARIABLE TO SAY
THE LEAST AND I JUST WANT TO
SHOW THIS TO YOU SO THIS IS THE
[INDISCERNIBLE] PROGRESSION
BASED ON F. A. F.
OVER TIME YOU SEE ONLY THE
TBREEN LINE AND THIS IS THE
TRICKLED PATTERN, WE ONLY HAD 13
PATIENTS WITH THE TRICKLE
PATTERN, WE HAD SOME
PRODUCTIVITY BUT ONLY ON THE
LEVEL OF THE RPE THAT WAS
IMMEDIATELY GONE WHEN YOU
BROUGHT PHOTO RECEPTORS ON, IN,
SO NOTHING PREDICTIVE.
SO WE SUGGEST INSTEAD TO USE THE
PHOTO RECEPTOR RPE RATIO OR EC,
RPE RATIO, BECAUSE WE COULD SHOW
THAT WHEN YOU HAVE NO SUCH GREEN
MARGIN LESIONS HARDLY MOVE,
HOWEVER WHEN THE MARGIN IS BIG,
THEY GROW LIKE CRAZY, WE LOOK @
THE DIFFERENT QUAR TILES OF
THIS, THE PRESENCE OF SUCH AN
EASE ZONE, THE LOWEST 84 TILE
WITH THE LOWEST ZONE HAS NO DEC
ACTIVITY, BUT DECK TASTE IS
IMPORTANT, LESIONS THAT DO NOT
MOVE WILL NOT SHOW ANY
THERAPEUTIC EFFECT.
THE SAME RATIO IS ALSO HIGHLY
PREDICTIVE FOR TREATMENT, HE IS
A FELLOW EYE PATE ISSUES AND
STUDY EYE SAME PATIENT AND YOU
SEE, HOW--WHAT THE MECHANISM OF
THERAPY IS, AND IF YOU THEN LOOK
ON THE PREDICTION OF THIS RATIO
AND RPE LOSS, YOU WILL SEE A
CLEAR DEFERENTIATION BETWEEN THE
4 QUAR TILES AND THIS IS EVEN
MORE SO FOR PHOTO RECEPTOR LOSS.
SO, YES, NOT EVERYTHING WORKS
FOR EVERYBODY, IF YOU HAVE A
HAMMER NOT EVERY GASHINGA LESION
IS A NAIL EMPLOY ITENTIFY THE
PATES THAT WILL BENEFIT AND THEN
YOU CAN WEIGH OUT RISK AND
BENEFIT.
WE DO SRO A LOT OF CLINICAL AND
OFTEFFECTABILITY IN GA WHERE NO
VISION IS IMPROVING IS IMPORTANT
AND WE HAVE THE DOCTORS AND WE
DO NEED TO TAKE TEEM FOR
PATIENTS TO EXPLAIN THEM, WHAT A
TERRIBLE DISEASE THEY HAVE.
THIS IS MY CONCLUSION, I DON'T
THINK I NEED TO READ IT AGAIN TO
YOU.
IT IS CLEAR THAT RESEARCH INTO
THE CAUSES AND PREVENTION OF
BLINDNESS IS A MULTIDISCIPLINARY
EXERCISE, SO WE CAME FROM THE
BIOLOGIC MECHANISMS, WE FOLLOWED
EARLY CONVERSION, WE CONSIDERED
REAL WORLD OUTCOMES, EXPLORED
NEW THERAPEUTIC MECHANISMS,
PROVIDED INTERDISCIPLINARY AI
EXPERTISE, CLOUD SHARING IS MOST
IMPORTANT, AND WE INTRODUCE
REALTIME INTO CLINICAL TRIAL
PLATFORMS AND THIS IS THE WAY
HOW TO BRING THE TECHNOLOGY TO
THE DOCTORS.
THAIRNG YOU SO MUCH FOR YOUR
INTEREST.
AND CONGRTULATIONS GENERATED TO
THE 1S THAT MADE ALL OF THIS
POSSIBLE BY COMING UP WITH OCT.
[ APPLAUSE ]
>> QUESTIONS, IF SOMEONE IN THE
AUDIENCE HAS 1, I WOULD MAYBE
START WITH URSULA, HOW SOON, WE
TALK ABOUT HARMONIZATION AND
STANDARDIZATION AND BRINGING
THOSE TO THE WIDER APPLICATIONS,
SO HOW SOON DO YOU THINK YOUR
SOFTWARE WILL BE IMPORTABLE AND
ON DEVICES BECAUSE YOU KNOW, YOU
SHOWED US THE VALUE OF TAKING
THESE VALUE METRIC OCTs AND
TURNING THEM INTO SORT OF
PHYSIOLOGICALLY AND
PATHOLOGICALLY RELEVANT
VISUALIZATIONS SO HOW SOON CAN
WE EXPECT SIMILAR SOFTWARE TO BE
SORT OF WIDELY APPLICABLE NSO
THE LAUNCH FOR THE SPECTRALIS
DEVICE BY MDR APPROVING WHICH IS
THE ONLY EXTERNAL CERTIFICATION
AND NOT MDD WHICH IS LIKE A
LABELING THAT JUST HAPPENED LAST
YEAR IN NOVEMBER.
SO WE TALK ABOUT REALLY WARM
BREAD AND THERE IS A VERY
SIGNIFICANT UPTAKE IN EUROPE,
IT'S NOT APPROVED BUT YOU CAN
USE IT BY RESEARCH AGREEMENT AND
MAKING YOUR OWN MEASUREMENTS.
THIS IS NOT MEANT TO BE DEVICE
BEPENDENT OF COURSE, OF COURSE
SPACTERAL SIS WERE ABUNDANTLY
PRESENT BUT WE'RE ALSO PROVYING
TOOLS FOR MAESTRO AND OTHERS BUT
IT HAS TO GO TEP BY TEP, THE
FIRST STEP TOOK US 10 YEAR ANDS
THE NEXT STEPS WERE FASTER NSO
PEOPLE CAN E-MAIL YOU TO GET
ACCESS TO THE RESEARCH
APPLICATION?
NCAN IN.
>> CAN PEOPLE REACH OUT TO YOUR
GROUP TO GET ACCESS TO THE
INFORMATION?
>> OF COURSE.
OF COURSE.
IT FLIES AROUND THE DPLOAB.
>> WE WE HAVE ANOTHER QUESTION
FROM THE AUDIENCE IN NTHANK YOU
SO UPON FOR YOUR WONDERFUL
TALKS, THIS IS A QUESTION FOR
YOU, SO YOU SHOWED THE VISIBLE
IMAGES OF THE LIGHT OCT OF THE
INNER RETINA.
HOW DO YOU THINK THAT WILL
CHANGE OUR ABILITY TO MANAGE
GLAUCOMA IN HAVING HIGHER ARE
PRODUCIBILITY OF MEASURE UPON
ANDS ALSO THE NUMBER OF STEPS TO
THE FLOOR WHICH WE HAVE ISSUES
WITH OCT AND RNFL?
>> I THINK THOSE ARE BOTH GOOD
AND IMPORTANT QUESTIONS THAT WE
DON'T HAVE ANSWERS TO.
IT'S STILL VERY EARLY IN
MEASURING IPL.
AND WE'RE LOOKING AT THICKNESSS
IN THE VARIOUS LAYERS BUT I
THINK THAT IT'S GOING TO TAKE A
BIT MORE TIME TO FIGURE OUT HOW
THOSE LAYERS CHANGE OVER THE
COURSE OF THE DEC.
THEORETICALLY, WE THINK THAT
WILL WE WILL PICK UP EARLIER
DISEASE BY LOOKING IN THE IPL,
BUT WE JUST DON'T KNOW YET.
>> THANK YOU.
>> QUESTION TO URSULA, REGARDING
THE [INDISCERNIBLE] INHIBITION.
SO WHICH COMPLEMENT TO YOUR
[INDISCERNIBLE]?
AND WHAT IS THE OUTCOME?
>> ME PERSONALLY, I AM NOT
[INDISCERNIBLE] COMPLEMENT BUT
THE QUESTION IS WHICH PATHWAY,
WHICH THERAPEUTIC TARGET IS
THERE, SO IT'S TARGETS C3, OR
NEXT 1 IS TARGETING C5, AND THE
NEXT 1 IS TARGETING C1 CAN THEY
ALL HAVE AN EFFECT ON THE PHOTO
RECEPTORS, WE WILL SEE TO WHICH
EXTENT IT WILL VARY.
MOST OTHER TARGETS ALSO DO THIS.
SO THIS BIOMARKER HAS NOTHING TO
DO WITH COMPLEMENT INHIBITION,
SPECIFICALLY.
IT JUST SEEMS TO BE A BIOMARKER
THAT IS LIKE THE END STAGE OF
PHOTO RECEPTOR MAINTENANCE OR
DAMAGE, NOT JUST SPECIFIC FOR
COMPLEMENT.
NTHANK YOU.
>> THANK YOU SO I HAVE A
QUESTION FOR CINDY.
WHAT IS THE BIGGEST BARRIER TO
US USING OCT IN THE NICU AND FOR
ADOPTION OF THIS TECHNOLOGY IN
THE WIDER PEDIATRIC POPULATION?
>> HAVING A COMMERCIAL SYSTEM.
I HAVE BIAS.
BUT IF THERE'S NOT A DEVICE OUT
THERE, THAT'S OUR BIGGEST
BARRIER RIGHT NOW AND I THINK
THE REASON, THE PEDIATRIC
POPULATION IS NOT WELL FUNDED,
YOU KNOW THIS IS NOT A MEDICARE
POPULATION, THIS IS MEDICAID.
THESE ARE IN PRIVATE INSURANCE
ISSUES OF GETTING KIDS AND
GETTING ACCESS SO I THINK THAT
IMPACTED THE FIRST COMPANY
INVOLVED WITH A SYSTEM AND I
THINK IT'S GOING TO DEPEND ON A
COMMERCIALLY VIABLE MODEL COMING
OUT THE NEXT TIME.
>> SO YOU DON'T THINK THAT
NURSES AND PHYSICIANS USING IT
IS GOING TO BE A BARRIER, YOU
THINK IT'S MORE THE MODEL FOR
SURVIVAL?
>> SORRY.
I WILL TAKE BACK, SO I ALSO
BEING THAT THE CHANGES OF 1212
IT WAS TIME DOMAIN, THIS WAS
SPECTRAL DOMAIN BUT IT WAS STILL
WE WERE TALKING ABOUT LIKE THAT
SYSTEM IS 30 KILOHERTZ.
SO WHEN WE'RE TALKING ABOUT NOW,
300 KILOHERTZ, THE ABILITY TO
CAPTURE RAPID IMAGE AND THEN THE
OTHER 1 WAS PAYING ATTENTION TO
ALL THE NURSES COMPLAINING ABOUT
THE RISK CHALLENGE AND ALL
EMPLOY SO A LIGHT SYSTEM THAT'S
RAPID AND EASY.
I THINK WE HAVE THAT BARRIER
DONE.
I THINK THAT I DON'T SEE AS A
PROBLEM RIGHT NOW AND NOW
AUTOLIKE OH, WE HAVE TO POP ON
THE EYE READY TO GO N1 LAST
QUESTIONS PERHAPS BECAUSE--
>> MY QUICK QUESTION IS, THANK
YOU FOR AGAIN, AS A COMMENT,
THANK YOU FOR ALL THE VERY
INTERESTING TALKS.
WOULD YOU CONSIDER A BASE LINE
OCT AT ANY TIME POINT AS BEING
SOMETHING THAT WOULD BE
IMPORTANT DOWN THE LINE FOR THE
FOLLOW UP OF A PATIENT GIVEN HOW
AVAILABLE OCT TECHNOLOGY HAS
BECOME AND AT WHAT AGE SHOULD
THAT BASE LINE BE OBTAINED AND
MAYBE HANDED TO THE PATIENT SO
THAT THEY HAVE IT FOR REFERENCE?
>> IT'S A GREAT, GREAT, QUESTION
BECAUSE WE TEST HEARING IN EVERY
INFANT BEFORE THEY LEAVE THE
HOSPITAL AND YET THE TEST FOR
VISION IN INFANTS IS A PEN LIGHT
FROM A PHYSICIAN.
SO I THINK OCT AT BIRTH AS PART
OF UNIVERSAL SCREENING MAY WELL
BE A CONSIDERATION AND CERTAINLY
SHOULD BE FOR THE KIDS AT
GREATEST RISK.
WE'VE IDENTIFIED CATARACT IN
FACT THROUGH OCT SCREENING THAT
WAS MISSED BY PEDIATRICIANS.
>> AND IN ADULTS I WOULD SAY
IT'S ALSO VERY IMPORTANT
ESPECIALLY WITH THE USE OF AI
CAN USING A SINGLE SCAN TO
PREDICT FUTURE TRAJECTORIES.
SO I THINK THAT, YOU KNOW HAVING
AN ADULT SCAN WOULD BE WORTH
WHILE,IME NOT SURE WHAT AGE, 40?
>> VERY, VERY COOL.
I THINK FOR THAT, AND I THINK TO
KEEP US ALL ON TIME, THANK YOU
TO MY SPEAKERS FOR REALLY
ENGAGING AND AMAZING TALK ANDS I
THANKS TO THE AUDIENCE FOR
ENGAGING.
THANK YOU.
KD--SALLY ARK PLAWZ [ APPLAUSE ]
[ APPLAUSE ]
>> OKAY, THANKS SO MUCH FOR
KEEPING ON TIME AMANI AND
SPEAKERS LET'S TAKE A 10 MINUTE
BREAK AND BE BACK HERE AT 10:37
FOR THE LAST SESSION.
OKEY SO LET'S GET GOING
WITH THE LAST SESSION, AI AND
DATA STANDARDIZATION AND IT'S A
PLEASURE TO INTRODUCE AARON LEE
WHO IS WITH THE UNIVERSITY OF
WASHINGTON AND HE WILL WILL MOE
THIS SESSION.
>> THANK YOU VERY MUCH.
I HOPE YOU CAN FIND YOUR SEATS
QUICKLY, I WAS JUST REFLECTING
ON THE LAST SESSION, I WAS
WONDERING IF THAT SESSION SHOULD
HAVE BEEN CALLED AI AND OCT
BECAUSE THERE WAS QUITE A BIT OF
AI IN THAT SESSION, BUT THIS
SESSION IS SORT OF GOING TO BE
FOCUSED.
AND HOW WE MUCH PUSH THE FIELD
FORWARD AND NOW WE HAVE THIS
AMEASING TECHNOLOGIES IN OUR
CLINICS.
THE FIRST SPEAKER IS AND THEY
WILL TALK ABOUT THE PUSHING THE
UBIQUITOUS OF THESE DEVICES TO A
WHOLE OTHER LEVEL AND BRINGING
THISEM INTO THE HOMES OF AND IF
YOU COULD COME UP HERE AND GIVE
YOUR TALK.
>> THANK YOU AARON AND I WILL
TALK ABOUT CORRELATED CT AT
HOME.
HERE THE DISCLOSURES, AND
EVERYTHING I WILL BE PRESENTING
IS DONE THRU A LOT OF HARD WORK
FROM THE NOTALL TEAM, MANY OF
THEM HAVE WORKED VERY HARD TO
MAKE THIS POSSIBLE, BUT I MUST
ALSO SAY THAT THIS HAS BEEN MADE
POSSIBLE BY ALL THE HARD WORK
WHICH HAS BEEN DONE BY THE OCT
COMMITTEE OVER THE USE AND
THAT'S WHAT WE ARE HERE TO
CELEBRATE EMPLOY DR. FUJIMOTO,
DR. SWANSEN, IF YOU WANT TO SEE
THE EFFECTS WE CAN LOOK AT THE
ROOM, THE COMPANIES HERE, THE
ORGANIZATIONS HERE ARE
INFLUENCED BECAUSE OF OCT AND A
LOT OF CARRIERS INCLUDING MYSELF
WERE INFLUENCED BECAUSE OF OCT,
SO THAT SHOWS THE TRUE IMPACT OF
WHAT OCT HAS HAD.
IN THIS PRESENTATION WE WILL
TALK ABOUT THE CONCEPT OF AT
HOME OCT, AND WHAT IS REQUIRED
FOR HOME OCT.
WHAT ARE THE TECHNICAL
CHALLENGES BEHIND IT, AND WHAT
IS THE ROLE OF ARTIFICIAL
INTELIENCE BEHIND IT AND HOW WE
CAN MAKE IT A REALITY.
SO WE LOOK AT THE GROWTH OF HOME
OCT, THIS IS FROM A PAPER IN
2017 AND UNTIL ABOUT 2001, WE
HAD 400 UNITS INSTALLED.
THERE WAS AN INFLECTION POINT
AROUND 2006 THAT MOVES US
TOWARDS THOUSANDS OF UNIT XTION
WE WERE SOMEWHERE BETWEEN
10-20,000 UNITS FOR OCT NOW.
SO WHEN IS THE NECKS INFLECTION
POINT?
IF YOU LOOK IT IS MOSTLY USE
INDEED OPHTHALMOLOGY AND
CARDIOLOGY BY THE SPECIALIST.
IT'S MOVING MORE TOWARDS THE
PRIMARY CARE,
DR. [INDISCERNIBLE] TALKED ABOUT
USING IT AT POINT OF CARE, THERE
IS AN NDA CLEARED DEVICE FOR
USING O, KREBS CYCLE T FOR EAR
INFECTION DIAGNOSIS BUT GOING
FURTHER FROM THAT, CAN OCT BE
USED AT HOME SO EACH INDIVIDUAL
HAS AN OCT AT HOME.
OF COURSE NOT ALL OF US WILL BE
BUT THE PATIENTS WHO ARE IN NEED
OF IT CAN POTENTIALLY USE IT AT
HOME AND THAT WILL TRULY
INCREASE ITS IMPACT.
WHAT DOES OCT AT HOME LOOK LIKE?
IT'S OF COURSE, THE POINT OF
HAVING IT AT HOME IS TO ACQUIRE
DATA AT A VERY HIGH FREQUENCY
AND HAVING SOME BIOMARKERS
TACKED AT THAT HIGH THROUGH
FREQUENCY ACQUISITION AND HAVING
THAT PLOTTED AS A FUNCTION OF
TIME.
SO 30 YEARS AGO OKRRK T GAVE US
CAPABILITY TO ELECTRIC AT THE
THIRD DIMENSION OF THE EYE, NOT
JUST THE SURFACE BUT WHAT LIES
BEHIND.
HOME OCT PROMISES US TO SHOW US
THE FOURTH DIMENSION OF TIME.
CAN WE TRACT THE BIOMARKERS AT A
HIGH TEMPERATURE FREQUENCY AND
SEE HOW THEY CHANGE OVER TIME IS
NOT JUST IN SPACE.
AND WHAT IS THE NEED FOR THAT?
THE NEED WE WILL FOCUS ON IS
AMD, WHICH IS THE LEADING CAUSE
OF PLIENDNESS IN THE UNITED
STATES.
AS DR. HUANG MENTIONED IT WAS
GREATLY IMPACTED WITH THE ADVENT
OF ANTIVEG F, IT DOES NOT
ANYMORE MEAN THAT THE PATES ARE
GOING TO GO BLIND.
IT'S NOT A 1 WAY STREET BUT
THEIR VEGZ CAN ACTUALLY BE
PROTECTED AND REGAINED FROM THE
TIME OF DIAGNOSIS.
HAD IS HOW THE YOWRNY OF AN AMD
PEASHT LOOKS LIKE, WHEN YOU HAVE
INTERMEDIATE AMD, THERE'S A
SIGNATURES 95 LOSS OF VISION,
PIVOTAL TRIAL SHOWED THAT
ANTIVEG F CAN ACTUALLY REVOAEVER
SOME OF THAT VISION AND
STABILIZE IT.
ALL THE PIVOTAL TRIALS DONE WERE
AT A FIXED DOSING REGIMEN, SO
WERE GETTING MONTHLY AND FOR THE
NEXT GENERATION DRUGS BI MONTHLY
TREATMENT AND THAT SHOWED VERY
GOOD RESULTS.
THIS WASN'T REALLY POSSIBLE IN
REAL LIFE.
AND TO TREAT PATIENTS EVERY
SIPPINGLE MONTH.
SO THERE ARE 2 PROMINENT
REGIMENS ARE TREATING PATIENTS 1
IS CALLED PREFRESH YOUR
RECOLLECTION N, WHERE WE LOOK AT
THE IMPAG IS THERE NO HIGH
REFLECTIVE AREA OF FLUID IN THE
IMAGE THAT MEANS THAT THE
PATIENT WILL NOT BE TREATED, IF
THERE IS A HYPER AREY FLECTIVE
AREA WHICH INDICATES PRESENCE OF
FLUID THEN THE PATIENT WILL BE
TREATED.
NOW THIS--NOW THIS REDUCES THE
BURDEN OF DRUG USE BUT DOES NOT
REDUCE THE BURDENOT PATIENT,
THEY HAVE TO COME AT VERY
REGULAR INTERVALS TO HAVE THEIR
RETINAS BE IMPAGGED ON OCT, THE
OTHER IS AN EXTENT TO WHERE A
PEESHT IS REESHTED ON EVERY
SINGLE VISITIT BUT IF THERE'S NO
FLUID SEEN, OR MAINTAINED, IF
THE FLUID IS SEEN, THEY PATIENT
IS BROUGHT IN SOONER UNTIL A
CERTAIN LIMIT.
IT'S IMPORTANT TO SEE ALL THESE
DECISIONS ARE BASED ON OCT AND
THIS IS WHERE OCT IS THE FLOWER
TO THE BEE, SO WOTHAT, YOU
CANNOT PLAN YOUR TREATMENT
REGIMENS AND THIS IS MEN AND
WOMEN HAS MADE OCT DIAGNOSTIC
COMPANIONS TO AMD TREATMENT.
THE CHALLENGE HAS BEEN THAT WITH
THIS TYPE OF REGIMEN WE'RE STILL
MAKING A GUESS ON WHAT THE
PATIENT IS GOING TO REACTIVATE
NEXT.
AND THIS ALSO LEADS TO A LOT OF
TREATMENTS IMIVEN WHEN THE
PATIENT MAY NOT NEED IT BECAUSE
THEY MAY COMPLETELY HAVE NO
SEENS OF DEC AT THAT MOMENT.
SO IF YOU LOOK AT WHAT HAPPENS
AT THE SNAPSHOT IMAGES, I AM
GIVING YOU AN EXAMPLE OF 2
AISLES WITH 2 NAP SHOTS BEING
ACHEN ON THE DAYS THE PATIENT IS
IN CLINIC.
IN BOTH CASES THE GREEN HERE
REPRESENTS PRESENCE OF
SUBRETINAL FLUID.
IT SEEMS LIKE THE PATIENT IS NOT
RESPONDING TO THE DRUG, YOU HAD
THIS IN THIS IPT GREATER ANNUAL
AND THEN THE PATIENT CAM BACK
INTO THE CLINIC AFTER THE
TREATMENT AND STILL HAD
SUBRETINAL FLUID EMPLOY HOWEVER
IF WE LOOK AT IMAGE IT IS IN
BETWEEN, 1 OF THESE EYES HAD
COMPLOATLY DRIED OUT BROADER
IMPACTS OTHER HAD SHOWN NOT MUCH
RESPONSE TO THERAPY.
THESE PATIENTS WERE BEING IMAGED
ON HOMOCT AND HAD IS HOW THE
TROUGH--TROJANOWSKI YECTRY LOOK
LIKE.
SO THE ENGINEERS IN THE AUDIENCE
WILL TALK ABOUT HOW SOMETHING
HAS THIS MUCH IN THE SIGNAL AND
WE ARE SAMPLING ONCE A MONTH, WE
ARE MISSING A LOT OF DATA, THIS
IS SEEMS ALMOST IMPOSSIBLE TO
TRACK A DEC WHICH IS SO DYNAMIC
WITH JUST SUCH SPARSE SAMPLES.
AND WE HAVE RESULTS TO PROVE
THAT IN REAL WORLD PATIENTS DO
NOT SEE THE SAME GAINS WHICH ARE
SEEN WITH MONTHLY CLINICAL TRIAL
TREATMENT.
THIS IS A REAL UNIVERSITY
STARTED THAT SHOWS THAT PATIENTS
DO NOT ON AN AVERAGE GAIN VISION
BUT MOSTLY JUST STABILIZE IT AT
1 YEAR TIME POINT.
REAL WORLD AMD CAUSES 10 BILLION
DOLLARS TO U.S. HEALTH SYSTEM
JUST IN DRUG COSTS AND ANTIVEG F
TREATMENTS ARE PART OF MEDICARE
PART B, WHICH IS WHEN ALL THE
DRUGS ARE USED AT THE CLINIC,
ENDOCRINOLOGY, EVERYTHING PUT
TOGETHER, THESE 2 DRUGS COST 10%
OF THE BUDGET, THAT SHOWS THE
BURDENOT HELT CARE SYSTEM.
THERE IS A HUGE BURDEN ON THE
PATIENT WITH THE FREQUENT
VISITSAs WELL AS INCLUDING
CAREGIVERS.
PATIENTS SHOWS IT TAKES 12 HOURS
FOR PATIENTS TO RECOVER FROM
THESE TREATMENT VISITS, 59% OF
THOSE GO OVER THE CAREGIVER, AND
ESTIMATES OTHERS SHOWN AT
AMERICAN SOCIETY OF RETINA
SPECIALISTS SHOW THAT IT COSTS
U.S. PRODUCTIVITY LOSS OF 1
BILLION DOLLARS EVERY YEAR
BECAUSE OF THE WET AMD TREATMENT
VISITS.
TO ADDRESS THESE THERE ARE NEW
THERAPIES WHICH HAVE BEEN
APPROVED BY FDA, TO EXTEND THE
TREATMENT INTERVALS,
[INDISCERNIBLE] HAVE SHOWN IN
CLINICAL TRIALS THEY CAN EXTEND
PATIENTS FURTHER.
ALTHOUGH SOME PATIENTS CAN GO UP
TO 16 WEEKS, MANY GO TO 12 WEEKS
BUT IT IS STILL A HETEROGENIUS
DISEASE, NOT EVERY PATIENT IS
EXTENDED AND THAT'S WHERE THE
RULE OF PERSONALIZATION COMES
INTO PICTURE.
WITH THESE NEW DRUGS WE ARE IN
NEW ERA OF AMD TREATMENT, SO THE
QUESTION IS ARE WE IN A NEW ERA
OF DIAGNOSTICS AS WELL.
SO TBENT YEARS AGO WHEN THE
FIRST ANTIVEG F TREATMENTS
RESUMMIT INDEED A LAUNCH OF OCT,
INTO MAIN STREAM, HOW DO THE NEW
TREATMENTS IMPACT THE NEXT
GENERATION OF DIAGNOSTICS AND
THIS IS WHERE THE REAL UNMET
NEED COMES INTO THE PICTURE AND
WE REALLY NEED INDIVIDUALIZED
HIGH FREQUENCY INFORMATION
WITHOUT INCREASING BURDEN ON
PATIENT ANDS THE HELT CARE
SYSTEM AND THAT'S WHAT HOMOCT
PROMISES TO DO BUT TO BE ABLE TO
MAKE IT FEASIBLE, WE NEED 3
THINGS TO HAPPEN, PATIENT HEAT
SHOCK SYSTEM BE ABLE TO TAKE THE
SCANS AT THE HOME BY THEMSELVES,
THERE SHOULD BE AI TO AUTOMATE
RELEVANT BIOMARKER ANDS THEN
PATIENTS SHOULD BE ABLE TO DO IT
OVER AN EXTENDED PERIOD,
SOMETIMES FOR YEARS TO MAKE IT
REALISTIC.
SO THAT'S THE TECHNOLOGY THAT
HAS MADE HOME OCT POSSIBLE,
HERE'S THE DISCIPLINARY VIS,
UNDER THE SPECERAL DO DOMAIN
WITH 300 BY 300 PICTURE AND 500
BY 500 KAN--KANAS TAKEN.
THE GOAL S&P THAT SOMEHOW WE
HAVE TO MAKE THE PUPIL IN THE
RIGHT XYZ LOCATION, THAT IS WHAT
WE KNOW TO GET A GOOD
SELF-IMAGE.
THIS IS DONE THROUGH PATIENTS
ALIGNING THESE 2 CROSSES, WHITE
AND THE RED 1S MUCH.
THE PATIENT MOVES THEIR FOREHEAD
UNTIL THE WHITE CROSS COMES OVER
TO THE RED 1.
THIS BRINGS THE PUPIL IN THE
CORRECT POSITION AND USING THE
ALIGNMENT PROBLEM FOR THE
SOLUTION IS VERY IMPORTANT
BECAUSE EVEN THE PATIENTS WHO
HAVE VERY POOR VISION, WE ARE
TALKING OF 23-20, THEY ARE ABLE
TO DO THIS ALIGNMENT EXERCISE.
I CAN TAKE OFF MY CONTACT LENSES
AND STILL BE ABLE TO DO IT.
I SEE THESE AS HUGE PLUS.
SO ARE THERE CLINICAL STUDIES TO
SHOW THAT THIS PROCESS ACTUALLY
WORKS?
YOU'DY KIM CAME IN AND DID A
STUDY WITH OVER 290 SUBJECTS AND
500 EYES WHERE PATIENTS WERE NOT
GIVEN ANY ASHES CYSTANCE WITH
THE TECHNICIANS, AND THEY ONLY
SAW A 2 MINUTE VIDEO TUTORIAL
AND THEN THEY HAD TO SELF-IMAGE,
THEY WERE TO SEE IF THE RESULTS
ACTUALLY MATCH.
THESE ARE ACTUAL PATIENTS,
MEDIAN AGE OF FEAT YEARS, 91% OF
SUBRECYCLINGS WERE WERE ABLE TO
SUCCESSFULLY SCAN.
THERE NOT A HUGE TEPENDENT ON
THE PATES FOR SELF-SCANNING
UNTIL IT FELL BELOW 23, 20.
THERE WAS STRONG AGREEMENT WITH
THE IN-OFFICE HOME OCT AS FAR AS
DETECTORS OF FLUID.
NEXT IS THE ROLE OF ARTIFICIAL
INTELIENCE AS DR. ROSEN SAID
YESTERDAY, THE CLINICIANS HAVE A
MICROSECOND WITH THE PATIENTS
AND THAT'S PROBABLY ON A SLOW
DAY, WE CANNOT BURDEN CLINICIANS
WITH MORE DATA AND THIS IS WHERE
THE ROLE OF AI COMES BO THE
PICTURE, THE AI SHOULD BE ABLE
TO DETECT BIOMARKERS AND
PROTENTIALLY PROVIDE A TRIGGER
TO THE POSITION THAT ADVANTAGED
THE RIGHT TIME TO EVALUATE THE
DATA.
SO DR. KIM'S STUDY USE OF DEEP
LEARNING ALGORITHM, FOR OCT
ANALYZER TO QUANTIFY FLUID IN
THE OCT SCANS.
AND THEY FOUND STRONG
CORRELATION BETWEEN THE HUMAN
GREATERS AND THE DEEP LEARNING
ALGORITHM WITH THE VERY SMALL
MAIN DIFFERENCE DUE IN THE PELT
AND ULTIMATE ANALYSIS
EMPLOY--THROUGH OUR OTHER
EXPERIENCES WE KNOW IT'S NOT.
EVEN THOUGH YOU GIVE A PERFECT
TECHNOLOGICAL SOLUTION, THERE IS
TEST, COMPLIANCE, SUPPORT,
ANXIETY OF THE PATIENTS,
FINANCES AND THIS IS WHY AT
NOTALL, WE UNDERSTAND WE HAVE TO
PROVIDE A FULL CONCEPT SOLUTION
AND WE HAVE PROVIDED A CENTER
THAT IS LED BY OPHTHALMOLOGISTS
AND STARTS WITH OPHTHALMIC
PROFESSIONAL ANDS MANY OF THEM
TRAIN WITH HOW TO WORK IN
PATIENT IN A CLINICAL SETTING.
THEY TAKE CARE OF ALL THE LODGE
LARGER DETAILS WHICH IS NOT AS
GLAMOROUS AS AI BUT ARE ESSENT
YELL TO MAKE THE CARE A REALITY.
NOW THE QUESTION IS, JUST THIS
NEW PARTAKEN--THEY DIME, DO SRO
DAT TO SUPPORT IT ACTUALLY
WORKS, ANOTHER DEVICE WHICH IS
USED TO DETECT CONVERSION FROM
WET TO DRY AMD, THERE IS A TINY
RETROSPECTIVE DATA ON PATIENT
COMPLIANCE AND PATIENTS ON THIS
PROGRAM HAD A TESTING FREQUENCY
OF 5.2 TESTS PER WEEK, PROBABLY
A VERY HIGH COMPLIANCE OF A
PATIENT WHO'S NOT GOING INTO
OFFICE AND NOT BEING TOLD BOY A
DOCTOR WHAT TO DO.
WE TRY TO SEE IF THIS MODEL
WORKS FOR HOMOCT IN A
LONGITUDINAL STUDY, THAT WAS
UNDER PROTOCOL AK FUNDED BY NEI,
THE 6 MONTH FOLLOW UP TODAY ON
HOME OCT, WITH PATIENTS FROM
2020 TO 20/32, HAD OVER 2000
SCANS AQUAR QUIRED AT A HIGH
SUCCESS RATE WITH A PATIENT
SHOWING ADHERENCE OF 3.6 STAN
SCANS PER WEEK.
SO THEY'RE ALMOST DOING THE SCAN
EVERY DAY.
THE MEDIAN TIME FOR ACQUISITION
WAS 47-SECONDS AND THAT INCLUDES
PATIENTS ALIGNING THEM AND
ACQUIRING THE IMAGE.
ALL SCANS REPORTED MATCH WITH
THE EXPERT GREATER ASSESSMENT OF
FLUID PRESENCE OR ABSENCE.
HADDA IS ALSO INTERESTING TO SEE
ARE THE FLUID VOLUME PROJECTRYS
WHICH ARE NOW PUBLISHED.
WE CAN SEE THE HETEROGENEITY IN
THE THESE PATES, NONE OF THEM
LOOK THE SAME AS EACH OTHER.
ANOTHER LONGITUDIAL STUDY DONE
BY DR. JEFF HAI AND NALSY
HOLCOMB SHOWED EXPERIENCE IN THE
PATIENT WITH HUGE HETEROGENEITY
IN THESE TRAJECTORIES.
PATIENT SATISFACTION IS A HUGE
FACTOR IF YOU WANT THEM TO DO
THESE TESTS IN THE--AT THEIR
HOME AND ON A REGULAR BASIS.
SO PATES WERE ASKED A NUMBER OF
QUESTIONS, I THINK 2 OF THE MOST
IMPORTANT 1S WERE EASE OF USE
AND CONVENIENCE OF DAILY
IMAGING.
NINETY-SEVEN% OF RESPONDENTS
GAVE A POSITIVE, A CORE OF 4 OR
5 ON GRADING FROM 1 TO 5.
SO THIS SHOWS THAT THE PATIENTS
DO FEEL COMFORTABLE USING THIS
DEVICE AT HOME, AN AN ECTOMYOSIN
DID HE TELLAL EXPERIENCE THAT
THE PATIENTS SHARES THAT GOES
FROM GOING TO THE CLINIC ALL THE
TIME, IT'S DEFINITELY MORE CALM
BY DOING THE 40-SECOND SCAN AT
HOME.
ANOTHER QUESTION IS THIS CAN BE
ACQUIRED, DOES IT IMPACT
CLINICAL DECISION MAKING IN WILL
IT HAVE ANY CHANGE IN HOW THE
PATIENTS ARE MANAGED IN SO TO
UNDERSTAND THAT, WE SHOWED
PATIENT--PHYSICIANS HOME OCT
DATA OF THE PATES WHEN WERE
MANAGED IN THE CLINIC USING
STANDARD OF CARE, AND WE ASKED
THEM WOULD YOU CHANGE YOUR
DECISION BASED ON THAT, THEY
WERE MASKED TO THE ACTUAL
DECISION THAT WERE MADE IN
CLINIC.
IN FROM--INTEGRATION PASSPORT 7%
OF THE CASES WHEN THE--42.7% OF
THE CASES IN THE CLINIC,
PHYSICIANS DECIDED NOT TO TREAT
AND GIVE HOME OCT DATA.
THIS SHOULDN'T BE SURPRISING
BECAUSE HOME PATIENTS ARE OFTEN
BEING TREATED IN A PREVENTIVE
FASHION.
ALTHOUGH, IN 2/3RD OF THE CASES
WHEN THE PHYSICIAN DID MAKE A
DECISION TO TREAT, THEY MADE A
DECISION TO TREAT THE PATIENT 1
WEEK BEFORE THEY WERE ACTUALLY
BEING TREATED.
THESE ARE EARLY RESULTS BUT
THESE POINT TO 2 OF THE BIGGEST
CHALLENGES WE FACE, 1 IS THAT
PASHTS DON'T GET TREATA THE
RIGHT TIME, SO EVENTUALLY POORER
OUTCOMES, SECOND PATIENTS ARE
TREATED WHEN THEY DID NOT NEED
TO BE TREATED AND THAT PROBABLY
INCREASES THE BURDEN AND THE
COST BURDEN ON THE HEALTHCARE
SYSTEM.
SO OUR FINDING SHOWS THAT IT HAS
IGF 95 CANT IMPACT ON THE
DECISION MAKING, WE HAVE ALSO
SEE IN THIS AN INTERVENTIONAL
TRIAL IN PUBLICATION WITH
RETINAL.
THIS IS WHERE HOME OCT STANDS
TODAY.
OVER 1800 PATIENT EYES, NOT
TESTING, NOT QA ALL PATIENTS
EYES HAVE BEEN TESTED.
78,000 VOLUMES,A QUIRED,
5 MILLION B SCANS, GENERATING
93,000 GIGA BYTES OF DATA.
THAT I THINK BRINGS UP TO A BIG
NUMBER DATA, AND AS OF FRIDAY,
THE PATIENT IS SCANNING EVERY
COUPLE DAYS, SO IT IS GENERATED
IN REALTIME.
WE HAVE STARTED WITH THE CONFORM
ABTS THAT'S WHEN WE WORK WITH
OUR SPONSORS OF THE CLINICAL
STUDIES SO FAR TO HAVE ACCESS TO
THOSE CONFORMATIVE IMAGES SO
THEN, IT IS AN EXAMPLE OF
BRINGING MEDICAL NEED,
TECHNOLOGICAL SOLUTION AND
COMPASSIONATE CARE TOGETHER TO
ACTUALLY BRING THIS TECHNOLOGY
TO HUNDREDS AND THOUSANDS IF NOT
MILLIONS OF PATIENTS IN THE
FUTURE.
THANK YOU.
[ APPLAUSE ]
>> UP NEXT WE HAVE AMITHA WHO
WILL TALK ABOUT DATA
STANDARDIZATION IN CLINICAL
TRIALS.
>> THANK YOU TO NEI FOR THIS
AMAZING TIEWPT TO CELEBRATE A
GREAT INVENTION AND THANK YOU TO
THE KEY NOTE SPEAKERS YESTERDAY
AND TODAY, FOR ARK MAZING TALKS,
I WILL TALK ABOUT DATA
STANDARDIZE WITH RESPECT TO 2
ASPECTS, CLINICAL TRIALS AND
IMAGE CURATION FOR AI.
RETINAL IMAGES, JUST 50 YEARS
AGO WAS STILL PAPER BASED.
ARTISTIC DOCUMENTATION ON PAPER
OF VESSELS, LESIONS, THINGS LIKE
THIS AND AT THE READING CENTER,
WE STILL HAVE A FEW OF THESE
LYING AROUND SOMEWHERE.
AND IT WASN'T UNTIL THE 80S THAT
PHOTOGRAPHY BECAME MAIN STREAM
IN CLINICAL TRIALS ABOUT YOU IT
WAS STILL FILM IMAGING AND THESE
WERE FILM PHOTOGRAPHS THAT WOULD
COME TO US IN THESE SLEEVES AND
WE HAD TO LOG AND USE LIGHT
BOXES AND STEREO VIEWERS TO LOOK
AT THEM.
BY THE 2000S, EVERYTHING BECAME
DIGITAL, AND EXPANDED BEYOND
FUNDERS PHOTOGRAPHY TO OCT
IMANNUALING AND ULTRA WIDE FIELD
AND EVERYTHING ELSE STARTED
EXPLODING WITH IMAGING AND SOON
ENOUGH WE HAD ARTIFICIAL
INTELLIGENCE COMING IN AND OCT
IN A BIG WAY.
SO IT'S A SHORT JOURNEY BUT AN
MAISHZING JOURNEY THAT WE'VE HAD
IN RETINAL IMAGING.
SO THE FUNDUS PHOTOGRAPH READING
CENTER WAS ESTABLISHED 50 YEARS
AGO WITH THE NEI AND NIDDK, WITH
SIM NOAL TRIALS AND SINCE THEN
WE'VE HAD MANY BEAUTIFUL READING
CENTERS FOR RETINAL IMAGING AND
ACROSS THE WORLD.
THESE ARE ALL FOR CHEMICAL
TRIALS AND WE'RE NOW CALLED THE
READING CENTER.
AND ALL HAVE A STANDARDIZED
GROAL AND READING TERMINALLING
AND TERMINOLOGY FOR CLINICAL
TRIALS.
THIS IS BY THE TANNED ARD
CERTIFICATION PROCESS WHERE WE
CREATE GUIDELINES ON HOW IT'S
TAKEN, WHAT IS THE ACCEPTABLE
EQUIPMENT AND WHAT IS THE SCAN
PROTOCOL AND THESE ARE TESTED ON
SUBMISSIONS, QUALITY IS MONITORS
AND THAT'S HOW THE IMAGING
ACQUISITION IS STANDARDIZED IN A
CLINICAL TRIAL.
FOR THE END POINTS THERE ARE
READER WHO IS ARE NOT
OPHTHALMOLOGISTS USUALLY, THEY
ARE TRAIN INDEED GRADING
PROTOCOLS AND CERTIFIED, EACH
TRAINER AND TRAINED IN A CERTAIN
PROTOCOL SO THEY'RE ALMOST LIKE
A HUMAN FORM OF AI BECAUSE IF A
GRADER IS TRAIN INDEED DIABETIC
RETINAL LOCATION NUMBER OF
PATIENTSATHY COLOR, THAT'S ALL
THEY DO, THEY ARE NOT TRAIN
INDEED OCT, AND IF THEY ARE
TRAINED IN OCT, THEY CANNOT
INTERPRET COLORS UNLESS THEY'RE
CROSS DOMAIN TRAINED, AND ALL
PATIENT HISTORY SO IT'S JUST
OBJECTIVE ASSESSMENT UNLIKE
CLINICAL INTERPRETATION AND THEY
GO THROUGH RIGOROUS INTEGRATOR
AGREEMENT THAT IS CONTINUOUSLY
MONITORS.
THIS IS CALLED CLINICAL TRIAL
IMAGES AND POINT PROCESS AND
THIS IS THE GUIDANCE DOCUMENT WE
ALL FOLLOW, IT TELLS YOU HOW
CERTIFICATION IS DONE, IMAGES
RECEIVED, GRADED, IT'S ALL
OUTLINES HERE.
DESPITE IN ENTIRE INDUSTRY OF
STANDARDIZATION OF CLINICAL
TRIALS THERE ARE LOTS OF
PROBLEMS.
AND AND THESE ARE DUE TO
VARIABLE, AND WHEN YOU HAVE AND
WHEN DATA POOLING IS VASKTED,
THE OVER ALL STUDY IS AFFECTED
AND THE HEART OF THE STUDY IS
THE HEART OF THE CLINICAL TRIAL
AND IF THAT'S AFFECTED THEN
EVERYTHING ELSE IS LOST.
AND TO PUT THINGS AT A VERY
SIMPLE PERSPECTIVE, WE ALL KNOW
ABOUT THE DIFFERENCES IN
SEGMENTATION AND ALL THE OCT
MACHINES AND THAT LOS ANGELESS
TO A VERY BASIC ISSUE FOR TRIALS
WHERE CENTRAL FOR FIELDS OF
THICKNESS IS A PROOMARY, SECOND
AREAY POINT IN CLINICAL TRIALS.
THOSE MATTERS MANAGE SO MUCH,
MOVING UP OR DOWN CHANGES
THICKNESS AND IF CHANGING
EQUIPMENT MADE WAY TO THE TRIAL
COULD GIVE FALSE EFFICACY ON A
PATIENT UNDERGOING THERAPEUTIC
AND TRIALS, AND 20% CHANGE IN
THICKNESS COULD HAPPEN JUST BY
SWITCHING FROM ZEIS TO A HIDELE
BERG INSTRUMENT.
WE MOVE THE LINES UP AND DOWN TO
MAKE IT ALL STANDARDIZED AND WE
USE REGRESSION FORMULAS LIKE
DRCR NET DOES USE REGRESSION
FORMULAS TO USE STANDARDIZED
MEASUREMENTS ACROSS MACHINES
SOPHISTICATED THESE ARE ALL WORK
AROUNDS THAT ARE USED AND JUST
WHEN WE THOUGHT WE HAVE A WORK
ARK ROUND FOR OCT, OCT
ANGIOGRAPHY COMES ALONG AND WE
HAVE THE MEASUREMENTS ON VESSEL
DENSITY WHICH ARE REPORTED IN
PERCENTAGE OR PERMANENT UNIT
TWHAS CANNOT BE PULLED SO THE
SAME DATA PULLING ISSUE BACK AT
IT AGAIN.
OKAY, SO FOR MANY YEARS IT USED
TO BE THICKNESS AND THAT'S ALL
BUT MOW WE HAVE ARK MAZING END
POINTS, RESEARCH THAT IS BEING
DONE IN END POINTS AND THERE'S A
LOT MORE LAYER BASED SUBJECTIVE,
OBJECTIVE QUANTITATIVE MEASURE
AMS, MANY MORE DETAIL
MEASUREMENTS THAT ARE BEING
DONE, YOU SAW THAT IN THE
PREVIOUS TALKS, DRILL,
INTEGRITY, THICKNESS, FLUID
QUANTIFICATION, QUANTIFYING
HYPER REFLECTIVE FOCI, YOU ABOUT
MOST OF THESE HAVE BEEN
SENSITIVE, THEY ARE DIFFICULT,
THEY NEED AI AND WHEN YOU HAVE
AI, YOU NEED STANDARD EYATION TO
GO BEYOND JUST HAVING, YOU KNOW
THE SAME EQUIPMENT, WITHIN THE
EQUIPMENT, YOU HAVE THE SAME
SCAN DENSITY, RESOLUTION, AREA
OF IMAGING, PATTERN, ALL THAT
MATTERS.
IF YOU HAVE A FLUID
QUANTIFICATION ALGORITHM AND AND
THE OTHER, IT WILL NOT BE
EQUIPULENT.
AND THERE ARE MANY DETAILS THAT
NEED TO BE ADHERED TO SO THIS IS
AT 2 SCANS, INCREASE IT TO 14
SCAN, THE VISIBLE IMPROVES,
MAYBE THE THICKNESS IMPROVES A
BIT.
CHANGE IT TO 25, IT CHANGES EACH
MORE SO THERE ARE THESE FINE
DETAILS WE NEED TO PAY ATTENTION
TO WHEN IT COMES TO THESE
ADVANCED IMAGING AND THE AI.
WHEN THE FDA CLEARS AI MODELS
FOR OR IMAGING FOR EXAMPLE FOR
RETINAL LOCATION NUMBER OF
PATIENTSATHY, THE REFERENCE
STANDARDS ARE USUALLY READINGS
AND ARE GENERATED DATA SO HUMAN
LABEL VERSUS,A I AND COMPARED TO
AND THE DEVICE IS--THE ALGORITHM
IS CLEARED FOR SPECIFIC DISEASE
AND RAM RABUT FUND PHOTOGRAPHS
WHICH IS CLEARANCE AND
OPHTHALMOLOGY FOR, IT'S EASY
ENOUGH, CAN YOU SAY, YOU KNOW
LIKE HERE, I ARK LABEL FOR
CANNON, THEY HAVE EXPANDED
FURTHER NOW BUT 1 OF THE FIRST
1S WAS CANON, AND HAD IS EASY
BECAUSE THIS IS EASY BECAUSE IT
IS RETINAL IMAGING FOR FUNDUS
PHOTOGRAPHY AND SEE THE DEVICE
AND BE DONE WITH IT BUT WHEN YOU
HAVE ADVANCED HIMMAGING LIKE ANY
LASER OR AVAILABLE AND GUIDED
THERE'S SO MUCH MORE TO SAY.
YOU CAN'T JUST SAY, I HAVE IT
NEEDS MORE WITH MACULAR CUBE,
CUBE SCANNING AND ALL THOSE ARE
IMPORTANT METRICS TO ADHERE TO.
AND WHEN WE TALK ABOUT AI, WHERE
DOES ALL THIS END POINT, ALL
THIS SPECIFICATION COME FROM WE
ALL TALK ABOUT IMAGE CURATION
WHICH IS SUCH AN IMPORTANT PART
FOR ACHIEVING THESE HIGH IMPACT
INFORMATION AND IT HAS A LOT OF
LABELS, FORMAT, ANNOTATIONS,
OVERLAYS AND AS READING CENTERS
WE USED TO DO CLINICAL TRIALS
BUT NOW THERE'S ANOTHER SITE TO
IT WHERE MANY COLLABORATORS,
INDUSTRY SPONSORS COME TO US AND
ASK US TO CURATE IMAGES AND MAKE
THEM AI READY AND IT'S A TIME
CONSUMING INTENSE YOB AND SO
MUCH SO THAT IN THE LIFE CYCLE
IMAGE CURATION TAKES NEARLY 80%
OF THE TIME INVOLVED IN MODEL
DEVELOPMENT.
WE ARE VERY EXCITED ABOUT THE
TOMMOLOGY PROGRAM.
SO ABOUT 5 YEARS AGO, WE WERE
LOOKING AT WHEN WE REWERE
CEIVING THIS REQUEST TO CURATE
IMAGES FOR ALGORITHMS SO WE HAD
THESE FUNDUS PHOTOGRAPHS,
RETINAL IMAGES, ALL FILE NAMES
LIKE THIS, THERE WAS NO WAY TO
KNOW WHAT DOES THIS IMAGE BELONG
TO, YES, THERE'S A SUBJECT
FOLDER, WE KNOW IT BELONGS TO
SUBJECT XYZ, BUT IS IT THE RIGHT
EYE, LEFT EYE?
THERE'S NO WAY TO KNOW FROM THE
IMAGE UNTIL YOU OPEN IT AND THAT
WHEN WE REALIZED OH MY GOD THIS
METADATA MATTERS.
THERE'S NO WAY TO TELL FROM THIS
IMAGE WHAT THIS BELONGS TO.
AND WHEN YOU TALK ABOUT 7 FIELD
IMAGES WHICH IS WHAT MOST
CLINICAL TRIALS USE WE HAVE
SPREADSHEETS, WE COULD CONVERT
THESE INTO DISCIPLINARY COM, WE
COULD GET THE SUBJECT ID, PHOTO
DATE OR MANUELLY KIND OF SOMEHOW
INCORPORATE IT INTO METADATA BUT
THINGS LIKE WHICH EYE THE IMAGE
WAS OR WHICH ANATOMICAL
LOCATION, THE RETINA, THESE WERE
NOT THINGS THAT COULD BE RELATED
BETWEEN AN IMAGE AND A
SPREADSHEET BECAUSE THAT DATA
DIDN'T EXIST.
THERE WAS NO NEED TO HAVE THAT
DATA AND HUMANS DON'T NEED THAT
AND HUMAN DON'T NEED TO BE TOLD
WHICH PART OF THE RETINA THIS IS
FROM, SO WE HAD TO BUILD AI FOR
AI, SO WE WERE BUILT AN AI THAT
COULD SAY, WHICH EYE THIS WAS
FROM, WHICH FIELD OF THE RETINA,
SO THIS ALEGORITHMS COULD LOOK
AT IMAGE AND SAY, THIS IS FIELD
1 AND WE ADDED A CONFIDENCE
FIELD TO IT, 99% CONFIDENT THIS
IS THE FIELD 1 AND 65.8%
CONFIDENT THIS IS FIELD 5 AND WE
GEPPED A WORK FLOW BECAUSE IN
THE READING CENTER THOUSANDS OF
IMAGES GO THROUGH THE DAY, SO,
WE NEEDED A STRONG WORK FLOW AND
PROCESS TO USE THIS AI FOR
LABELING.
AND THIS FIELD DETECTOR WE SAID,
WELL, IF IT'S 99% CONFIDENT, WE
WILL LET IT GO BUT IF IT WAS
UNDER THAT THEN A HUMAN HAD TO
CHECK THE IMAGES AND ABOUT 80%
OF THE TIME THE AI DETECTOR
COULD HAVE 99% CONTIARAS DENSE,
SO IT WAS OHM OCCASIONALLY WE
NEEDED A CHECK, SO WHEN WE LOOK
AT THIS, IT WAS DARK IMAGES OR
THE FIELD WASN'T IDENTIFIED AND
WHEN WE GRANTED THE FIRST TIME,
ABOUT 11,000 IMANNUALS, IT TOOK
12 MINUTES TO LABEL ALL THESE
AND CURATE THEM AND ORGANIZE
THEM AND IF YOU HAD A HUMAN
DOING THAT, OUR CALCULATION WAS
86 HOURS.
SO THAT WAS SAVED FOR CURATING,
AT THE SAME TEE WOO DID A
HUNDRED THOUSAND IMAGES AND IT
TOOK ABOUT HALF AN HOUR TO
CURATE THE WHOLE DATA SET.
WITH RETINAL AGAIN, THERE ARE A
LOT IMANNUALS AND IF YOU GET TO
OR T, THERE ARE LOTS OF THEM.
HOW ARE THEY BUILDING AI ON
THESE OCTs, WHAT PROCESS ARE
BEING USED FOR IMAGE CURATION,
SOME USE SPORTS BA UNITED STATES
THEY'RE MORE AVAILABLE ON THE
NEWER SYSTEMS WITH HEIDELBERG,
SOME OF THEM HAVE THE
DISCIPLINARY COMCONVERTER, THERE
ARE FEW, THERE ARE OPEN SOURCE
CRYPTS TO CONVERT IMAGES TO
DISCIPLINARY COM, THERE ARE
INDIVIDUAL SCANS, EACH KAN--KANA
IS EXPORTED AS A 2 D IMAGE SO
YOU GET 1282 D JPEGS TO DEAL
WITH, SOME PEOPLE ARE USING
SCREEN SHOTS, YES, THERE ARE
PUBLICATIONS WITH SCREEN SHOTS
OF OCT, WE DON'T KNOW HOW MOST
PEOPLE ARE PUTTING THEM INTO AI
AND DEVELOPING MODELS.
SO FOR CURATION, OF OCTs WE
HAVE A LOT MORE OF DETAILS WE
HAVE TO ADHERE TO WHEN WE'RE
BRINGING THOSE TOGETHER BUT WHEN
CONVERTING THE DISCIPLINARY
DICOM, THE METADATA NEEDS TO
INVOLVE TONS OF DETAILS TO MAKE
SHOULDURE THAT WHAT THE MODEL IS
TRAINED ON IS WHAT IT'S BEING
DEPLOYED ON.
BECAUSE DEPLOYMENT IS A WHOLE
AND OTHER DIMENSION OF AI,
BECAUSE WHEN YOU DEPLOY AI, YOU
ARE DEALING WITH HUMANS, AND
WHEN YOU REALIZE QUICKLY IS THAT
YOU'RE DEALING WITH HUMAN
SPECIES WHEN YOU DEPLOY AI.
IT'S NOT OCT BASED, IT'S
AUTOFLUORESCENCE, BUT IT WAS
INSTALLED IN CLINICS FOR
SCREENING PATIENTS FOR GA
BECAUSE CLINICAL TRIALS USE AN
AREA LIMIT, THEY SAY, YOU KNOW I
WANT A GA ON AUTOFLUORESCENCE TO
BE 2.5 TO 19 SQUARE MILLIMETERS
SO THIS RUNS JUST THE PATIENT
FALLS IN THAT RANGE AND THEN,
CLINICS CAN TAKE FURTHER IMAGES
LIKE OCT, FA, DO ALL THE
REQUIRED TESTS RATHER THAN PUT
THE BURDEN RIGHT AWAY.
ASK WE GET A CALL, ALGORITHM NOT
WORKING.
WHAT HAPPENED OUR HEIDELBERG WAS
TOO BUSY SO WE TOOK ON SOMETHING
ELSE.
YOU CAN'T DO THAT.
YOU HAVE TO DO HEIDELBERG ONLY,
IT'S TRAINED FOR.
WE GET A CALL AGAIN, THE ALLEGOR
RIG IMPEDIMENTS NOT LOOKING,
WHAT HAPPENED.
TAKE A ELECTRIC AT IT, THERE'S A
GRID ON THE IMAGE, TAKE THE GRID
OFF, BECAUSE AI CAN'T SEE IF
THERE'S A GRID.
YOU TAKE THE GRID OFF,
MEASUREMENTS COME, SO EVERY
SINGLE DETAIL MATTERS,
ESPECIALLY WHEN YOU'RE
PROSPECTIVELY DEPLOYING THESE
FOR USE AND HANDING IT OUT TO
THE PUBLIC FOR USE EMPLOY SO TO
SUMMARIZE CURATION IS THE
CORNERSTONE OF AI MODEL
DEVELOPMENT, WITHOUT WHICH IT
WILL BE VERY DIFFICULT TO
PROGRESS IN THE FIELD, IT'S NOT
ALL APPLES, TO APPLES EACH WITH
OCTs, THERE'S A LOT MORE
DETAILS WE NEED TO TALK ABOUT
AND I THINK I WILL PUT A SPEECH
FOR CARRY GATES WHO TALK ABOUT
ALL THE SOLUTIONS, I SAID I HAVE
THE PROBLEMS AND SHE HAS THE
SOLUTIONS.
THANK YOU.
[ APPLAUSE ]
>> THANK YOU, SHE DID MY JOB FOR
ME BUT NEXT IS KERRY GOETZ, SHE
WILL TALK ABOUT NEI EFFORTS FOR
ADVANCING OCULAR IMAGING
STANDARDS.
>> THANK YOU FOR HAVING ME I'M
EXCITE TO BE AT OCT FEST, OVER
THE PAST FEW YEARS I'VE BEEN
ENAMORED WITH THE TECHNOLOGY AND
THE OFFICE I RUN AT THE
NCEREBELLUMS I, THE OFFICE OF
DATA SCIENCE AND HEALTH
INFORMATIC SYSTEM VERY MUCH
INVOLVED IN SHARING STORIES
ABOUT HOW THIS KIND OF
TECHNOLOGY CAN BE TRANSFORMATIVE
TO HEALTHCARE.
JUST WANT TO SAY ABOUT MY
OFFICE, WE USE OUR NEW PLAN
WHICH HAS A CROSS CUTTING DATA
SCIENCE OF EMPHASIS AS OUR
GUIDING LIGHT.
AND WE ARE REALLY FOCUSED ON
MAKING THINGS FAIR IN 2 WAYS, SO
FINDABLE, ACCESSIBLE,
INTEROPERABLE AND REUSABLE BUT
ALSO FULLY AI READY AND I THINK
THAT'S REALLY WHERE THIS IMAGING
HAS GREAT POTENTIAL.
SO WE TALKED ABOUT THE LAST 2
DAYS ABOUT RETINALPPLICATION,
IDENTIFYING EVERYTHING FROM
OCULAR CONDITIONS TO GLAUCOMA,
CAT RACK, ALL THOSE THINGS BUT
ALSO NONOCULAR THINGS, HEART
DISEASE, ALZHEIMERS, METABOLIC
DISORDERS, WE HAVE THE TRULY
AMAZING ADVANTAGE THAT THESE ARE
NONIMAGED AND THEY ARE DONE BY
NONTRAINED PROVIDERS, THEY CAN
BE DONE BY THE SELF, AND VERY
QUICKLY.
SO IT'S A FABULOUS WAY FOR US TO
BUILD OUT APPLICATIONS FOR
SUBTLE HEALTH REFLECTIVE
TECHNOLOGY.
SO IN THIS CASE, SOME PEOPLE ARE
USING OCULAR IMAGING TO CREATE
HEALTH SCORES, THESE CAN BE
SCORES FOR CARDIAC HEALTH, THESE
CAN BE A GENERALIZED HEALTH
SCORE, LIKE TODAY, I DIDN'T GET
MUCH SLEEP LAST NIGHT AND I WILL
GET A HEALTH SCORE THAT WILL
TELL ME MY SLEEPLESS SCORE, MAKE
SURE YOU'RE DOING BETTER TO
SLEEP BETTER, THOSE SUBTLE
NUDGES TO HELP BEHAVIOR.
AND WE HAVE THESE TECHNOLOGIES,
I'VE BEEN FASCINATED IN SHARING
WITH THE PUBLIC ABOUT THAT--DO
THIS NONINVASIVELY IN THE HOME
AND WE'VE HEARD ABOUT THOSE
ALREADY.
I REALLY SEE WHERE THIS KIND OF
DEVICE IS BIG, IT'S A PLP
READING CUFF THAT EXISTING IN
NATCHER WHICH IS HERE IN CAMPUS,
CAN YOU WALK UP TO 1 OF THESE,
SIT IN FRONT OF IT, PUSH A
BUTTON AND BE ABLE TO GET SOME
INFORMATION RISK ANALYSIS, NOT
DIAGNOSTICS PER SE BUT
SUBSIDIARILE INFORMATION ABOUT
YOUR LIFESTYLE AND HABITS.
JUST LIKE THIS.
SO HAVE YOU AN INTERESTING BLOOD
PRESSURE READING, WHAT MIGHT YOU
WANT TO CHANGE, MAYBE YOU NEED
TO EAT MORE STARCHY VEGETABLES,
GREEN VEGETABLES, MAYBE YOU NEED
TO WALK MORE, GET MORE SLEEP, I
REALLY THINK THIS IS POSSIBLE.
AND WITH THE ADVANCES WITNESS
HOME AND TECHNOLOGIES, AS I WAS
SET UP NICELY FOR, THESE CAN BE
THINGS IF PEOPLE ARE A HIGH RISK
CONDITION THAT THEY'RE DOING
REPEATED APPLICATIONS AS WE
SAID.
WE TO HAVE THESE REPEATED
MEASURES JUST LIKE IN-HOME BLOOD
FLUICOSE MONITORING.
SX HEAT I HAD THE PLEASURE
OF---AND I HAD THE PLEASURE OF
SHARING THESE STORIES, INSIGHTS
INFORMATION WITH HIGH LEVEL
GOVERNMENT FOLKS ADVOCATE ANDS
PEOPLE IN THE HEALTHCARE SPACE,
SO I HAD THE GREAT OPPORTUNITY
TO PRESENT OCT IMAGING AT A
WHITE HOUSE EEIVET THAT WAS
ATTENDED BY PRESIDENT BIDEN, I
YOLK THAT THIS WAS LIKE ADULT
SCIENCE FAIR WITH THE PRESIDENT
AS THE JUDGE, WE DID NOT WIN TOP
3 BUT WE WERE VERY CLOSE AND
EVERYONE WHO CAME TO OUR BOOTH,
I WAS ACTUALLY DOING OCTs, ON
INDIVIDUALS AT THIS EVENT,
MYSELF, I'M A DATA SCIENTIST, SO
THAT'S WITH SHARED EASE OF USE,
AND EVERYONE WAS FLOORED.
THEY WERE LIKE WHY, WHY IS THIS
NOT AVAILABLE.
TWO QUESTIONS I GOT: WHERE CAN
I IMET THIS DONE?
AND WHY IS THIS NOT POSSIBLE IN
OUR COMMUNITY?
WHY CAN'T I JUST ROLL UP AND GET
AN OCT AT MY PHARMACY?
AND THE REASONS ARE REALLY MANY
AND WE HIGHLIGHT TD A LOT OF
THOSE.
SO WE NEEDED INTEROPERABILITY,
CONNECTING IMAGING DEVICES TO
OUR ECOSYSTEM OF HELT CARE RIGHT
NOW THEY LIVE ON DEVICES, THEY
LIVE ON PROPRIETARY SYSTEMS, WE
NEED TO CONNECT ALL THOSE SO WE
CAN START USING TECHNIQUES AND
FINDING PRESIDENTERNS AND
LOOKING AT PROGRESSION.
WE NEED STANDARDS, WE NEED
TANNED ORDERS IN ON TWO-CENTS OF
THE WAY AND I WILL SHARE IT IN A
MINUE BUT JUST TO SAY WE NEED
STANDARDS OF REPRESENTATION OF
THE MEASURES AND THE METADATA SO
FOR INITANCE LIKE AMITHA WAS
SAYING, WE ARE ALWAYS KNOWING
EYE WAS IMAGES AND ARE WE
REPRESENTING THAT EYE AS OS OR
L, WHAT ARE WE SAYING ABOUT IT
SO WE NEED TO HAVE CONSISTENCY
IN THAT REPRESENTATION FOR
MACHINE ACTIONABILITY AND WE
NEED INNOVATION, SO, BRIDGE TO
AI AND TOOLS TO ACCESS THESE AND
I THINK THE NEI IS REALLY
FOCUSED ON TRYING TO GET PEOPLE
INTO A SHARING CULTURE.
SO I'M SURE A FEW OF YOU
ATTENDED THIS WORKSHOP,S AS A
WORK CLOUD, BUT IT'S AN ASPECT
OF THE WORKSHOP THAT WHAT PEOPLE
WANTED FROM THE STANDARDS
ADOPTION METHOD AND DICOM IS THE
STABBED ARD FOR MEDICAL IMAGING
IS INTEROPERABILITY, ALL RIGHT,
SO, AND A FEW OTHERS HERE WROTE
AN ARTICLE IN ASRS ABOUT HOW WE
ENVISION INTERROPERABILITY WITH
IMAGING AND A LARGE PART OF
THAT, INVOLVES FIRE, SO THIS IS
THE FAST HEALTHCARE
INTERROPERABILITY RESOURCES,
INTERROPERABILITY USED IN MOST
ELECTRONIC HEALTH RECORD SYSTEMS
SO AGAIN, WE WANT TO BRING THOSE
INTO THE FIRE ECOSYSTEM AND WE
WANT TO CONNECK, WE WANT TO
CONNECT THE METADATA AND THE
IMAGE OBJECTS INTO THE
HEALTHCARE ECOSYSTEM.
SOPHISTICATEDY WE NEED STANDARDS
AND WE'VE BEEN, I THINK MIKE
SHOWED THIS EXACT SLIDE BUT I
THINK WE NEED TO BE ABLE TO
DEVELOP STANDARDS FOR
REPRESENTING THE IMAGE DATA A
LOT OF FOLKS, AMITHA WAS READY
TO SHOW THIS, THIS IS LOCKED
INTO THE PROPRIETARY SYSTEMS SO
WE CAN'T GET ACCESS INTO THOSE
FIELDS WE NEED IN BULK AND WE
NEED EXPORTABLE KOOM PEWTER
ACTIONABLE FORMATS.
SO WE HAD A WORKSHOP AGAIN, MOST
PEOPLE REALLY JUST, THEY WANT TO
SEE THIS IMAGING COME TOGETHER
WITH THE REST OF OUR SCIENCE AND
HEALTHCARE SPHERE.
THERE WAS BACK UP STATEMENTS,
TRYING TO GO QUICKLY SO WE CAN
HAVE GOOD DIALOGUE IN OUR OPEN
SESSION, BUT AFTERNOON AGROWS SO
THIS IS WHERE WE WANT TO GO.
HOW ELSE CAN WE DO THIS.
SO WE WROTE PAPERS, I'M AT THE
NATIONAL EYE INSTITUTE, WE
PARTNERED WITH THE F, DIDA AND
THE OFFICE OF NATIONAL
COORDINATOR OR ONC TO JUST SAY
WHAT KINDS OF THINGS CAN WE AS
FUNDING AGENCIES, AS POLICY
MAKERS DO TO ADVANCE
INTEROPERABILITY
STANDARDIZATION, FDA FORMALLY
RECOGNIZED DICOM, AS THE
STANDARD FOR OCULAR IMAGING AND
THIS HAS SEVERAL IMPLICATION AS
IN TERMS OF DEVICE SUBMISSION TO
THE F, DIDA AND ALSO AUDITING.
ONC HAS LISTED DICOM AS A
STANDARD - ISA, WHICH IS A
FORMAL RECOGNITION OF THAT BEING
THE STANDARD AND THE NEED FOR IT
TO BE OPEN AND EXCHANGEABLE WITH
ELECTRONIC HEALTH RECORD SYSTEMS
AND THEN AT NEI, LIKE WE SAID,
WE WANT TO REALLY--WE HAVE THE
DATA MANAGEMENT AND SHARING
POLICY THAT CAME INTO EFFECT IN
2023, EARLY 2023 AND WE WANT TO
ENCOURAGE PEOPLE TO CONTINUE
USING STANDARDS IN AN OPEN
FASHION AND SHARE THOSE WITH
OTHER PEOPLE.
WE HAVE SO MUCH DATA AT OUR
HANDS AND THERE'S SO MUCH
POTENTIAL BUT IF EVERYONE HOLD
ITS NEAR AND DEAR, WE'RE
ANYTHING TO SLOW DOWN
INNOVATION, SOPHISTICATEDY WE
ALSO AGAIN NEED STANDARDS IN
TERMS OF OTHER DATA SO IT DID NO
GOOD IF WE HAVE STANDARDIZATION
AROUND OTHER IMAGING BUT STILL
NO STANDARDIZATION AROUND LIKE
VISUAL ICUITY, WHAT ABOUT LIKE
IOP, SO SALLY BAXTERS GROUP HAS
DONE WORK IN ACTUALLY LOOKING AT
THE EPIC CODES, SO EP IC EHR
WHICH IS WIDELY USED IN OUR
SPACE AND SEEING HOW MANY OF
THOSE MAPPED TO STANDARD
TERMINOLOGIES THAT ARE ACCEPTED
IN THE U.S. ELECTRONIC HEALTH
RECORDS AND HEALTHCARE SYSTEM.
AND WHEN WE FIND GAPS WE SUBMIT
THEM TO GOVERNING BODIES, WE
SUBMIT THEM TO STANDARDS LIKE
SNOMED AND LOINC, AND WE'RE
TRYING TO DO THE GAP ANALYSIS TO
FIND THE THINGS THAT AMITHA
NEEDS TO DO COMPUTING ON HER
STUDIES AND MAKE SURE THEY'RE
REPRESENTED AND WE ALSO HAVE
WORK WE'RE DOING WITH USEDI,
WHICH IS THE OFFICE OF THE
NATIONAL COORDINATOR SO WE WOULD
LIKE TO ELEVATE SOME OF THOSE
CODES TO THE POLICIES AROUND
WHAT NEEDS TO BE
INTEROPERABILITY WITHIN HELT
RECORD SYSTEMS AND WE HAVE NOW
ACTUALLY SOME POLICY THAT
REQUIRES THOSE SYSTEMS TO SUBMIT
SHARED DATA AMONG AND BETWEEN
THEMSELVES AND IF NOT THERE'S A
FINANCIAL PENALTIES THAT
ACCUMULATE BY DAY FOR THAT.
SO WE REALLY THINK THAT'S A HUGE
STUDENT FOR POLICY MAKING MUCH
SO AGAIN INMODEL CITIZENIVATION,
BECAUSE I THINK OTHER PEOPLE
MENTIONED IT, WE NEED DATA, THE
ABILITY FOR YOUNG PEOPLE, PEOPLE
WHO ARE JUST CURIOUS TO GET
THEIR HANDS ON DATA IN ITS
NATIVE FORMAT AND ITS STANDARD
FORMAT AND BE ABLE TO JUST SAND
BOX, PLAY AROUND.
I REALLY AM A CURIOUS PERSON
MYSELF SO IF I CAN GET MY HANDS
ON SOMETHING AND WITHOUT A LOT
OF BARRIERS THAT WILL REALLY YOU
KNOW HELP ADVANCE THE FIELD.
WE HAVE A BRIDGE AI PROJECT AND
AARON AND CECILIA WILL BE
SHARING INFORMATION ON A VERY
LOW BAR, SO THAT'S FABULOUS, WE
ARE ALSO WORKING WITH ALL OF US,
TO ADD OCULAR IMAGING TO THE ALL
OF US RESEARCH THEORY.
WE'RE CREATING A DATA SET SO
WE'RE TAKING IMAGES USING
SYNTHETIC IMAGING THAT WILL BE
FREELY OPENLY AVAILABLE, THAT
WILL NOT BE ACCURATE TO HUMAN
REPRESENTATION BUT IT GIVES US
SOMETHING TO WORK WITH AND
EDUCATE FOLKS ON AND IT WILL BE
IN A FHIR SERVER SO WE CAN BRING
IN THAT TECHNOLOGY, HOW DO YOU
IMPLEMENT SYSTEMS TO EXCHANGE
THOSE DATA POINTS.
>> SO WE'VE BEEN DOING WORK WITH
COMMON DAILY BASIS THEA MODELS,
AS IN NEI, WE'RE FOCUSED ON
RESEARCH, SO LOADING THOSE LOCAL
CODES, MATCHING THOSE LOCAL
CODES TO A COMMON DATA MODEL SO
WE CAN DO OBSERVATIONAL HEALTH
STUDIES, WE ACTUALLY JUST
PUBLISHED, IT WAS JUST ACCEPTED
IN OPHTHALMOLOGY RETINA, A STUDY
THAT WAS LOOKING AT INTRA
VITREAL, ANTIVEG F AND KIDNEY
FAILURE AND THIS WAS LED BY
CINDY TAI FROM JOHNS HOPKINS AND
WE WERE ABLE TO LOOK AT ACROSS
12 DATABASES, 584 MILLION PEOPLE
AND CHECK FOR ADVERSE KIDNEY
EVENTS BASED ON THOSE
MEDICATIONS.
AND SO WE ALSO NEED INCENTIVES.
SO AGAIN, DR. CHANG HAS SAID
BEFORE, WE HAVE A LOT OF STICKS.
WE NEED CARROTS, WE NEED TO
INCENTIVIZE PEOPLE TO SHARE
DATA.
WE HAVE THE PUBLICATION TYPE
THAT WAS MEPGZED FROM TBST ABOUT
DATA TYPE WHICH IS HUGE FOR OUR
COMMUNITY.
WE'RE ALSO THINKING OF WAYS
WHERE WE CAN INCENTIVIZE AN
INDIVIDUAL'S EFFORT TOWARD GOOD
DATA SHARING AND YOU'LL HEAR
MORE ABOUT THAT IN COMING MONTHS
IF YOU FOLLOW NEIs X ACCOUNT,
I'M SURE.
SO JUST CONCLUDING THOUGHTS.
WITH ALL THESE ADVANCES, BOTH IN
THE TECHNOLOGY AND IN AI SPACE,
THIS COULD REALLY TRANSFORM
HEALTH.
I OFTEN FIELD WEIRD OVERSELLING
IT, OR I FEEL LIKE I'M
OVERSELLING IT AND BUT I DON'T
THINK I'M OVERSELLING IT AT ALL
BUT SITTING HERE THE LAST 2 DAYS
AND HEARING ABOUT THE WORK
THAT'S DONE AND FUTURE
INHOIVATIONS THIS, IS AN
OPPORTUNITY TO TRANSFORM HEALTH
EMPLOY BUT WE NEED DATA SHARING,
WE NEED COLLABORATION, WE FLEED
TO BUILD COMMUNITIES OF
STANDARDS BELLING GROUPS AND WE
NEED TO GET ONBOARD AND BUILD
THAT COOPERATION.
MY YOB IS TO TRY TO WORK WITH
THE STANDARDS AND
INTEROPERABILITY PIECE.
IT TAKES A VILLAGE.
I HAVE A VILLAGE.
I HAVE TECHNOLOGY I CAN
SHOWCASE, AND I JUST THINK, LIKE
THIS IS THE FUTURE, THIS IS
LITTLE--THIS IS AN EXAMPLE OF A
STATION, YOU WALK UP TO IN A
GROCERY STORE OR PHARMAC EXPE
CHECK YOUR HEALTH IN MANY WAY
ANDS THIS IS DEFINITELY COULD BE
PART OF THAT IN THE VERY NEAR
FUTURE.
SO IF YOU WANT TO FOLLOW THE
OFFICE OF DATA AND SCIENCE
HEALTH INFORMATICS, WE DO TRY TO
POST ABOUT EVENTS SUCH AS THESE
ON OUR NEWS LETTER.
YOU CAN YOIN OUR COMMUNITY,
WE'RE VERY OPEN AND TRANSPARENT,
WE WANT EVERYONE ONBOARD AND I
WILL LEAVE IT WITH THAT.
[ APPLAUSE ]
>> ALL RIGHT, I WOULD LIKE TO
THANK THE SPEAKERS FOR STAYINGON
TIME AND BEING A BIT EARLY SO WE
CAN HAVE A ROBUST DISCUSSION
EMPLOY IF YOU CAN MAKE YOUR WAY
TO THE STAGE.
WE WILL GET THE SEATS OUT HERE
AND SOME MICROPHONES.
AND I'M HOPING THAT ALL OF YOU
WILL HAVE QUESTIONS AND
COMMENTS.
FEEL PREE TO COME TO THE
MICROPHONES.
I WAS REFLECTING THAT MANY OF
YOU ARE USING AI AT SOME LEVEL
AND SO I'M SURE YOU HAVE SOME
THOUGHTS AND CONSIDERATIONS TO
BRING UP HERE.
OKAY, GREAT.
>> THANKS.
GREAT TALK.
ANY COMMENTS ON HOW EXACTLY THE
DATA STANDARDIZATION SHOULD BE
EXECUTED.
SO LET ME BE SPECIFIC.
OCT REGARDLESS OF THE WEB SOURCE
OR WIDE BAND START FROM A CASE
BASE AND EVERYBODY USING
DIFFERENT WAYS TO RECONSTRUCT
IMAGE AND THEN PEOPLE USE
DIFFERENT WAYS TO ENHANCE THE
IMPAG, ARE ALL THOSE THINGS PART
OF THE STANDARDIZATION OR IS
THAT PART OF THE DISCLOSURE?
>> I'M FLAD YOU ASKED THAT
QUESTION BECAUSE--[INAUDIBLE
]--I ADDED THIS SLIDE AT THE
LAST MINUTE AND I COULDN'TAD IT
SO MY FAULT FOR THAT.
BUT 1 THING WE WANT TO DO FOR
STANDARDIZATION IS THAT REASON,
THE DEVICE MANUFACTURES MEASURE
THINGS DIFFERENTLY, APPLY
TECHNIQUES DIFFERENTLY, WE ARE
ENGAGED WITH A FEW OTHER FOLKS
ACROSS NIH INCLUDING NIERK BIB,
AND ADVANCING THE IDEA OF
PHANTOMS SO IF WE COULD HAVE A
STANDARD THAT CAN BE APPLIED
LIKE, CERTIFIED BY SOMEONE SUCH
AS NIST AND APPLIED ACROSS THE
MACHINES, THAT WAY YOU KNOW,
THIS IS REPRESENTATIVE OF A
NORMALIZED STANDARD.
NAND JUST TO ADD TO THAT A
LITTLE BIT, I THINK THE DICOM
STANDARD IS MEANT FOR THE FINAL
END PRODUCT IN TERMS OF THE
B-SCAN IMAGE THAT CLINICIANS USE
AND VIEW TO MAKE MEDICAL
DECISIONS AND THAT'S GREAT FOR
AI ALGORITHMS THAT BUILT ON TOP
OF THAT BUT TO YOUR POINT WE
DON'T HAVE A RESEARCH STANDARD
FOR OCULAR INSTRUMENTS WHERE
THOSE MORE RAW DATA, LIKE THE
DATA COMING OFF THE SPECTROMETER
AND THE INTERMEDIATE PROCESSING
STEPS ARE NOT ENCODED IN ANY
STANDARD FORM YET BUT IT WOULD
BE NICE TO SEE THE RESEARCH
COMMUNITY COME FORWARD AND BRING
SOMETHING FORWARD FOR THAT.
>> GREAT.
THANK YOU ERCH FOR CONTINUING
THIS IMPORTANT DISCUSSION, AS I
CLINICAL RESEARCHER, I RECOGNIZE
THE IMPORTANCE OF
INTEROPERABILITY, AND--AND FROM
WHAT I UNDERSTAND YOU CAN USE
STANDARD MEASUREMENT TOOLS
REGARDLESS OF THE MACHINE, HOW
DID THEY COME TO THE AGREEMENT
IN TERMS OF HAVING AN IMAGING
STABBED ARD THAT COULD BE
MEASURED USING A COMMON TOOL.
I'LL SAY FROM TALKING ABOUT BUT
USUALLY THAT THEY NEEDED TO
REACH CONSENSUS AND IN, LIKE, CT
SCANS AND MRIs, THERE'S FEWER
MANUFACTURES, SO THEY DO KIND OF
HAVE SOME BENEFIT THERE, THEY
DON'T NEED TO BRING SO MANY
PEOPLE ONBOARD BUT AS YOU WILL
SEE TECHNOLOGIES IMPROVE AND
BECOME MORE STANDARD PRACTICE
THAT THOSE KINDS OF THINGS WILL
NEED TO HELP JUST BASED ON
MARKET INFLUENCE AND THE NEED
FOR CONNECTEDNESS.
SO HOPEFULLY, THERE'S BOTH
INTERNAL AND EXTERNAL PRESSURES
THERE.
>> YEAH, I AGREE WITH THAT.
I THINK HAVING JUST 3 BIG
COMPANIES TO START OFF WITH
RADIOLOGY AND A LOT OF
RADIOLOGISTS HAD A SAY IN HOW
DATA WAS PRESENT EARLY ON
WHEREAS FOR OPHTHALMOLOGY MOST
OF US JUST DIDN'T EACH KNOW HOW
TO ELECTRIC AT AN OCT SCAN, EACH
TODAY, MANY CLINICIANS JUST LOOK
AT THE REPORT AND THOSE 3
NUMBERS ARE JUST THE 1S SCANNED
WITH, IS THERE FLUID OR NOT,
THERE'S NOTHING MORE THAT'S
DONE, SO THE LEVEL OF
INTERPRETABILITY IS VERY
DIFFERENT.
>> I HAVE A QUESTION SINCE WE
HAVE SO MANY OCT EXPERTS IN THE
AUDIENCE BUT WHEN YOU GET THE
RAW DATA BACK FROM THE OCT
SYSTEM, LIKE HOW SIMILAR IS THAT
BETWEEN DIFFERENT MACHINES?
DO WE KNOW THAT AND IS THERE
LIKE A SOURCE THAT WE BEING --CD
START AND EVERYTHING IS MORE
SIMILAR.
NI THINK DAVID IS MOVING TO THE
MIC.
>> THANK YOU.
>> WELL I THINK, I WILL POINT
OUT TO--THAT YOU ACTUALLY IN
YOUR PRESENTATION HAD A NICE
SLIDE WHERE YOU COMPARED THE
ANGLES, THE ANGLE MEASURES AND
THE CURVEATURE AND SO, I THINK
WE JUST NEED TO EXPLORE THAT
MORE AND AGAIN I'M VERY MUCH A
STORYTELLER AND LET'S SHOW
PEOPLE, THIS IS ACTUALLY THE
DIFFERENCE THAT WE SEE.
>> CHRISTINE [INDISCERNIBLE] I
WOULD LIKE TO ADVOCATE FOR
ANATOMICAL STANDARDIZATION AS
PART OF THE INITIATIVE FOR MACK
LA RESEARCH, WE HAD A WORK GROUP
CALLED WHY THE MACULAR AND THERE
WAS A BIG DISCUSSION ABOUT WHAT
IS THE MACULAR, AND IT IS
POSSIBLE TO TRACK BACK THROUGH
NEUROANATOMY, LITERATE AND YOU
ARE COME UP WITH A SET OF
COACHING DEFINITIONS THAT HAVE
DEFINED NUMBER OF RODS, CONES
AND RPE CELLS AND WE PUT THIS IN
A REVIEW THAT CAME OUT A COUPLE
WEEKS AGO ADVOCATING FOR THE USE
OF THE MACULAR LUTIA WHICH WAS
THE FIRST NAME AND SO IF THE
DATA SCIENCE FOLKS COULD INCLUDE
PEOPLE WITH INTERESTS IN
NEUROANATOMY AND
NEUROPHYSIOLOGY, WE COULD, I
THINK REACH GOOD
STANDARDIZATION.
FORTUNATELY THERE ARE--YOU CAN
MEASURE 3-MILLIMETER MACK LA
LUTIA ON BOTH THE SECTIONAL
ANALYSISERAL SIS AND
[INDISCERNIBLE].
THAT'S GOOD, OKAY, BUT OCT
BECAUSE OF SIGNAL SOURCES ARE
SUBCELLULAR, WE NEED SOME
DEFINED, SOME DEFINITIONS OF THE
PARTS OF CELLS, ALTER
STRUCTURES, WHAT ORGANELLES ARE
INVOLVED SO I THINK THAT WILL BE
GOOD TO INCLUDE THIS IN THE
DISCUSSION.
THANK YOU.
>> I'LL JUST, TAG ON TO YOUR
COMMENT.
SO I ATBREE HUNDRED PERCENT,
THAT'S SOME OF THE WORK WE'RE
DOING WITH FANDOMS IS ACTUALLY
HAVING A NORMALIZED
REPRESENTATIVE IN THESE MACHINES
TO MAKE SURE EVERYONE IS
MEASURING THINGS IN THE SAME
WAY, 1 OF THE STRUGGLES WITH
THAT IS TO FIGURE OUT LIKE WHAT
IS QUOTE-UNQUOTE NORMAL AND DO
WE NEED DIFFERENT TYPES OF
NORMAL BASED ON AGE AND GENDER
AND THINGS LIKE THAT, SO I'M
VERY INTERESTED IN YOUR PAPER
BECAUSE IT SOUNDS LIKE WE COULD
GET SOME OF THOSE NUMBERS,
RIGHT, THOSE MEASURES?
>> DAVID IN.
>> I HAVE SOME COMMENTS ABOUT
STANDARDIZATION OF SIGNAL.
I THINK OCTs RELATIVELY SIMPLE
IN THAT ALTHOUGH THERE ARE MANY
LONG SCALES AND LINEAR SCALES,
THERE THEY ARE AT LEAST
INTERCONVERTIFICATION, EASILY,
AND YOU COULD STANDARDIZE, LIKE
THE [INDISCERNIBLE] UNIT IN CT,
YOU COULD HAVE A STANDARD UNIT
BUT OCT IN GEOGRAPHY MAY BE
QUITE DIFFICULT IN THE
DECORALATION BASED ON AMPLITUDE
OR COMPLEX AMPLITUDE OR FACE
VARIANTS REALLY BEHAVE QUITE
DIFFERENTLY AND THEY SCALE
DEFICIENTLY WITH SIGNATURES 95
STRENGTH.
THEY JUST HAVE VERY DIFFERENT
PROPERTIES SO UNLESS YOU HAVE
THE RAW SPECTRAL DATA OR RAW OCT
DATA, FROM WHICH FLOW SIGNAL IS
COMPUTED, YOU ALMOST CANNOT
POSSIBLY INTERCONVERT THEM.
SO, I'M NOT SURE HOW YOU WOULD
DEAL WITH THAT.
MAYBE THESE ALGORITHMS NEED TO
BE PUCK LICK SO THAT, YOU KNOW
AT THE SAME IMAGE CAN BE COATED
IN SEVERAL DIFFERENT WAYS SINCE
THEY ARE NOW INTERCONVERTIBLE.
THEY PROBABLY HAVE THE SAME
THING IN MRI SINCE PULSE
SEQUENCE GENERATE DIFFERENT DATA
THAT NOT REALLY, CANNOT BE
INTERCONVERTIBLE AFTERWARDS
SOPHISTICATED I DON'T KNOW HOW
THEY DEAL WITH THAT.
WE COULD PROBABLY BORROW FROM
THAT.
>> YEAH, NO, THANKS.
THAT IS INSIGHTFUL, RIGHT NOW
WITHY JUST PROPRIETARY SOFTWARE
METRICS, THAT'S THE WAY WE DO IT
FOR CLINICAL TRIALS.
THERE'S NO OTHER WAY.
NI HAVE A BIT OF A PET PEEVE
WITH OCT MANUFACTURES IMAGES
THAT THEY PRODUCE, BUT A ALWAYS
PUT A LINEAR SCALE LIKE
200-MICRONS ANDIME NOT SURE HOW
YOU DEAL WITH IT BUT THE FACT IS
THAT EYE SAYS HAVE DIFFERENT
LENGTH ANDS THAT COULD BE 20,
MAYBE 30% DIFFERENCES IN THE
SCALE OF THE IMAGES SO HOW DO WE
DEAL WITH THAT?
WHAT DO WE DO WITH INCASULAR
MEASURES?
BECAUSE THAT'S WHAT THE SYSTEM
IS CALIBRATED TO PRODUCE?
THAT IS A VERY GOOD POINT AND 1
OF THE DETAILS THAT IS EVEN MORE
DIFFICULT TO STANDARDIZE UNLESS
YOU'RE TAKING AXIAL LENS ON
EVERY PATIENT AND INCORPORATING
THAT AS PART OF METADATA ALSO,
THAT IS TRUE.
>> I JUST WANT TO, BEING ARK
WARE OF THE DICOM, IS THE
PRECESS OF THE ORIGINAL DATA WE
CAPTURE, GOING BA TO WHAT DAVID
SAID, SO IT'S RELATIVE AT FIRST,
IT HAS 18 PARTS OF 1 STANDARD,
THAT NOT EVERYBODY'S FOLLOW
WITH, MAIORITY ARE NOT, WE TRIED
FOR 20 YEARS TO BRING DICOM
STANDARD TO OPHTHALMOLOGY, I'VE
GIVEN UP 15 YEARS AGO.
SO I WISH EVERYBODY ELSE GOOD
LUCK BUT PERHAPS WE SHOULD SAVE
EVERYTHING IN RAW DATA FORMAT
AND THEN IT'S MORE EXCHANGEABLE
BECAUSE IN OCT, YOU HAVE
VARIATION OF B-SCALE AND WHICH 1
TO THE NEXT AND WHICH 1 WE
CHOOSE.
SOME AVERAGE HUNDRED FRAMES,
SOME AVERAGE 20 OR 50, SO UNLESS
YOU COMPARE ALL THOSE UNLESS YOU
HAVE THE RAW DATA WILL BE QUITE
CHALLENGING.
I THINK THERE'S SOMETHING TO BE
SAID ABOUT USABILITY OF THE DATA
ALSO WITH PRESENTATION.
ULTIMATELY THE MOST IMPORTANT
USER OFF THE DATA IS THE
OPHTHALMOLOGIST TREATING THE
PATIENT AND FOR THEM YOU NEED A
PRESENTABLE FORMAT.
AND RAW DATA IS EXCEL EPT FOR
RESEARCH AND ALGORITHM
DEVELOPMENT AND THAT'S WHAT WE
NEED, BUT NEEDS TO BE SOMETHING
SIMPLER AND PROBABLY DICOM IS
THE EASIEST WAY AND I WOULDN'T
SAY DICOM IS GIVEN UP BY KERRY'S
POSITION IS ALL ABOUT DICOM, SO
WE HAVE HOPE.
WE HAVE HOPE WITH THE NEI
BRINGING IT ALL BACK.
>> YEAH.
>> AND I'LL JUST MENTION THAT
SINCE THE BRCA PROJECT CAME UP
QUITE A FEW TIMES, IN THAT
PROJECT WE WORKED WITH MANY OF
THE MANUFACTURES AND INSISTED ON
THEM CONVERRING THEIR DATA TO
DICOM AND THEY ALL AGREED.
SO NOW THEY HAVE THE ABILITY TO
TURN THEIR DATA FOR BOTH OCT,
AND OCTA INTO THE PROPER
STANDARDS COMPLIANT NOW, THE
FUTURE IS SLOW LE CREEPING
FORWARD WHERE WE WILL HAVE
FINALLY HAVE DICOM IN THE FIELD
OF OPHTHALMOLOGY.
NAND I WILL JUST TAG THAT DICOM
WORKING GROUP 9 AND REACTIVATED
AND INVITE ANYONE WHO HAS
INTEREST TO YOIN THAT WORK
EMPLOY.
>> THANK YOU FOR ALL YOUR
WONDERFUL PRESENTATIONS I HAVE A
QUESTION FOR DR. MOHEM, I WAS
WONDERING THE APPROXIMATE COST
OF THE OCT DEVICE WAS FOR
PATIENTS?
>> SO--HOME OCT IS PROVIDED AS A
SERVICE, NONAPOPTOTIC AS A
DEVICE SO THE CONCEPT WOULD BE
REIMBURSEMENT CODES AS ALWAYS IS
ASSOCIATE WIDE THE PATIENT, WILL
SCAN AT HOME, THE MONITORING
SERVICE, THEY WILL BILL MEDICARE
EVERY 30 DAYS FOR THE SERVICE
PROVIDED AND THE PHYSICIAN WHO
REVIEWS THE DATA WILL BILL
MEDICARE FOR REVIEW OF THE
RETURN.
SO PATIENTS TECHNICALLY SHOULD
HAVE NO COST IF MEDICARE WAS THE
SERVICE.
THEY WILL BE LIABLE FOR ANY
CO-PAY IF THEY DON'T HAVE
ADDITIONAL INSURANCE.
THAT'S THE MODEL.
IT'S NOT I PURCHASE A DEVICE AND
YOU KNOW YOU HAVE TO PAY FOR
THAT.
>> THANKS.
>> DR. FUYI MOTO.
>> MANUFACTURES HAVE CHOSEN
DIFFERENT METHODS OF DISPLAY TO
ENHANCE THE VISIBLE, THE
PERCEPTION THAT THE IMAGE IS
GOOD, THAT IT HAS CONTINUITY OR
IMAGING DEPTH, LOG, SQUARE ROOT
AND SO FORTH AND THEN THIS
CONCEPT OF AVERAGING OF COURSE
IMPROVES THE APPEARANCE BUT
DESTROYS INFORMATION, VARIANTS
THAT WOULD YOU SEE BETWEEN THE
IMAGES BECOME CONTINUOUS BUT
BLURRED, RIGHT?
SO THE PREVIOUS COMMENT ABOUT
SAVING THE ORIGINAL DATA IS
ACTUALLY THE ONLY WAY TO
RELIABLY RECONSTRUCT EVERYTHING.
THERE'S TOO MANY STEPS, THAT
HAVE ADJUSTABLE PARAMETERS.
THE PROBLEM OF COURSE IS THAT IF
YOU AVERAGE 16 FRAMES, THEN YOU
HAVE TO TORE ALL OF THOSE FRAMES
OR IN OCTA, YOU'RE MULTISCANNING
THE DATA SETS GET VERY, VERY
LARGE BUT THAT UNFORTUNATELY IS
THE WAY TO PRESERVE THE
INFORMATION, EVERYTHING IS
DECIMATED NOW, LOG SCALE,
TYPICALLY 8 BIT, AND A LOT OF
INFORMATION IS LOST IN THE DATA.
>> I WAS DO AGREEN CELLS WITH
THE COMMENT RAISED EARLIER THAT
PERHAPS THERE NEEDS TO BE
ANOTHER REPRESENTATIONAL
STANDARD FOR RESEARCH WHEN IT
COMES TO STORING THE RAW DATA
AND THE INTERMEDIATE FORMS OF
THAT DATA.
THE FIRST STEP IS, YOU KNOW
ENCODE ING THAT IN SOME CONSISTT
FASHION AMONG THE DEVICES AND
THE SECOND PART WOULD BE HOW TO
THINK ABOUT IT ACROSS DEVICES.
>> I TOTALLY APPRECIATE THE
SERVICE THAT YOU'RE CREATING AT
NOTALL, BECAUSE MY MOTHER ALSO
HAS AMD AND SHE GOES EVERY 2
MONTHS TO THE OPTO PEOPLE AND
THIS WILL HELP BECAUSE SIT AT
HOME, SHE CAN BE ENGAGED ALMOST
DALE COMPETENT SO FORTH.
SO WHAT IS THE TIMELINE AT THIS
POINT?
ARE YOU RECRUITING OTHER
PATIENTS?
>> THAT'S A GOOD QUESTION.
SO WE HAVE MULTIPLE CLINICAL
TRIALS GOING ON, WE ARE WORKING
CLOSELY WITH FDA, SO WE
OBVIOUSLY CANNOT SAY ANYTHING
YOU KNOW CERTAINTY BUT
HOPEFULLY, THE DEVICE SHOULD BE
APPROVED FOR MARKETING SOMETIME
IN THE NEAR FUTURE BUT OF COURSE
TELL BE A PROCESS BEFORE IT CAN
REACH A LARGER POPULATION.
SO WE ARE DOING OUR BEST.
THE TEAM IS WORKING DAY IN AND
DAY OUT TO BRING IT TO AS MANY
PATIENTS AS POSSIBLE AND FOR
THOSE WHO NEED IT THE MOST.
>> THANK YOU.
>> ALL RIGHT, I THINK WE'RE
PRETTY MUCH AT TIME UNLESS
THERE'S ANY OTHER LAST MINUTE
QUESTIONS.
I THINK THE SPEAKERS AGAIN FOR
THE WONDERFUL TALKS AND GREAT
DISCUSSION THAT WE'VE HAD.
[ APPLAUSE ]
>> MY YOB IS BASICALLY TO GIVE
CLOSING REMARKS HERE AND TRY TO
SYNTHESIZE THINGS.
I THINK THIS HAS BEEN AN AMAZING
2 DAYS OF SCIENCE THAT WE'RE
HEARING ABOUT, AND YOU KNOW THEY
ASKED ME TO TRY TO SYNTHESIZE
THIS AND I WILL DO MY BEST BUT
JUST TO THE DISCLAIMERS, WE
CAN'T GET EVERYTHING, BUT WHEN
WE HAVE SOMETHING THAT'S TOUGH,
YOU KNOW WHAT I TRY TO DO IS GO
BACK TO BASICS, YOU KNOW WHICH
IS OUR MISSION STATEMENT AT THE
NCEREBELLUMS I TO ELIMINATE
VISION LOSS AND IMPROVE QUALITY
OF LIFE THROUGH VISION RESEARCH
AND YOU KNOW I SEE MY JOB AS
TRYING TO HELP CREATE AN
ENVIRONMENT WHERE ALL OF YOU CAN
THRIVE AND DO THE BEST--DO THE
BEST RESEARCH TO ADVANCE THAT
MISSION.
AND YOU KNOW I THINK IT'S PRETTY
OVERWHELMING IN A WAY, IF YOU
STEP BACK, THERE ARE SOME OF THE
SMARTEST PEOPLE IN THE WORLD IN
THIS ROOM RIGHT NOW, AND I THINK
THAT YOU KNOW WAWE REALLY WANT
TO DO IS TO CREATE A MILIEU
WHERE THE WHOLE IS GREATER THAN
THE SUM OF THE PARTS AND WE
DEFINITELY DON'T WANT A WORLD
WHERE THE HOLE IS LESS THAN SOME
OF THE PARTS.
AND SO, I THINK THAT'S IMPORTANT
TO KEEP IN MIND.
I TOOK SOME MENTAL NOTES AS I
WAS LISTENING HERE XI THOUGHT I
WOULD SUMMARIZE THE POINTS I
TOOK AWAY, NUMBER 1, I WANT TO
START WITH WHAT BROUGHT US HER.
JIM, DAVID AND ERIC, AMAZING
WORK AND 1 THING IS THAT THEY'RE
ALL ENGINEERS WHO GOT INTERESTED
IN THE VISION SPACE AS ARE MANY
OF YOU IN THE AUDIENCE, AND YOU
KNOW I THINK THAT YOU KNOW IN
THIS FIELD, WE NEED THAT
METHOLOGICAL EXPERTISE TO
ADDRESS PROBLEMS.
THE BEST ENGINEERS AND
METHODOLOGISTS ARE GOING TO WANT
TO DEVELOP INNOVATIVE
METHODOLOGIES NOT TO TAKE OFF
THE SHELF METHODOLOGIES AND AMRI
THEM TO THE EYE.
AND I THINK IT'S INCUMBENT UPON
US AS A COMMUNITY TO SHOW THAT
THE EYE IS A REMARKABLE ORGAN
AND THE VISUAL SYSTEM IS FOR
DEVELOPING THOSE METHOLOGICAL
ADVANCES, THAT'S HOW WE WILL
ATTRACT THE BEST PEOPLE AND
THAT'S HOW THIS FIELD WILL
THRIVE.
SO IF YOU HAVE IDEAS ABOUT HOW
WE CAN DO THAT BETTER, PLEASE
SORT OF LET US KNOW.
NUMBER 2, IS, YOU KNOW WE JUST
HEARD THIS DISCUSSION ABOUT THE
BENEFITS OF STANDARDIZATION, YOU
KNOW, CHRISTINE, AARON, YOU KNOW
HOW MANY OF YOU TALKED ABOUT
DIFFERENT ASPECTS OF
STANDARDIZATION, ANATOMY,
DIGITAL FORMATS, CLINICAL
STANDARDS, OTHER SEGMENTATION
METHODS AND I THINK THAT I LOVE
THAT, OF COURSE, AND I LOVE THAT
WHAT WE'RE DOING HERE TO TRY TO
ACHIEVE THAT.
YOU KNOW MY OBSERVATION
WITHSTAND ARD SYSTEM THAT
EVERYBODY LOVES IT, BUT WHY LOVE
IT MORE WHEN EVERYBODY FOLLOWS
MY STANDARD, YOU KNOW, NOT YOUR
STANDARD.
AND I THINK THAT TO MAKE THIS
WORK THEREY GOING TO HAVE TO BE
GIVE AND TAKE AND WE WILL HAVE
TO DEVELOP A STANDARD THAT
EVERYBODY'S HAPPY ENOUGH WITH
BUT PROBABLY NOBODY'S GOING TO
BE A HUNDRED% HAPPY AND I WOULD
CHALLENGE THIS COMMUNITY TO
THINK ABOUT THAT IN TERMS OF
DEVELOPING CREW COMMUNITY
STANDARDS.
YOU KNOW IN TERMS OF HOW TO DO
THAT, CINDY TOTH, AND PETE
CAMPBELL WERE INVOLVED WITH AN
R. O. P. PROJECT INVOLVING
STANDARDIZING CLINICAL
REPRESENTATION AND IT TOOK
MULTIPLE YEARS BUT IT WORKED IN
THE END, TALK TO THEM, OR MANY
OTHER PEOPLE WHO'VE SUFFERED
THROUGH THIS, BUT IT'S POSSIBLE.
YOU KNOW ANOTHER ISSUE, I WANT
TO PIGGYBACK, NUMBER THERE IS I
WANT TO PIGGYBACK ON SOMETHING
KERRY BROUGHT UP AND THATIOLE
AND AMITHA TALKED ABOUT HOW
ASKED THIS QUESTION ABOUT
REGARDING HOW THE OCT FIELD
WOULD BENEFIT FROM
STANDARDIZATION OF YOU KNOW
MEASUREMENTS, SEGMENTATION, YOU
KNOW THE TECHNICAL
ASSPECTRA PRESENTATIONS, YOU
KNOW SHARED NORMATIVE DATABASES
AND JUST TO DOUBLE DOWN ON THIS
THING KERRY MENTIONED THAT
THERE'S BEEN AN INITIATIVE THAT
I BELIEVE CAME OUT OF NIBIB, IT
WAS REALLY, I HEARD ABOUT IT
FROM BRUCE AND CANNED WHAT AND
THEY WERE WORKING WITH THE FDA,
AND FOLKS LIKE DAN HAMMER AND
GOT INTERNAL AUDIT VOLVED
THROUGH KERRY, USING DEVELOPING
FANDOM TO TRY TO ACHIEVE THIS.
AND YOU KNOW KERRY IS OUR
CONTACT FOR THAT.
IF YOU ARE INTERESTED AND
SERIOUS ABOUT THAT, PLEASE TALK
TO KERRY.
YOU KNOW DAVID, I APPRECIATE
YOUR THOUGHTS ABOUT OCT XOCT
ANGIOGRAPHY AND I THINK THAT
WILL BE, SCIENCE ANALOGY
DISCOVERY ARE A TEAM SPORT AND
THAT'S COME ACROSS HERE, IF WE
WANT TO SOLVE BIG PROBLEMS WE
WILL HAVE TO DO IT TOGETHER
THROUGH THINGS LIKE
STANDARDIZATION, NUMBER 4 IS
THAT MANY OF YOU TALKED ABOUT
DATA SHARING.
I THINK THAT IS AWESOME AND YOU
KNOW THE REALITY IS THAT, WELL,
I WILL GIVE YOU MY OPINION IS
THAT THE REALITY IS THAT OUR
CURRENT ACADEMIC SYSTEM IS BASED
ON THE PAPER AS THE CENTER OF
THE UNIVERSE AND OUR DAT ARE
SECONDAR TOW THAT PAPER, THEY'RE
KIND OF A TAG ALONG AND WE KNOW
THAT DIFFERENT PEOPLE ANALYZING
THE SAME DATA SET CAN COME UP
WITH DIFFERENT CONCLUSIONS AND
YOU KNOW ON TOP OF THAT, YOU
KNOW CHRISTINE, THEY TALKED
ABOUT THIS EXAMPLE OF THESE
WHITE DOTS AND WHAT ARE THEY,
AND THE REALITIES WE MAY NOT
KNOW BECAUSE THESE PEOPLE MAY
NOT HAVE ACCESS TO THAT RAW DATA
AND SO, THIS HAPPENS, ALL THE
TIME, AND I THINK THAT KNOWLEDGE
DISCOVERY WILL BENEFIT IF WE
HAVE LARGE DATA SETS, MAYBE
THEY'RE CENTRAL, MAYBE THEY'RE
FEDERATED DATA SETS WHERE
COMMUNITIES OF PEOPLE, I THINK
URSU LA YOU USED THIS PHRASE,
LIKE MINDED PEOPLE, IN YOUR
TALK, WHERE THESE LIKE MINDED
PEOPLE CAN MINE THESE LARGE DATA
SETS AND ITERATIVELY WORK WITH
EACH OTHER TO DISCOVER THE
TRUTH.
YOU KNOW WE'RE ALL GOING TO FEEL
DIFFERENT PARTS OF THE ELEPHANT
WHEN YOU ANALYZE THAT DATA SET
WHERE YOU WORK TOGETHER AND IF
YOU HAVE DIFFERENT CONCLUSIONS
WE'RE NOT RIGHT AND WRONG BUT
WE'RE WORKING TOGETHER TO
ITERATIVELY FIGURE OUT WHAT'S
GOING ON, I THINK THAT WILL
BENEFIT AND MAYBE WE NEED A NEW
PARADIGM FOR SCIENCE WHERE DATA
IS AT THE HUB AND PUBLICATIONS
COME OUT OF THE SAME DATA SETS
AND WE TRY TO FIGURE OUT TRUTH
BASED ON THAT.
AND I WOULD CHALLENGE THIS
COMMUNITY TO FIGURE OUT WHAT ARE
THE RULES OF THE GAME IF WE MOVE
IN THAT DIRECTION.
BECAUSE I THINK IT WOULD BE
GREAT FOR THAT.
OBVIOUSLY THE ENGINEERING AND
THE COMPUTER SCIENCE COMMUNITY
HAVE REALLY INNOVATED IN TERMS
OF THINKING THAT WAY AND MAYBE
WE CAN LEARN THINGS FROM THAT.
NUMBER 5, IS THAT, THIS ISSUE OF
TRANSLATION OF THE REAL WORLD,
OF RESEARCH INTO REAL WORLD PROD
UBIQUITINNATIONS.
YOU KNOW WE HAD A DISCUSSION
ABOUT THAT YOU KNOW JIM AND
DAVID, YOU BROUGHT OUT COMMENTS
THAT I'VE BEEN THINKING ABOUT
PRETTY MUCH ALL NIGHT ABOUT THE
IMPORTANCE OF INVOLVING
INDUSTRY.
AS I THINK ABOUT THAT, MAYBE THE
COMMUNITY WOULD BENEFIT FROM A
BIT OF GUIDANCE ABOUT HOW TO
DESIGN STUDIES LIKE WHAT STUDIES
TO PERFORM HOW TO DESIGN THEM
AND WHAT END POINTS WOULD
INDUSTRY BE INTERESTED IN CAN
HOW WOULD WE YOU KNOW TEMON
STRAIGHT THAT POTENTIAL TO MAKE
IMPACT AND IT SHOULD BE
ATTRACTIVE TO PEOPLE AND MAYBE
THAT IS AN AREA WHERE NIH CAN BE
HELPFUL, YOU KNOW FOR EXAMPLE,
WORKING WITH FDA OR CMS OR WHO
THE PEOPLE ARE TO COME UP WITH
GUIDANCE ABOUT YOU KNOW WHAT
TYPES OF STUDIES WOULD BE NEEDED
BEFORE YOU DESIGN THEM AND DO
THEM, NOT AFTER THE FACT WHEN
YOU SHOW THEM YOUR DATA AND IT'S
NOT GOOD ENOUGH.
AND SO JUST IF YOU HAVE IDEAS
ABOUT THAT, JUST, YOU KNOW
PLEASE SORT OF LET US KNOW
BECAUSE I'VE BEEN WORKING
THROUGH OW WE CAN MAKE EVERYBODY
MORE EFFICIENT, AND ANOTHER
ISSUE, NUMBER 6 IS POPULATION
HEALTH.
SOME OF YOU TALKED ABOUT IN THE
END, YOU KNOW, CLEARLY IN THIS
COUNTRY AND WORLD NOT EVERYBODY
HAS EQUAL ACCESS TO CARE, AND
KERRY MENTIONED THIS THING ABOUT
THE CVS KIOSK AND MAYBE THERE
WILL BE WAYS TO USE THESE
TECHNOLOGIES TO INCREASE
ACCESSIBLE TO CARE AROUND THE
COUNTRY AND THE WORLD.
LOVE THOSE IDEAS.
AND LASTLY, I JUST WANT TO THANK
ALL THE PEOPLE WHO PUT THIS
EVENT TOGETHER.
YOU KNOW WE STARTED OFF BY
SAYING IT WAS DONE ON SHORT
NOTICE, BECAUSE OF THE LASKER
AND THE NATIONAL MEDAL OF
TECHNOLOGY AWARDS, AND SO THERE
WERE A LOT OF PEOPLE WHO PLANNED
THIS, CAPHILL, DAVID, OUR TEAM
AT THE NCEREBELLUMS I AND THEN
THE PEOPLE WHO SIT OUTSIDE,
MICAH, AMY AND A LOT OF PEOPLE,
THAT REALLY GOT US HERE.
AND YOU KNOW IT WAS TO THE POINT
WHERE,--AND THE OTHER THING I
WANT TO EMPHASIZE IS THAT WHEN
WE DID THIS, I THINK ALL OF YOU
NOTICED THAT IN THE BEGINNING
NOT EVERYTHING WAS PERFECT, YOU
KNOW WE HAD ISSUES WITH THE
TABLE BLOCKING THE DISPLAY AND
THE ECHOES THAT WE DIDN'T
RECOGNIZE BUT I JUST WANT TO
GIVE OUT THE TEAM IN THE BACK,
YOU KNOW FROM CAPITAL
CONSULTANTS WHO SORT OF
RECOGNIZED THOSE PROBLEM ANDS
TRIED TO FIX THEM IN REALTIME,
YOU KNOW TO THE POINT WHERE LIKE
DAVE AND CAPHILL WERE MOVING
CHAIRS AND TABLES TO GET STUFF
OUT OF THE WAY BECAUSE I THINK
LIKE IN A WAY, NOT EVERYTHING IS
LIFE IS PERFECT BUT TIMES WE'RE
DEFINED BY HOW WE RESPOND TO
THOSE IMPERFECTIONS, AND I HOPE
THAT'S A PARADIGM WE WANT AT
NEI.
WE'RE TRYING TO SOLVE BIG
PROBLEMS AND EVERYTHING WE DO
WILL NOT BE TO EVERY SINGLE
PERSON'S LIKING BUT I JUST HOPE
THAT YOU RECOGNIZE THAT WE'RE
TRYING AND WHAT WE'RE TRYING TO
DO IS ITERATIVELY FIGURING OUT
WHAT WE'RE TRYING TO DO AND DO
BETTER AND JUST DO THE BEST JOB
FOR ALL OF YOU.
AND LAST THING I WANT TO SAY IS
THANKS TO ALL OF YOU FOR
ATTENDING.
YOU KNOW THERE'S--I WANT TO
CONGRATULATE JIM, DAVID AND ERIC
WHO AREN'T HERE AND ALSO JUST AN
AMAZING SORT OF, YOU KNOW IT
HAPPENS EVERY FEW DECADES IN THE
VISION FIELD AND YOU KNOW THESE
ARE SORT OF LEGENDARY ARK
COMPLISHMENTS AND I JUST WANT TO
CALL THIS OUT.
AND THEY'RE--I WANT TO
ACKNOWLEDGE THAT THERE ARE A LOT
OF OTHER PEOPLE IN THE ROOM WHO
HAVE DONE AMAZING STUFF,
TOGETHER, IN SOME CASES WITH
THESE 3 AND YOU KNOW JOEL'S NAME
CAME UP QUITE A FEW TIMES IN
THESE SLIDES AND MANY OTHERS
HAVE DONE LOOK THE LINES OF
SCIENCE BEING A TEAM SPORT.
AND YOU KNOW, CINDY TOTH USED
THIS PHRASE, OCT IS BEING AN
INCREDIBLE GIFT TO THE COMMUNITY
AND I JUST WANT TO CALL THAT
OUT.
SO JUST 1 THING I TOOK AWAY FROM
THIS IS THERE'S AN AMAZING CAST
BUT I THINK THERE'S A LOT OF
EVIDENT THAT THE FUTURE IS MORE
EXCITING THAN THE PAST.
SO WITH THAT, YOU KNOW I JUST
HOPE THAT YOU ENJOY THE REST OF
YOUR STAY HERE IN DC, YOU KNOW
TRY TO SEE THE CHERRY BLOSSOMS
IF YOU CAN AND JUST SAFE TRAVELS
BACK HOME, THANK YOU TO ALL THE
SPEAKERS.
[ APPLAUSE ]
JUST A QUICK FEW ANNOUNCE WANTS
IF THERE ARE SPEAKERS TRAVELING
TOA THE AIRPORTS AT THE SOUTH
SHUTTLES ARE, MEET AT THE SOUTH
ENTRANCE AT 12:15, THERE MAY BE
A COUPLE OTHER SPOTS FOR
NONSPEAKERS WHO ARE HEADING
THERE AS WELL, NUMBER 2 IF
ANYBODY LOST A METROSMART CARD
IT'S OUT IN THE LOBBY WITH 1 OF
THE STAFF, AND SAVE TRAVELS TO
EVERYBODY WHO'S GOING A FAR
DISTANCE.