Optical coherence tomography (OCT) has revolutionized the management of ophthalmic diseases with the precise anatomic information it provides with non-invasive imaging. The high-resolution cross-sectional tissue details make OCT a natural complement to ophthalmic surgery. Intraoperative OCT (iOCT) has the potential to provide real-time feedback to surgeons thus improving surgical care and outcomes. This research activity will focus on translating OCT technology into the operating room and will be led by Justis P. Ehlers, MD, of the Cleveland Clinic Cole Eye Institute. Dr. Ehlers is a highly trained retina surgeon with extensive experience in the field of iOCT. His immediate career goals include developing his skills as a clinician-scientist through focused educational endeavors while establishing a clinical framework for the use of OCT in the operating room. The three aims of this research activity reflect these goals and include (1) completion of a comprehensive prospective study utilizing iOCT during ophthalmic surgery, (2) design and testing of OCT-friendly surgical instrumentation, and (3) development and implementation of iOCT software platforms.
The first aim will provide a rich database for the utility of iOCT in various procedures (e.g., cataract surgery, corneal transplantation, macular hole surgery, epiretinal membrane surgery). Based on the initial feasibility study, multiple condition-specific studies will be carrid out to refine the use of iOCT.
The second aim will address the problems with current instrumentation and the associated poor light transmission and limited OCT-visibility. Novel materials and instrument prototypes are being tested for their optical properties to develop OCT-friendly instruments that allow for visualization of the underlying tissue and the instrument.
The third aim will address the shortcomings of current software packages. Novel software algorithms are in development for this research activity that will provide automated real-time analysis of subtle changes in the conditions of the eye during surgery (e.g., macular hole geometry alterations). In the long-term, Dr. Ehlers plans to develop comprehensive disease-specific platforms for the application of iOCT to surgical eye care in order to improve patient outcomes and test these indications in a multi-center clinical trial. In addition to the research activity, r. Ehlers will enroll in the Clinical Research Scholars Program at Case Western Reserve University to further hone his research skills and develop a foundation for a successful career as an independent clinician-scientist. Dr. Ehlers has assembled an outstanding mentorship team (Drs. Peter Kaiser, Cynthia Toth, and William J. Dupps). The mentors'experience in instrument design, biomedical engineering, translational OCT research, software development, and iOCT greatly enhances the strength of this research proposal. Dr. Ehlers has also developed strong partnerships with collaborators in instrument design (Peregrine Surgical), software development (ImageIQ), and OCT technology (Bioptigen). These partnerships also greatly strengthen the foundation of the proposal and the likelihood of both short-term and long-term success.

Public Health Relevance

Optical coherence tomography (OCT) is an imaging technique that provides invaluable information regarding the anatomy of the eye and the presence of disease processes, such as scar tissue or edema. Currently, OCT is used in the office setting, but the anatomic information that OCT provides is a natural complement to surgery. This research activity's focus is the integration of OCT into ophthalmic surgery in order to improve visualization of surgical maneuvers, enhance understanding of the completion of surgical objectives, and improve surgical outcomes for patients.

National Institute of Health (NIH)
National Eye Institute (NEI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZEY1)
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Agarwal, Neeraj
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Cleveland Clinic Lerner
Schools of Medicine
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Ehlers, Justis P; Wang, Kevin; Vasanji, Amit et al. (2017) Automated quantitative characterisation of retinal vascular leakage and microaneurysms in ultra-widefield fluorescein angiography. Br J Ophthalmol 101:696-699
Trichonas, George; Traboulsi, Elias I; Ehlers, Justis P (2017) Ultra-widefield fundus autofluorescence patterns in retinitis pigmentosa and other retinal dystrophies. Ophthalmic Genet 38:98-100
Browne, Andrew W; Ehlers, Justis P; Sharma, Sumit et al. (2017) Intraoperative Optical Coherence Tomography-Assisted Chorioretinal Biopsy in the DISCOVER Study. Retina 37:2183-2187
Arepalli, Sruthi; Traboulsi, Elias I; Ehlers, Justis P (2017) ELLIPSOID ZONE MAPPING AND OUTER RETINAL ASSESSMENT IN STARGARDT DISEASE. Retina :
Uchida, Atsuro; Srivastava, Sunil K; Ehlers, Justis P (2017) Analysis of Retinal Architectural Changes Using Intraoperative OCT Following Surgical Manipulations With Membrane Flex Loop in the DISCOVER Study. Invest Ophthalmol Vis Sci 58:3440-3444
Runkle, Anne; Srivastava, Sunil K; Ehlers, Justis P (2017) Microscope-Integrated OCT Feasibility and Utility With the EnFocus System in the DISCOVER Study. Ophthalmic Surg Lasers Imaging Retina 48:216-222
Ehlers, Justis P; Uchida, Atsuro; Srivastava, Sunil K (2017) THE INTEGRATIVE SURGICAL THEATER: Combining Intraoperative Optical Coherence Tomography and 3D Digital Visualization for Vitreoretinal Surgery in the DISCOVER Study. Retina :
Ehlers, Justis P; Uchida, Atsuro; Srivastava, Sunil K (2017) Intraoperative optical coherence tomography-compatible surgical instruments for real-time image-guided ophthalmic surgery. Br J Ophthalmol 101:1306-1308
Runkle, Anne P; Kaiser, Peter K; Srivastava, Sunil K et al. (2017) OCT Angiography and Ellipsoid Zone Mapping of Macular Telangiectasia Type 2 From the AVATAR Study. Invest Ophthalmol Vis Sci 58:3683-3689
Hallahan, Katie M; Cost, Brian; Goshe, Jeff M et al. (2017) Intraoperative Interface Fluid Dynamics and Clinical Outcomes for Intraoperative Optical Coherence Tomography-Assisted Descemet Stripping Automated Endothelial Keratoplasty From the PIONEER Study. Am J Ophthalmol 173:16-22

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