The summer’s drawing to a close (for most of us) and the last big conference of the season has passed. The American Society of Retina Specialists (ASRS) held its annual scientific meeting online last month, and it was a fascinating experience.
A number of exciting developments were discussed at ASRS 2020, with great applications in retina and other areas of ophthalmology. The season’s favorite topics of telemedicine and coronavirus were naturally discussed, but so too were gene therapy, emerging technologies and drug delivery devices. All in all, it’s an exciting time for anyone involved in retina.
Coming Soon From a Sci-fi Screen to You
For the technology obsessed or sci-fi fans among us (including your correspondent), one of the most exciting developments is of course, artificial intelligence (AI). How ophthalmology is harnessing this technology, (and preventing Skynet from taking over the planet), is a fascinating area of study. We are now witnessing AI deployment for screening diabetic retinopathy, visual field tests and in a variety of other fields.
AI’s sister technologies, namely augmented reality (AR) and virtual reality (VR) are now even being used to help people with low vision due to diseases like AMD. For example, California-based Ocutrx are offering headsets that are incredibly light and easy to use, like the company’s flagship product Oculenz, which is specifically designed for use by age-related macular degeneration patients.
Oculenz was discussed during the first day of the ASRS conference and it’s easy to understand why. The lens uses complex algorithms to reposition video pixels from blurred vision areas to adjacent areas with viable vision. It is completely wireless and smart-enabled, meaning it can be integrated with laptops, smartphones or tablets in the home.
Another exciting development is observable in the realm of gene therapy too, particularly in treating RPE65-associated Leber Congenital Amaurosis (LCA). This condition is a severe inherited retinal degeneration (IRD) with a typical presentation between birth and 5-years-old.
As you can imagine there is strong demand for therapy that can identify the genes that cause the condition. This process often requires the guidance of a specialist or genetic counselor, which has generally limited patient access. There is also a considerable paucity of online resources devoted to gene therapy.
With the launch of voretigene neparvovec (Luxturna®, Spark Therapeutics, PA, USA) the first in vivo gene therapy approved by the U.S. Food and Drug Administration (FDA), a new frontier is opening. This is a welcome development as voretigene neparvovec is an exciting and novel development. It is of the utmost importance that patients are able to access as much information as possible in tandem with the drug’s launch.
One more product now cleared for use by the FDA is the EyeArt® AI Eye Screening System for diabetic retinopathy (DR). Manufactured by Eyenuk Inc, an AI and medical technology and services company based in California, this autonomous AI technology has diagnostic outputs for each eye of any given patient. It can be used to screen for all forms of DR, one of the leading causes of blindness globally.
Eyenuk claims an impressive 97% imageability rate for the device, that is, of all patients screened who already had diabaetic retinopathy 97% were correctly identified. This rate was replicated at primary care centers where the machine’s operators did not have prior ophthalmic experience. Also, 90% of participants were diagnosed without the need for dilation.
The EyeArt system is designed for use by Canon CR-2 AF and Canon CR-2 Plus AF cameras. We’re very excited to see how this apparently easy-to-use AI technology is fully implemented. It certainly represents a welcome development for DR patients.
We’re Always Going to Have to Use Needles (Probably)
Anesthesia is very much a bread-and-butter aspect of the medical industry. While the basic technology behind anesthesia is relatively unchanged, ophthalmology is experiencing interesting developments, especially for patients receiving intravitreal injections (IVIs).
IVIs can cause discomfort for patients and are often considered to be a bottleneck in clinical efficiency, thus more research is being devoted to finding a more painless approach. One of these novel ideas was applying anesthesia with a cooling effect. In one study presented at ASRS, Cooling Anesthesia for Intravitreal Injection With a Novel Device: Results of the Prospective COOL-2 Study, cooling anesthesia was applied in lieu of regular anesthesia, and pain was recorded in visual analog scale at the time of injection.
All in all, 70% of the patients preferred the cooling anesthesia, though overall pain levels were reported to be the same. Improving patient comfort is an excellent goal, and while there is more work to do in this area, cooling anesthesia holds great potential. Not only that, it will have broad applicability to many disciplines in ophthalmology.
Finally, if you’ve ever seen the Tom Cruise film Minority Report, you might be about to feel a pang of déjà vu. A group of scientists at the Hong Kong University of Science and Technology (HKUST) are currently working on the world’s first artificial eye: the Electrochemical Eye (EC-Eye) This 3D eye is feted to likely offer better vision than bionic eyes, and even a regular eye, in the future.
The EC-Eye’s most remarkable feature is a fully 3D retina. This manufactured retina is made of an array of nanowire light sensors which mimic the photoreceptors in human retinas. Nanowire has a higher density than photoreceptors in the human retina, which means that in theory, this EC-Eye can receive more light signals and view higher image resolutions than the regular human retina.
The technology behind the EC-Eye still needs further development and more studies on its performance and biocompatibility are required. That being said, this is seriously cool stuff. Who knows, maybe in a decade or so we’ll be swapping our boring old peepers for the EC-lEyes, especially if they come in my favorite color purple.
Editor’s Note: The American Society of Retina Specialists Annual Scientific Meeting (ASRS 2020) was held virtually on 24-26 July.