Presentation by Duke University Medical Center at OIS@ASRS 2016. Participant: Cynthia A. Toth, MD - Duke University Medical Center Powered by: Healthegy For more ophthalmology innovation Visit us at www.ois.net

1. Duke University Medical Center
History of OCT Imaging in
Vitreoretinal Surgery
Cynthia A. Toth, M.D.
Joseph AC Wadsworth Professor of Ophthalmology
Professor of Biomedical Engineering
Royalties: Alcon, Hemosonics
Research Support: Genentech, NIH

2. Machemer R, Parel JM, Buettner H.
A new concept for vitreous surgery. 1.
Instrumentation. AJO. 1972.
45 years since the invention of pars plana vitrectomy
Machemer R, Buettner H, Norton EW, Parel JM.
Vitrectomy: a pars plana approach.
Trans AAOphth Otolar.1971.

3. Machemer R.
Two instrument techniques
in pars plana vitrectomy.
Arch Ophthalmol. 1974.
Parel JM, Machemer R, Aumayr W.
An automated
operating microscope.
Am J Ophthalmol. 1974.
Pars plana vitreoretinal surgery
required new tools and techniques
While the tools have
advanced
The microscope has
lagged behind

4. Operating without OCT
• OCT imaging has revolutionized
pre and postoperative assessment
• The surgeon goes back to an
en face OCT-free view during
surgery

5. Stage A. intraoperative iOCT:
2D outside the microscope at a pause in surgery
Portable imaging 2007
Bioptigen research system
Vitreomacular traction Vitreous removed
-Dayani PN, Maldonado R, Farsiu S, Toth CA. Intraoperative use of HH SDOCT imaging in macular surgery. Retina, 2009
-Scott AW, Farsiu S, Enyedi LB, Wallace DK, Toth CA. Imaging the infant retina with a HH SDOCT device. AJO, 2009
-Ehlers JP, Kernstine K, Farsiu S, Sarin N, Maldonado R, Toth CA. Analysis of pars plana vitrectomy for optic pit-related
maculopathy with intraoperative OCT. Arch Ophthalmol. 2011
Imaging over time intervals
Bioptigen Envisu

6. Stage B iOCT. Microscope integrated
Real-time 2D scans
View 3D volumes at a pause in surgery or later
-Tao YK, Ehlers JP, Toth CA, Izatt JA. Intraoperative SDOCT for vitreoretinal surgery. Optics Letters, 2010.
-Ehlers JP, Tao YK, Farsiu S, Maldonado R, Izatt JA, Toth CA. Integration of SDOCT into a surgical microscope for intraoperative
imaging. IOVS 2011
-Hahn P, Migacz J, O'Connell R, Maldonado RS, Izatt JA, Toth CA. Use of OCT in intraoperative ophthalmic imaging. OSLI 2011
-Binder S; Falkner-Radler C, Hauger, C; Matz H; Glittenberg, C. Feasibility of intrasurgical Spectral domain optical coherence
tomography Retina. 2011.
Duke/ Izatt- Bioptigen
Retinal imageB-Scan
Medical Univ. Vienna
Binder-Carl Zeiss Meditech

7. Stage B iOCT: Real-time 2D OCT:
Current Commercial MIOCT
Ehlers JP, Goshe J, Dupps WJ, Kaiser PK, Singh
RP, Gans R, Eisengart J, Srivastava SK.
Determination of feasibility and utility of MIOCT
during ophthalmic surgery: the DISCOVER
Study RESCAN Results. JAMA Ophthalmol. 2015
Monocular
heads up display
to view 2D images
Bioptigen/Leica
EnFocus 2300

8. • Integrated Scanner
• Swept Source OCT (1060 nm)
• Up to 7.4 mm axial imaging range,
• 7.8 µm axial resolution
• 200 kHz A-line rate
• GPU-based Volumetric Image Computation and Rendering
• Custom CUDA GPU pipeline for live acquisition and processing
• Utilizes single nVidia GTX Titan Black GPU
• Each group of 16 B-scans: 86 ms-acquire, 18 ms-process, and 12.5 ms-render
• Stereo Heads up Display
• In oculars or 3D screen
Stage C iOCT
4D MIOCT System components
Oscar Carrasco-Zevallos
Yuankai Kenny Tao
Joseph Izatt
Liangbo
Linus Shen
Stereo
HUD
Tao YK et al Optics Letters 2010
Carrasco-Zevallos et al Nature Scientific Reports 2016
Viehland C et al, Biomed. Opt. Expr. 2016.
Shen L et al Biomed Opt Express. 2016
Brenton Keller
Christian
Viehland

9. Stage C iOCT Integrated Components for
Vitreoretinal Surgery

10. The next Stage of iOCT :
Image-guided surgery
• IMPROVE SPEED & QUALITY OF IMAGING/RENDER
– Display volumes faster
– Remove Artifacts
– Stabilize systems
• INTUITIVE SURGEON CONTROL
– Control of viewpoint
• AUGMENT REALITY
– OCT ANGIOGRAPHY

11. iOCT Collaborators
Ophthalmology
Paul Hahn
Lejla Vajzovic
DH Nam
Bozho Todorich
Michael Seider
Dilraj Grewal
Justis Ehlers
Ramiro Maldonado
Adrienne Scott
Sai Chavala
Pouya Dayani
Duke Advanced Research in SD/SSOCT
Imaging (DARSI) Laboratory (Toth)
Pam Bhullar
Rachelle O’Connell
Du Tran Viet
Michelle McCall
Neeru Sarin
Eric Yuan
Monica Sevilla
Alexandra Dandridge
Vincent Tai
Adam Rothman
Philip Desouza
Biomedical Engineering
Joseph Izatt
Oscar Carrasco-Zevallos
Brenton Keller
Christian Viehland
Linus Shen
Crystal Chukwurah
Gar Waterman
Justin Migicz
Fitzpatrick Center,
Duke University
Funding
NIH Biomedical Research Partnership Grant
R01-EY023039, “Intraoperative OCT Guidance
of Intraocular Surgery" (Izatt/Toth MPI),
NCRR UL1 RR024128-01
R21 EY019411
Duke Advanced Imaging
Laboratory
Sina Farsiu
Stephanie Chiu
David Cunefare
Cole Eye Institute
Sunil Srivastava
Justis Ehlers
BJ Dupps
Kenny Tao
Anthony Kuo
Neel Pasricha
Christine Shieh
Ryan McNabb