NYU Langone Doctors Develop New Ophthalmology Technology
At NYU Langone Health, a doctor whose groundbreaking invention changed ophthalmology in the 1990s is building on his breakthrough with new eye care research. Dr. Joel Schuman is one of the inventors of Optical Coherence Tomography (OCT), an imaging device that allows doctors to objectively review the retina. Now Dr. Schuman leads a team of researchers working to develop the next big ophthalmologic innovation.
Aired on December 13, 2019.
TRANSCRIPT
> YOUR RETINA IS TISSUE IN THE BACK OF THE EYE THAT HOLDS THE KEY TO DIAGNOSING MOST BLINDING DISEASES.
ITS APPEARANCE CAN INDICATE CONDITIONS LIKE MACULAR DEGENERATION, DIABETIC RETINOPATHY AND GLAUCOMA.
IT WASN'T UNTIL OPTICAL COHERENCE TOPOGRAPHY IN THE 1990s THAT REVIEWING THE RETINA WAS EVEN POSSIBLE.
WHAT WERE PEOPLE USING BEFORE?
THEY WERE LOOKING.
THEY WERE LOOKING AT THE BACK OF THE EYE AND MAKING A SUBJECTIVE ASSESSMENT OF WHAT IT LOOKS LIKE.
THAT WAS HOW WE DID IT.
UP UNTIL THE MID '90s.
THIS DOCTOR IS A PROFESSOR AND THE CHAIRMAN OF OPHTHALMOLOGY AT NYU.
HE WAS PART OF THE TEAM THAT INVESTED THIS.
IT IS A WAY OF MAKING A THREE DIMENSIONAL MAP OF THE BACK OF THE EYE.
IN THIS CASE WE ARE TALKING ABOUT EYES.
IT CAN SEE THE RETINA, WHICH IS THE NERVE TISSUE IN THE BACK OF THE EYE.
IT'S LIKE AN ULTRASOUND BUT USING LIGHT INSTEAD OF SOUND WAVES.
WHAT THAT DOES IS IT ALLOWS US TO DIAGNOSE DISEASE MUCH EARLIER THAN WE EVER COULD BEFORE AND TO FOLLOW TREATMENT OF THE DISEASE.
IS MY TREATMENT WORKING OR NOT?
IS SOMETHING GETTING WORSE OR NOT?
THE FIRST TIME THE PATIENT COMES IN, YOU KNOW OR YOU CAN FIGURE OUT, DOES THIS PATIENT HAVE SOME SORT OF DISEASE?
ALL OF THESE THINGS CAN BE MEASURED VERY ACCURATELY AND PRECISELY WITH OCT.
THE DOCTOR SAYS OPHTHALMOLOGY BEFORE OCT WAS SIMILAR TO NEUROLOGY BEFORE THE ADVENT OF CT SCANS OR MRIs.
WHEN NEUROLOGISTS WOULD MAKE JUDGMENT CALLS ON WHERE IN THE NERVOUS SYSTEM AN ABNORMALITY ORIGINATED.
WHAT OCT DOES AND ONE OF THE REASONS THAT I WAS INTERESTED IN BEING INVOLVED IN INVESTING OCT IS THAT IT ALLOWS US TO TAKE THE SUBJECTIVITY OUT OF THE ASSESSMENT OF EYE DISEASE AND OUT OF THE QUESTION OF WHETHER OR NOT SOMEBODY IS GETTING WORSE.
WE CAN ACTUALLY MEASURE THE TISSUE.
IT'S DONE OBJECTIVELY, QUANTITATIVELY AND IT IS NON-CONTACT AND NON-INVASIVE AND VERY QUICK.
NOW DECADES AFTER OCT FIRST CHANGED THE FIELD, HE IS RESEARCHING WAYS TO USE THE TECHNOLOGY AS A FOUNDATION FOR NEW INNOVATIONS IN EYE TREATMENT.
IN TERMS OF WHERE OCT IS NOW, WE'RE ABLE TO MEASURE STRUCTURES IN THE EYE.
WHERE WE ARE GOING IS BEING ABLE TO MEASURE HOW THE TISSUE IS WORKING.
THE NERVE TISSUE THAT'S IN THE BACK OF THE EYE, THE RETINA, IS PART OF THE BRAIN.
THE BRAIN DOESN'T REGENERATE.
BECAUSE IT DOESN'T REGENERATE, DAMAGE TO THE RETINA IS REALLY SERIOUS.
THE RETINA DOESN'T GET BETTER.
WE ARE DOING EXPERIMENTS HERE TO TRY TO RESTORE FUNCTION TO RETINA THAT'S BEEN DAMAGED.
AND WE'RE EXCITED ABOUT THAT.
HIS TEAM IS LOOKING INTO UTILIZING DIFFERENT WAVELENGTHS OF LIGHT TO DETERMINE HOW MUCH OXYGEN IS GETTING INTO THE ISSUE.
THEY ARE USING A TECHNOLOGY CALLED ADAPTIVE OPTICS TO ACTUALLY SEE DAMAGE.
THE TEAM IS COLLABORATING WITH IBM TO DEVELOP ARTIFICIAL INTELLIGENCE CAPABLE OF PRODUCT -- PREDICTING.
WE ARE USING DEEP LEARNING TO ANALYZE OCT IMAGES AND ALSO VISUAL FIELDS TO DETERMINE WHETHER OR NOT SOMEBODY IS LIKELY TO GET WORSE OR NOT AND ALSO TO ANALYZE THAT IMAGE ITSELF.
KIND OF AN AUTOMATED WAY WHERE THE MACHINE COULD DO THE READING.
THE TEAM PROVIDES IBM WITH DATA, KEEPING PATIENTS ANONYMOUS.
IBM WORKS ON DEVELOPING MACHINE LEARNING.
THAT COLLABORATION BRINGS THESE DIFFERENT SKILL SETS TOGETHER IN ORDER TO CREATE A GREATER WHOLE, WHICH IS ALGORITHMS, THESE WAYS OF ANALYZING OCT, ANALYZING VISUAL FIELDS, PUTTING EVERYTHING TOGETHER AND BEING ABLE TO SAY, OKAY, THIS PATIENT HAS DISEASE, THIS PATIENT DOESN'T, THIS PATIENT IS GOING TO GET WORSE QUICKLY, YOU BETTER ACT, THIS PATIENT IS GOING TO GET WORSE SLOWLY, MAYBE YOU DON'T NEED TO SEE THEM THAT OFTEN AND TREAT THAT AGGRESSIVELY.
SOME OF THE CURRENT RESEARCH ON EYE TREATMENT IS, QUOTE, UNQUOTE, A LITTLE FAR OUT.
EXPERIMENTS THAT VERY WELL COULD FAIL BUT EVIDENCE SUGGESTS COULD BE SUCCESSFUL.
ONE OF THE THINGS THAT WE ARE DOING LIKE THAT IS A GENTLE ELECTRICAL STIMULATION TO RESTORE VISION.
SPECIFICALLY, WE ARE LOOKING AT THIS IN PEOPLE WITH GLAUCOMA.
HAVE YOU HAD CHANGES?
NO.
THIS SCIENTIST HEADS UP THE STUDY.
COLLABORATING WITH A COLLEAGUE IN GERMANY.
TODAY SHE'S MEETING WITH A PATIENT.
A PROFESSIONAL VIOLINIST DIAGNOSED WITH GLAUCOMA.
WE ARE DOING AN EXPERIMENTAL INTERVENTION THAT'S CALLED REPETITIVE TRANSORBITAL STIMULATION.
WE USE A LOW ELECTRICAL CURRENT.
WE PLACE TWO ELECTRODES AND WE DELIVER STIMULATION OVER TEN DAYS FOR 30 TO 45 MINUTES.
WE ARE TRYING TO MIMIC THAT NATURAL PROCESS OF HOW THE CELLS COMMUNICATE FROM THE EYE TO THE BRAIN BY USING THIS ELECTRICAL STIMULATION.
THE IDEA IS FOR THOSE CELLS IN THE EYES IN THE RETINA THAT AREN'T WORKING TO THEIR FULL CAPACITY, WE WILL SEE IF WE PROVIDE THIS EXTERNAL STIMULATION, WE WILL HELP THEM TO FUNCTION BETTER, MORE EFFECTIVELY, MORE EFFICIENTLY SO COMMUNICATION -- THE INFORMATION THEY SEND BACK TO THE BRAIN MAY BE IMPROVED SO PEOPLE MAY PERCEIVE AN IMPROVED VISION.
OCT IMAGING WILL ALLOW THE DOCTOR TO DETERMINE WHETHER THE STIMULATION IS WORKING OR NOT.
SHE SAYS THE EXPERIMENTAL MEDICAL INTERVENTION WON'T CHANGE THE MECHANISM OF GLAUCOMA BUT IT MAY HELP SLOW THE PROGRESSION OF THE DISEASE.
THAT'S THE OUTCOME THAT THE TEAM ARE HOPING FOR.
I CERTAINLY HOPE THAT AFTER THESE SESSIONS ARE OVER THAT I WILL NOTICE SOME IMPROVEMENT IN MY VISION.
I UNDERSTAND THAT THAT MAY NOT HAPPEN.
BUT I WOULD LIKE TO SEE IF IT MAY.
RESEARCH IS OFTEN EXCITING.
IT OFTEN DOESN'T WORK.
BUT I'VE BEEN LUCKY TO BE IN SEVERAL STUDIES THAT HAVE LOOKED AT NEW THINGS THAT ACTUALLY DO WORK.
LIKE OPTICAL COHERENCE TOMOGRAPHY.
WHILE NYU HELPS EXPERIMENTAL TREATMENTS AND ARE IN THE EARLY STAGES OF RESEARCH, ONE COULD BE THE NEXT BIG BREAKTHROUGH IN EYE CARE.
