Multi-Modal Retinal Imaging, On Spotlight at APVRS 2022 Symposium

Between artificial intelligence (AI), genetic therapies, and a whole host of other technological developments that ophthalmology is able to take advantage of right now, it’s a very exciting time to be in our industry. During the 15th Congress of the Asia-Pacific Vietro-Retina Society (APVRS 2022) the Media MICE team covered a number of topics where researchers are making leaps and bounds, all for the benefit of patients and significantly improved patient outcomes. We’ve already covered some of these topics in our recent highlights from the conference and the latest update we have for you is all about imaging the retina.

Held on the final day of the APVRS 2022, the symposium on Advanced Retinal Imaging really proved the old maxim of ‘saving the best ‘till last’, and brought together some of the top retina-focused minds in the region. The symposium covered hot topics including central serous chorioretinopathy, polypoidal choroidal vasculopathy, myopia, uveitis, diabetic retinopathy (DR), age-related macular degeneration (AMD) and more, and how imaging is revolutionizing their treatment. The full session is still available to view on demand so make sure you check it out.

When the ‘Sheu’ Fits the Topic

To kick things off we’d like to give another ‘shout out’ to Dr. Shwu-Jiuan Sheu from the department of ophthalmology at Kaohsiung Medical University Hospital (Kaohsiung, Taiwan). That’s because she was featured in another symposium during APVRS, namely Uveitis Pearls for Diagnosis which we’ve already covered in another report. In this symposium, she gave an interesting presentation on Imaging in Posterior Uiveitis, which not only was insightful but also perfectly, well, perfect for a magazine focused on the posterior segment. It stood out as it provided an excellent overview of some of the most important imaging technologies ophthalmologists can rely on today.

While she covered a number of topics related to multi-modal imaging in the treatment of uveitis the topic that particularly caught our interest was fundus autofluorescence (FAF), a non-invasive imaging modality that can map naturally and pathologically occurring fluorophores in the posterior segment. Dr. Sheu reported that this technique is particularly useful as it can identify the hyper-autofluorescence caused by uveitis, which occurs from a ‘loss of rhodopsin from photoreceptors.’ She also recommends using a multi-modal imaging approach when diagnosing and treating uveitis, and in addition to FAF, she also recommends conventional fundus, ultrawide-field imaging (UWF), and other techniques.

Diabetes – A Half a Billion Ticking Timebomb

Dr. Srinivas Sadda, the director of the Artificial Intelligence & Imaging Research Department at the Doheny Eye Institute, and professor of ophthalmology at the University of California Los Angeles (UCLA) provided another excellent presentation; UWF Imaging in Screening DR: Implications from AI. During his presentation, he pointed out the global need for improved diabetic retinopathy (DR) screening and treatment options as by 2040 there will be ‘620 million people diagnosed with diabetes’ – naturally making them likely to become ophthalmology patients. The challenge, Dr. Sadda said, was intervening early enough with this new cohort of future patients to save their sight. As currently, only 29% of patients are meeting standard screening recommendations.

Dr. Sadda stated he believes that autonomous, AI-based approaches are now available that have sufficient capacity and reliability to facilitate DR screening programs. The trick is that they must be able to ‘consider the entire retina area’ while doing so. He points to the use of UWF imaging as being particularly beneficial, especially for eyes with severe levels of DR, as its broad focus provides the best data for ‘optimal assessment and prognostication’. Finally, Dr. Sadda said that in one of his own studies, a deep learning model using UWF images was able to perform ‘at a level that suggests utility in a clinical environment,’ and that a trial is currently underway to ascertain its performance in a real-world setting.

If You Smoke Please Stop

Furthermore, the last symposium was Classification of AMD on OCT: Update from CAM, presented by Dr. Lim Tock Han, an adjunct professor at the Lee Kong Chian School of Medicine in Singapore. The CAM group was originally founded to investigate treatments for geographic atrophy (GA) and to manage chronic systemic disease related to macular atrophy, and one of the recommendations that Dr. Han takes from this collective is that the use of color fundus photo is insufficient to ‘identify early stages of the disease’, especially for GA. He said that instead, clinicians should always opt for a multi-modal imaging technique to achieve the best diagnostic results.

Dr. Han also spoke about the importance of identifying cases of AMD drusen (drusens being yellow pigment deposits under the retina made out of lipids and proteins), and cases associated with macular atrophy. He said that this requires a ‘deep dive into multi-modal imaging’ to differentiate AMD drusen from other cases as the treatment pathway is different from more conventional cases of AMD. Finally, he said that the attendees in general (and those from the Asia-Pacific region specifically) should adopt a population-based approach to managing patients with AMD by intervening early and promoting smoking cessation, which remains a major problem in the region. 

Remember to check out the APVRS website if you want to watch this symposium and others like it in full and on demand, and remember that we’ve already published a number of other highlight articles from the same conference which you should read. If you’re interested in the latest developments in the retina as well as imaging technologies, then let us know in the comments about what makes you most excited. Thanks again to everyone at the APVRS for putting together such a sterling effect, we can’t wait to visit again later this year.

Editor’s Note: The 15th Congress of the Asia-Pacific Vitreo-retina Society (APVRS 2022) was held on November 18 to 20, 2022, in Taipei, Taiwan. Reporting for this story took place during the event.

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