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20130227 supa-pals-challenges-in-retinal-imaging

Jano van Hemert
Jano van Hemert

This document discusses challenges in retinal imaging. Specifically, it notes that eye health care is a rapidly expanding market and retinal imaging requires constant innovation in physics and computer science. It also summarizes that the demand for eye care services is increasing significantly due to growing rates of diabetic retinopathy and the associated economic costs. Technologies like Optos SLO/OCT aim to address this increasing demand through wider retinal imaging capabilities.

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Challenges in retinal imaging Jano van Hemert jvanhemert@optos.com Sunday, 3 March 13 1 Summary Eye health care is a rapidly expanding market. Retinal imaging requires constant technology innovation from physics and computer science. Sunday, 3 March 13 2
Who, why, what and how? Sunday, 3 March 13 3 Growing Geographically Who? Leveraging Direct & Indirect Channels Finland Optos Iogen OG Iogen OPKO None China Optos Global Vision France OG Topcon Optos EDC Lamy Japan OPKO - Shenyang OG None Optos Chuo Sangio OPKO EDC Lamy OG Qualitas OPKO - None Italy Optos Oftalmedica OG Polyoftalmica South Korea OPKO Newtech Optos Seokwang OG Wooree Tech OPKO - Humanplustech Turkey Optos VSY India OG VSY & GeM Optos Biomedix OPKO Nidek Turkey OG Mehra Eyetech OPKO - Biomedix Direct Core Distributor Other Distributor Offices 21 OPTS 22 Feb 2013 09:21:24 GMT Optos revenue 2012 Optos pro鍖ts 2012 199.12 p +3.62 p +1.85% Volume 7,312 $196.4m +53.1m +37% from 2011 $25.9m +0.8m +3% from 2011 Sunday, 3 March 13 4
What? 1. vitreous body 2. ora serrata 3. ciliary muscle 4. ciliary zonules 5. canal of Schlemm 6. pupil 7. anterior chamber 8. cornea 9. iris 10. lens cortex 11. lens nucleus 12. ciliary process 13. conjunctiva 14. inferior oblique muscle 15. inferior rectus muscle 16. medial rectus muscle 17. retinal arteries and veins 18. optic disc 19. dura mater 20. central retinal artery 21. central retinal vein 22. optic nerve 23. vorticose vein 24. bulbar sheath 25. macula 26. fovea 27. sclera 28. choroid 29. superior rectus muscle 30. retina Sunday, 3 March 13 5 Why? Diabetic retinopathy incidence in +40 year-old diabetics in the US is 28.5賊4% [1]. The cost of diabetic retinopathy to the US is approximately $500 million annually [2]. The demand for eye-care services in The Netherlands will increase by 200300% between 2010 and 2020 [3]. [1] Zhang X, et al. JAMA. 2010 Aug 11;304(6):649-56. [2] Javitt JC, et al. Diabetes Care. 1994;17(8):909-917 [3] Keunen JE, et al.. Ned Tijdschr Geneeskd. 2011;155(41):A3461 Sunday, 3 March 13 6
Why? Sunday, 3 March 13 7 How? Sunday, 3 March 13 8
How? Sunday, 3 March 13 9 How? GREEN RED G+R Fluorescein Sunday, 3 March 13 angiography 10
Why? Sunday, 3 March 13 11 Why? Sunday, 3 March 13 11
Why? Sunday, 3 March 13 11 Why? Sunday, 3 March 13 11
Why? Sunday, 3 March 13 11 How? OptosSLO/OCT Sunday, 3 March 13 12
Challenge: uptake of technology Sunday, 3 March 13 13 Birth0of0ophthalmic0imaging SOURCES OF ILLUMINATION It was the lack of a strong, stable source of illumination that held up the development of the ophthalmo- scope in the 19th century. Early users of the Helmholtz ophthalmoscope had to put up with a naked flickering candle as a light source. During this first decade, the candle was largely replaced by the oil lamp and then the paraffin- burning lamp. Various valiant attempts were made at this time to allow the source of illumination to follow the move- ments of the ophthalmoscope: the first by Ricardus Ulrich in 1854 with his candleholder precariously at- tached to the observation tube,4(p40) and the second by Lionel Beale in 1869 with his built-in oil lamp.5(p97) Figure 1. Early model of the Helmholtz ophthalmoscope, 1851. Late in the 18th century, Swiss- born physician and chemist Aime Ar- 卒 gand had invented a device that was to evolve into the most common source of illumination during the second half of the 19th century: the gas lamp. In the ordinary oil lamp, combustion was not complete. Ar- cation retinal pho- gands improvement was the replace- ier efforts. ment of the conventional wick with Photographie des a ring. The flame became a hollow heil 1891;29:397.) cylinder with a current of air ascend- ing through the inside so that the burning surface was doubled. Ar- gands brother accidentally discov- [1] Keeler CR.Arch Ophthalmol. 120(2):194-201. placed as a ered that a glass cylinder chimney over the flame steadied it, [2] Gerloff O. Ueber die Photographie des Augenhintergrundes. Klin Monatf Augenheil 1891;29:397. created a draft, and allowed the flame to yield the maximum amount of Sunday, 3 March 13 light.6 14 Figure 2. Nineteenth-century gravity-fed oil lamp (left) and gas lamp (right). The gravity-fed oil lamp was fol- lowed by the gas-burning lamp, which worked on the same prin- New York ophthalmologist, dem- ety of the United Kingdom, it never ciple (Figure 2); by 1869, this source onstrated this new technology at the went into production.8 Sir James
2004... Sunday, 3 March 13 15 2004... Sunday, 3 March 13 15
2004... Sunday, 3 March 13 15 2007... [1] Moshfeghi DM. Review of Ophthalmology. Nov. 2007 Sunday, 3 March 13 16
2007... The present gold standard for ROP screening is binocular indirect ophthalmoscopy by an ophthalmologist experienced in the sequential changes of ROP. This recommendation comes from the Policy Statement on ROP screening from the AAO, the Section on Ophthalmology from the American Academy of Pediatrics, and the American Association for Pediatric Ophthalmology and Strabismus. ... [1] Moshfeghi DM. Review of Ophthalmology. Nov. 2007 Sunday, 3 March 13 16 2007... The present gold standard for ROP screening is binocular indirect ophthalmoscopy by an ophthalmologist experienced in the sequential changes of ROP. This recommendation comes from the Policy Statement on ROP screening from the AAO, the Section on Ophthalmology from the American Academy of Pediatrics, and the American Association for Pediatric Ophthalmology and Strabismus. ... ... Interestingly, there has never been a study validating the reproducibility or reliability of this technique. [1] [1] Moshfeghi DM. Review of Ophthalmology. Nov. 2007 Sunday, 3 March 13 16
Diagnosis for people with OHT, Glaucoma suspected COAG or COAG Clinical0pathways Diagnosis of OHT, suspected COAG and COAG Assessment IOP > 21 mmHg1 Any Any Any Optic nerve head Normal or Normal Suspicious Damage suspicious Visual field1 Normal or Normal Defects Defects uncertain Suspected OHT COAG tropic averaging also averages the voxels in the image plane, resulting in non-uniform speckle COAG An Optic Nerve Head impression of more speckle noise. Hence the frame averaged images size, which adds to the appear smoother but may exhibit less detail. High Normal Fly-through movies of the full data sets allow for a quick evaluation of the different IOP IOP averaging procedures (see media in Fig. 6). The 3x B-frames averaging preserves all features due to oversampling, with higher signal to noise ratio compared to single frames. Speckle noise is more strongly reduced with 6x B-frame averaging, and image blurring is only slightly perceptible. OHT COAG Suspected Refer to pathway pathway COAG pathway consultant (see (see pages (see page 10) ophthalmologist pages 89) 1213) [1] Diagnosis and management of chronic open angle glaucoma and ocular hypertension. NHS National Institute for Health an Clinical Excellence (NICE). Apr 2009. See key priorities for implementation on page 14. Sunday, 3 March 13 17 While0we0could0have... 1 Repeatable. 6 NICE clinical guideline 85 Quick reference guide [1] Klein T. Optics Express. 19(4):30443062 (2011) Sunday, 3 March 13 18 Fig. 8. The densely sampled (1900x1900) OCT volume enables reconstruction of depth- resolved fundus images (684kHz). Corresponding depth locations of the fundus images are color coded in the averaged B-frame on the left. The complete fundus image (integrated along the full depth) in the top left is inserted for comparison and is the same as in Fig. 5. Local
or0perhaps... Sunday, 3 March 13 19 or0perhaps... The test, pioneered by experts at the University of Edinburgh, will look at 1,000 patients with suspected heart disease. The study will prove whether scans can detect signs of heart disease, which can be difficult to diagnose. Researchers will use specialist equipment on loan from Optos an eye care company based in Dunfermline, Fife. Sunday, 3 March 13 19
Challenge: medical devices market Sunday, 3 March 13 20 Market0clearance0in0the0USA } Special 510(k) Abbreviated 510(k) Classes I, II, III Traditional 510(k) Premarket Approval } Class III Sunday, 3 March 13 21
Average0Eme0for0510(k)0 submissions0to0clear Average number of days to clearance: 2006 97 days 2007 110 days 2008 118 days 2009 136 days 2010 146 days 2011 138 days [1] Emergo Group. http://www.emergogroup.com/research/fda-510k-review-times-research 2013-01-31 Sunday, 3 March 13 22 And0so0on... Sunday, 3 March 13 23
CongratulaEons... now0the0bad0news Sunday, 3 March 13 24 Challenge: technology itself Sunday, 3 March 13 25
Sunday, 3 March 13 26 Sunday, 3 March 13 27
Spot0the0problem Sunday, 3 March 13 28 Spot0the0problem Sunday, 3 March 13 28
Spot0the0problem Sunday, 3 March 13 28 Sunday, 3 March 13 29
Sunday, 3 March 13 30 Sunday, 3 March 13 30
Sunday, 3 March 13 31 Sunday, 3 March 13 31
Sunday, 3 March 13 31 Summary Eye health care is a rapidly expanding market; its estimated growth is $1,097m by 2016. + Retinal imaging requires constant technology innovation from physics and computer science. = Do work with us! Sunday, 3 March 13 32
Thanks for listening Contact me at Sunday, 3 March 13 33

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20130227 supa-pals-challenges-in-retinal-imaging

  • 1. Challenges in retinal imaging Jano van Hemert jvanhemert@optos.com Sunday, 3 March 13 1 Summary Eye health care is a rapidly expanding market. Retinal imaging requires constant technology innovation from physics and computer science. Sunday, 3 March 13 2
  • 2. Who, why, what and how? Sunday, 3 March 13 3 Growing Geographically Who? Leveraging Direct & Indirect Channels Finland Optos Iogen OG Iogen OPKO None China Optos Global Vision France OG Topcon Optos EDC Lamy Japan OPKO - Shenyang OG None Optos Chuo Sangio OPKO EDC Lamy OG Qualitas OPKO - None Italy Optos Oftalmedica OG Polyoftalmica South Korea OPKO Newtech Optos Seokwang OG Wooree Tech OPKO - Humanplustech Turkey Optos VSY India OG VSY & GeM Optos Biomedix OPKO Nidek Turkey OG Mehra Eyetech OPKO - Biomedix Direct Core Distributor Other Distributor Offices 21 OPTS 22 Feb 2013 09:21:24 GMT Optos revenue 2012 Optos pro鍖ts 2012 199.12 p +3.62 p +1.85% Volume 7,312 $196.4m +53.1m +37% from 2011 $25.9m +0.8m +3% from 2011 Sunday, 3 March 13 4
  • 3. What? 1. vitreous body 2. ora serrata 3. ciliary muscle 4. ciliary zonules 5. canal of Schlemm 6. pupil 7. anterior chamber 8. cornea 9. iris 10. lens cortex 11. lens nucleus 12. ciliary process 13. conjunctiva 14. inferior oblique muscle 15. inferior rectus muscle 16. medial rectus muscle 17. retinal arteries and veins 18. optic disc 19. dura mater 20. central retinal artery 21. central retinal vein 22. optic nerve 23. vorticose vein 24. bulbar sheath 25. macula 26. fovea 27. sclera 28. choroid 29. superior rectus muscle 30. retina Sunday, 3 March 13 5 Why? Diabetic retinopathy incidence in +40 year-old diabetics in the US is 28.5賊4% [1]. The cost of diabetic retinopathy to the US is approximately $500 million annually [2]. The demand for eye-care services in The Netherlands will increase by 200300% between 2010 and 2020 [3]. [1] Zhang X, et al. JAMA. 2010 Aug 11;304(6):649-56. [2] Javitt JC, et al. Diabetes Care. 1994;17(8):909-917 [3] Keunen JE, et al.. Ned Tijdschr Geneeskd. 2011;155(41):A3461 Sunday, 3 March 13 6
  • 4. Why? Sunday, 3 March 13 7 How? Sunday, 3 March 13 8
  • 5. How? Sunday, 3 March 13 9 How? GREEN RED G+R Fluorescein Sunday, 3 March 13 angiography 10
  • 6. Why? Sunday, 3 March 13 11 Why? Sunday, 3 March 13 11
  • 7. Why? Sunday, 3 March 13 11 Why? Sunday, 3 March 13 11
  • 8. Why? Sunday, 3 March 13 11 How? OptosSLO/OCT Sunday, 3 March 13 12
  • 9. Challenge: uptake of technology Sunday, 3 March 13 13 Birth0of0ophthalmic0imaging SOURCES OF ILLUMINATION It was the lack of a strong, stable source of illumination that held up the development of the ophthalmo- scope in the 19th century. Early users of the Helmholtz ophthalmoscope had to put up with a naked flickering candle as a light source. During this first decade, the candle was largely replaced by the oil lamp and then the paraffin- burning lamp. Various valiant attempts were made at this time to allow the source of illumination to follow the move- ments of the ophthalmoscope: the first by Ricardus Ulrich in 1854 with his candleholder precariously at- tached to the observation tube,4(p40) and the second by Lionel Beale in 1869 with his built-in oil lamp.5(p97) Figure 1. Early model of the Helmholtz ophthalmoscope, 1851. Late in the 18th century, Swiss- born physician and chemist Aime Ar- 卒 gand had invented a device that was to evolve into the most common source of illumination during the second half of the 19th century: the gas lamp. In the ordinary oil lamp, combustion was not complete. Ar- cation retinal pho- gands improvement was the replace- ier efforts. ment of the conventional wick with Photographie des a ring. The flame became a hollow heil 1891;29:397.) cylinder with a current of air ascend- ing through the inside so that the burning surface was doubled. Ar- gands brother accidentally discov- [1] Keeler CR.Arch Ophthalmol. 120(2):194-201. placed as a ered that a glass cylinder chimney over the flame steadied it, [2] Gerloff O. Ueber die Photographie des Augenhintergrundes. Klin Monatf Augenheil 1891;29:397. created a draft, and allowed the flame to yield the maximum amount of Sunday, 3 March 13 light.6 14 Figure 2. Nineteenth-century gravity-fed oil lamp (left) and gas lamp (right). The gravity-fed oil lamp was fol- lowed by the gas-burning lamp, which worked on the same prin- New York ophthalmologist, dem- ety of the United Kingdom, it never ciple (Figure 2); by 1869, this source onstrated this new technology at the went into production.8 Sir James
  • 10. 2004... Sunday, 3 March 13 15 2004... Sunday, 3 March 13 15
  • 11. 2004... Sunday, 3 March 13 15 2007... [1] Moshfeghi DM. Review of Ophthalmology. Nov. 2007 Sunday, 3 March 13 16
  • 12. 2007... The present gold standard for ROP screening is binocular indirect ophthalmoscopy by an ophthalmologist experienced in the sequential changes of ROP. This recommendation comes from the Policy Statement on ROP screening from the AAO, the Section on Ophthalmology from the American Academy of Pediatrics, and the American Association for Pediatric Ophthalmology and Strabismus. ... [1] Moshfeghi DM. Review of Ophthalmology. Nov. 2007 Sunday, 3 March 13 16 2007... The present gold standard for ROP screening is binocular indirect ophthalmoscopy by an ophthalmologist experienced in the sequential changes of ROP. This recommendation comes from the Policy Statement on ROP screening from the AAO, the Section on Ophthalmology from the American Academy of Pediatrics, and the American Association for Pediatric Ophthalmology and Strabismus. ... ... Interestingly, there has never been a study validating the reproducibility or reliability of this technique. [1] [1] Moshfeghi DM. Review of Ophthalmology. Nov. 2007 Sunday, 3 March 13 16
  • 13. Diagnosis for people with OHT, Glaucoma suspected COAG or COAG Clinical0pathways Diagnosis of OHT, suspected COAG and COAG Assessment IOP > 21 mmHg1 Any Any Any Optic nerve head Normal or Normal Suspicious Damage suspicious Visual field1 Normal or Normal Defects Defects uncertain Suspected OHT COAG tropic averaging also averages the voxels in the image plane, resulting in non-uniform speckle COAG An Optic Nerve Head impression of more speckle noise. Hence the frame averaged images size, which adds to the appear smoother but may exhibit less detail. High Normal Fly-through movies of the full data sets allow for a quick evaluation of the different IOP IOP averaging procedures (see media in Fig. 6). The 3x B-frames averaging preserves all features due to oversampling, with higher signal to noise ratio compared to single frames. Speckle noise is more strongly reduced with 6x B-frame averaging, and image blurring is only slightly perceptible. OHT COAG Suspected Refer to pathway pathway COAG pathway consultant (see (see pages (see page 10) ophthalmologist pages 89) 1213) [1] Diagnosis and management of chronic open angle glaucoma and ocular hypertension. NHS National Institute for Health an Clinical Excellence (NICE). Apr 2009. See key priorities for implementation on page 14. Sunday, 3 March 13 17 While0we0could0have... 1 Repeatable. 6 NICE clinical guideline 85 Quick reference guide [1] Klein T. Optics Express. 19(4):30443062 (2011) Sunday, 3 March 13 18 Fig. 8. The densely sampled (1900x1900) OCT volume enables reconstruction of depth- resolved fundus images (684kHz). Corresponding depth locations of the fundus images are color coded in the averaged B-frame on the left. The complete fundus image (integrated along the full depth) in the top left is inserted for comparison and is the same as in Fig. 5. Local
  • 14. or0perhaps... Sunday, 3 March 13 19 or0perhaps... The test, pioneered by experts at the University of Edinburgh, will look at 1,000 patients with suspected heart disease. The study will prove whether scans can detect signs of heart disease, which can be difficult to diagnose. Researchers will use specialist equipment on loan from Optos an eye care company based in Dunfermline, Fife. Sunday, 3 March 13 19
  • 15. Challenge: medical devices market Sunday, 3 March 13 20 Market0clearance0in0the0USA } Special 510(k) Abbreviated 510(k) Classes I, II, III Traditional 510(k) Premarket Approval } Class III Sunday, 3 March 13 21
  • 16. Average0Eme0for0510(k)0 submissions0to0clear Average number of days to clearance: 2006 97 days 2007 110 days 2008 118 days 2009 136 days 2010 146 days 2011 138 days [1] Emergo Group. http://www.emergogroup.com/research/fda-510k-review-times-research 2013-01-31 Sunday, 3 March 13 22 And0so0on... Sunday, 3 March 13 23
  • 17. CongratulaEons... now0the0bad0news Sunday, 3 March 13 24 Challenge: technology itself Sunday, 3 March 13 25
  • 18. Sunday, 3 March 13 26 Sunday, 3 March 13 27
  • 19. Spot0the0problem Sunday, 3 March 13 28 Spot0the0problem Sunday, 3 March 13 28
  • 20. Spot0the0problem Sunday, 3 March 13 28 Sunday, 3 March 13 29
  • 21. Sunday, 3 March 13 30 Sunday, 3 March 13 30
  • 22. Sunday, 3 March 13 31 Sunday, 3 March 13 31
  • 23. Sunday, 3 March 13 31 Summary Eye health care is a rapidly expanding market; its estimated growth is $1,097m by 2016. + Retinal imaging requires constant technology innovation from physics and computer science. = Do work with us! Sunday, 3 March 13 32
  • 24. Thanks for listening Contact me at Sunday, 3 March 13 33