As always, one of the highlights of this years AAO conference was the exhibition (1). It is always a good place to identify new developments that are likely to reach our shores in the future. It is also interesting to see how, due to differences in the way the FDA approve of medical devices as compared with Europe, finding out where the US actually lags behind us. For example, this year much fuss was made about the FDA approval of the Topcon Maestro OCT, an excellent primary care instrument we have had access to for some years now (2). For once, OCT advances took a back seat at such an exhibition and the focus was more on improving use of the already excellent available technology. ARVO announced its launch of a patient education campaign with the release of some useful education videos – check them out at www.arvo.org/oct.
Figure 2
Electrophysiology
I am convinced we are seeing a resurgence in the use of electrophysiology in the detection and management of eye disease. This was certainly borne out by the AAO conference this year. The Diopsys system was attracting much interest in the exhibition arena (3).
Figure 3
This uses a small electrode, similar to a small plaster, secured to the face under the lower lid (4) and produces a characteristic electroretinography (ERG) output curve when the patient views various pattern targets (5).
Figure 4
Figure 5
A similar technique may easily generate a visually evoked pattern response (VEP). The former curve shows changes in pattern when, for example, ganglion cell damage occurs in glaucoma, or where maculopathy changes result from use of drugs like hydroxychloroquine. The latter may detect when a visual pathway defect is reducing vision in the absence of apparent ocular disease. Having such easily and quickly performed objective testing in practice may be the biggest thing since visual fields testing. We hope to cover this in some detail next year.
There were plenty of research papers presented to support my view too. A presentation by Dr Kristen Bowles, AAO Ezell Fellow, showed how ERGs (using the Espion E2 from Diagnosys LLC) are refining the detection of photoreceptor dysfunction, either due to disease or drug adverse responses.
Blue light
While back in the UK, viewers were watching Watchdog, I came across a new lensmeter, the HLM-9000 from Coburn (6), which, interestingly, includes a function allowing the easy assessment of either ultraviolet or blue light transmittance through any lens. I would expect to see this become incorporated in more focimeters in the future.
Figure 6
Imaging
Digitisation continues apace and there were yet more variations on a theme aimed at using smartphones as retinal imaging devices. Perhaps the one attracting most attention was the newly introduced Volk iNview (7). This is, in the words of the supplier, ‘a combination product comprised of a mobile application (Apple App Store) and an indirect ophthalmoscopic lens attachment that fits for an Apple iPhone/iPod.’ I have had mixed results with these sorts of phone-based cameras in the past and look forward to trying this one out.
Figure 7
Another imaging system new to me is the Annidis RHA (8). We are familiar with the concept of light-based imaging utilising different wavelength input to differentiate layers under observation; shorter wavelengths able to best capture more anterior retinal layers and longer wavelengths penetrating to the choroid.
Figure 8
The RHA incorporates multispectral imaging so able to differentiate 10 layers accurately. The longer wavelengths (up to 940nm) are able to penetrate deep enough to offer impressive views of the choroid. The unit also boasts stereo imaging, autofluorescence, 80º wide field viewing and, something I was impressed by, the ability to enhance the contrast of vessel images according to the level of haemoglobin oxygenation within them. This may prove invaluable in monitoring those with vascular diseases such as diabetes.
Blepharitis
Most of us are now recommending prolonged heat treatment and pressure to patients with meibomium gland dysfunction – hopefully the days of the minimally warm and questionably sterile hot towel are long gone. Microwave (such as the EyeBag) and chemically heated techniques are available. Electrically charged versions have had less success – I remember trying out some ‘humidity goggles’ a while back and felt they were too expensive, fidgety and cumbersome – not something likely to encourage compliance. I did like, however, the Heated Eye Pad on show (from Digital Heat) and indeed tried it out myself (9).
Figure 9
The pre-charged unit applies the correct meibum melting heat directly to the area and maintains this adequately (as the infrared image of my eyes upon removal of the gadget shows (10).
Figure 10
I was also curious about the LidPro device (11) from MIBO which provides a rubberised frictional motion to inflamed eyes (not dissimilar to the BlephEx from Scope) to aid debris removal and reduce inflammation.
Figure 11
Amblyopia
Management of amblyopia has traditionally used some stimulation of the amblyopic eye, through a visual task, while occluding or fogging the better sighted eye. Anything that makes this process more interesting and appealing, while able to include good control over the target and testing times, has to be worth a look. The Vivid Vision Home (12) uses a virtual reality adaptor allowing the child (or even adult if having a go) to view downloaded imagery and should address compliance issues nicely. This is proving popular in US paediatric clinics.
Figure 12
Low vision
There were a few nice developments in low vision technology on display. I like the new 7-inch video magnifier from Eschenbach – the Visiolux Digital HD (13). The high definition image should help with contrast compromise and the unit has HDMI and USB connectivity allowing it to be combined with a TV or digital screen for extra magnification and image enhancement. Most importantly for this kind of advice, it looks difficult to break.
Figure 13
Finally, I really like the look of the spectacle mounted smart camera device called the OrCam (14) and can not wait to get hold of one.
Figure 14
The smart camera is mounted on the spectacle side with little visibility and incorporates optical character recognition software allowing the viewer to hear any text they are looking at to be read out with excellent accuracy and clarity. It also may be programmed to identify and announce familiar objects and faces – what a great innovation.
