Eyes on the Ultimate Prize…

Last year, when I was told that the panel of the Sanford and Sue Greenberg Prize to End Blindness had named me as one of the 13 award winners, Sanford Greenberg sent me his autobiography. “Hello Darkness, My Old Friend: How Daring Dreams and Unyielding Friendship Turned One Man’s Blindness into an Extraordinary Vision for Life” tells of his personal journey with sight loss and his achievements, which led to setting a prize with the goal of ending blindness so that others wouldn’t face the same struggle. It has been a huge inspiration to me; it helped me see how my own efforts are a piece of the bigger puzzle of ending preventable blindness. So many causes of blindness can now be effectively treated if they are diagnosed early enough – which, unfortunately, doesn’t always happen. That’s why it’s so important to me that my research group’s efforts in improving diagnostic imaging technology have been recognized with the Greenberg Prize.

I started working on OCT in 1990 when I was a graduate student. Because I didn’t have much experience with ocular diseases, I didn’t know what specific function OCT would have in ophthalmology, but I knew that noninvasive, high-resolution imaging would be useful for eye structures, which are small yet complex. It was a (lucky) educated guess that panned out. 

An important factor in the success of OCT has been the relentless technological advance over the past three decades. The OCT system we now use in the clinic is more than a thousand times faster than the prototype I initially built – and, within my lifetime, I predict that it will get more than 10 times faster still. Eventually, I can see it yielding a 180° retinal scan for analysis in a few seconds, with so much detail that clinicians will be able to pick up on neurological and vascular diseases as well as ophthalmic disorders. Image interpretation is also becoming a lot easier with the application of artificial intelligence.

My research group, the Center for Ophthalmic Optics and Lasers, or COOL Lab, has mostly focused on OCT angiography over the past few years. Improving spatial resolution to assess capillary caliber and flow is an important technological frontier for us to tackle. We’re also hard at work to improve field of view for better peripheral retina imaging.

But no technology will eradicate global blindness without equitable distribution of eye care resources around the world. For OCT, this means it has to become even more economical. It is now fairly ubiquitous in ophthalmology clinics in the US, Europe, and Asia, but I would like to see it available in primary care settings, optometry practices, and emergency rooms everywhere.

This is why the award recipients who have impressed me most are representatives of the Aravind Eye Care System and LV Prasad Eye Institute in India. The sheer volume of eye clinic visits and surgeries they have delivered at a low, sustainable cost is phenomenal. Spreading models like that all over the world would probably have the biggest impact on saving vision for the greatest number of patients possible at an affordable cost. 

We all have our role to play in this plan, so I will be using the Greenberg Prize money to fund pilot research projects at OHSU, supporting students and postdocs to develop their innovative ideas. Sanford Greenberg lost his vision due to glaucoma and I truly believe that, with the help of OCT and OCT angiography, we will be able to detect glaucoma with very high sensitivity and specificity, making comprehensive glaucoma screening cost effective. This would be a huge step toward eradicating preventable blindness.