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Faster, Deeper Imaging Emerges From Atlantis

STUART MICHAELSON

Comic-book hero Aquaman was an Atlantis exile who eventually led the undersea kingdom. In reality, the legendary world’s namesake, DRI (Deep Range Imaging) OCT-1 Atlantis from Topcon Medical of Oakland, NJ, may help lead improved retinal treatment through quick, deep penetration of ocular depths.

Atlantis — with swept-source OCT for posterior imaging, longer wavelength (1,050 nm) compared with SD-OCT (850 nm) and greater scanning speed (100,000 A scans/sec, four times that of Topcon’s 3D OCT-2000) — is used in Canada, Japan, Colombia, Peru, Chile, Argentina, Panama, Costa Rica, Mexico, and throughout Europe. US doctors utilize it or, while awaiting FDA approval, consult or research, like K. Bailey Freund, MD, of Vitreous-Retina-Macula Consultants of New York.

The retinal specialist has used Atlantis for about a year-and-half and expects benefits in glaucoma challenges (Atlantis “can image the optic nerve where it looks deeper into the nerve to see structural changes including those occurring at the level of the lamina cribrosa”), comfort (“patients don’t have to sit at a machine and maintain steady fixation as long”), and oncology.

HIGH-DENSITY RASTER SCANS

Atlantis, Dr. Freund says, acquires scans “much faster than the current SD-OCT (SD-OCT) devices. Rapid-scan acquisition provides a more robust data set with reduced motion artifacts. We can obtain high-density raster scans, which can then be analyzed in novel ways. Instead of looking just at cross-sections, we can now look at retinal and choroidal structures with detailed en face views. En face scans allow us to study the retinal and choroidal tissues at varying depths in a manner never before possible. We can better appreciate the three-dimensional relationships” at the vitreoretinal interface, within the retina, and into the choroid.

He says its wavelength “allows us to go deeper into the tissue and see things that were difficult to see with SD-OCT,” with which many scans are typically needed for quality images of the choroid. “The greater speed-and-tissue penetration of SS-OCT allows the user to easily visualize the choroidal vasculature in order to analyze its structure and measure its thickness.”

BENEFITS SEEN FOR ONCOLOGY

For penetration depth, Dr. Freund says: “With the SD-OCT, you are forced to choose to focus on the retinal tissue or to maximize your ability to see the choroidal or the vitreoretinal interface;” with Atlantis, “you don’t have to make the choice between seeing the choroid or the vitreoretinal interface. It acquires everything from the vitreous, through the retina and into the choroid. The device enhances visualization into the vitreous more so than with the other devices” and excels with highly myopic eyes with a posterior staphyloma, while its long 12 mm scan lines “are particularly useful in these cases; in eyes with a thin sclera, we can even look through the sclera into the orbital fat posterior to the globe.”

He also sees oncology advantages (“tumors such as nevi, melanoma, metastases, lymphoma, and hemangioma are located in the choroid”) and says Atlantis “may be useful going in the other direction: into the vitreous, the ability to see what’s happening in diseases involving the vitreoretinal interface such as vitreomacular adhesion, vitreomacular traction (VMT), complicated epiretinal membranes, macular hole, and diabetic tractional detachments.” RP