Glaucoma refers to a condition in which there is a gradual buildup of the pressure in the eye. Glaucoma is considered to be the leading cause of the preventable blindness in most parts of the world. In the countries like the USA, almost 2.7 million are suffering from the disease that is actually incurable. The prevalence of the disease increases with increase in age. Considering the rapid increase in the age all over the world, the number of the individual suffering from this disease is expected to increase. One of the greatest challenges in the treatment of this particular disease is that it is basically asymptomatic[3].
Figure 1:Glaucoma affected eye[3]
The goal of the treatment of the disease is control of the IOP which helps to avoid the visual field loss the contemporary medicine has actually alleviated the mankind from the dangers of the disease both through the prevention of the causes and also provision of the cure of the glaucoma. The technological breakthroughs in the primary open angle commonly abbreviated as the POAG have actually been very dramatic. The buildup of the pressure in the earlier is normally associated with the failure of one of the normal fluid channels failure to drain[8]. Due to the insidious nature in the earlier intervention, there has been a minimized chance of the sight loss. The report seeks to highlight the Centre stage information that led to the radical change in the technological treatment of the disease. The diffusion of ideas or the coknowledge of the glauma is attributed to these changes.
Glaucoma treatment has evolved greatly in the bpastv30 years. The treatment has been from the eye drop error to the surgery. Although medications have been used traditionally in the first-line therapy of the glaucoma, the recent available reports have indicated that the earlier and even immediate surgery may be used to prevent the progressive visual fields[9]. The very ancient medications included the use of the medication like beta-blockers, miotics and the prostaglandin. The design of the CIGTS was to determine the patient that has been newly diagnosed with the open –angle glaucoma is properly managed by the initial treatment using the IOP.This was equivalent to lowering the process of medication. These kinds of the medications were used prior to the emergence of technology for surgery. There was very little information regarding the structure of the affected tissues which was later covered in the “classic paper”.
The extensive information regarding the structure of the specific tissue affected by the glaucoma was considered as the “classic paper”. The advent of the non-penetrating surgery with the help of the artificial drainage devices commonly known as the ADD, Collagen implants commonly referred to as the deep sclerotomy and the technology of the micro catheter marked the turning point in the treatment of the glaucoma. The information regarding the accumulation of the fluid alongside the knowledge of the location of the affected fluid channels and their functionality became the center of the information[9]. All other information regarding subsequent treatment of the glaucoma has been surrounding the scanning process. One of the most promising and the amazing technology is the canaloplasty that utilizes the flexible tube which is as thin as the human strand hair in the creation of the alternative bypass and ensure the enlargement of the normal fluid channels. This is done without creating any interference with the rest of the structures of the eye.
What papers extended the work presented in the “Classic Paper”? What new work was enabled by the findings of the “Classic” paper?
The use of the adaptive optics that is commonly referred to as the AO to the retinal image acquisition techniques allows in vivo visualization of the structures of the cells through the real time measurements and the subsequent correction of the ocular aberrations. The application of the AO has been used in the fundus cameras, the scanning laser ophthalmoscopy (SLO) among others. The currently available technique for the adaptive optics retinal camera is the super easy to use blood illumination camera of the AO[5].This camera is known to provide the 2-D cellular resolution imaging of the retina.AO-SLO allows the surgeon to properly evaluate the integrity of the photoreceptor cells of an individulas.This technique actually shows the circulation of the leukocytes and also the red blood cells in the retinal blood capillaries that enables the detection of the non-perfusion in the eyes of the a diabetic patient a condition commonly known as retinopathy. In the cases of the eyes with the glaucoma, the technique has made it possible for the detection of the pathologic changes in the retinal nerve fiber bundles[11].
The characteristics of the structure-function correlation have been of great interest to both scientist and the clinicians. Although it may appear naturally that the correlation exists, the proving it in the practical terms has been found to be very difficult. This has actually limited its subsequent application in the clinics. It may not necessarily mean that the correlation will be linear[4]. This will be dependent on the function and the structure that are under representation. This will involve the use of the common measurement units. The measurement unit that may be used here will include the establishment of the number of the ganglion cells in order to express the results of the function and the structure. In so doing while using very advanced technology, it will be possible to establish the inherent correlation that is linear. It is important to note that even after the establishment of such measurements, the other factors will have to be considered including the location of the retina, the age of the patient and the structural tissue density. The concept of the correlation was first effectively captured in the “classic paper”.
According to the scholars in the same field, the system of the OCT is a better method of following after detection of the glaucoma. The upside of these cutting edge glaucoma fixes is that they are far more secure than and similarly as great as far as bringing down intraocular pressure as customary eye medical procedure called trabeculectomy. Clinical preliminaries have demonstrated this, with early medical procedure sparing the patient the bother of applying eye drops every day and from experiencing their many reactions[8]. Since lion’s share of glaucoma patients are in their propelled years, it is required for them to have restorative co-morbidities like diabetes, hypertension and coronary illness. Consequently, eye prescriptions in these cases can accomplish more damage than anything else one it has hit the tipping point of 75 µm of the retinal layer of the fiber thickness. This is due to the fact that it indicates a proper relationship between the functional loss and the structural components.
At about the range of 50 µ and 55 µ, the OCT is not capable of measuring the change in the RNFL thinning bur the progression of the glaucoma can be measured using the visual field at the same range[3]. The upside of these cutting edge glaucoma fixes is that they are far more secure than and similarly as great as far as bringing down intraocular weight as customary eye medical procedure called trabeculectomy. Clinical preliminaries have demonstrated this, with early medical procedure sparing the patient the bother of applying eye drops every day and from experiencing their many reactions. Since lion’s share of glaucoma patients are in their propelled years, it is required for them to have restorative co-morbidities like diabetes, hypertension and coronary illness. Consequently, eye prescriptions in these cases can accomplish more damage than anything else. The emergence of the swept-source OCT has brought proper improvement in the speed processing of the image and the depth range. The depth range has been as a result of the less sensitivity loss that characterizes the scanning depth. This on its own has been regarded as the technological innovation[7].
An ophthalmic OCT system that is commercially found in the market commonly referred to as the Topcon Medical System allows for the scan rate of up to 100 kHz A- It is projected that in the near future there will be up to 200kHz followed by the long term 400kHz.The available faster steed is actually preferred since it allows the sampled 3-D scanning of the larger area of the eye part called retina. Also there is provision of the longer scanning depths. The swept source has a uniform greater sensitivity the scan from the nerve fiber layer, the choroid and finally the lamina cribosa.The better sensitivity together with the high speed combined with the 150nm wavelength of the current system enable proper measurements of the OCT of the retina of the organ with the cataract. The visualization and the access of the choroid are possible since the longer wavelength enable for the lowered scattering without considering the fundus pigmentation[13].
The technique of the OCT is actually an evolving techinique.This technique works at a faster speed and has therefore enhanced the capability for looking at the process that are considered dynamic including the flow of the blood. The bio directional Dopler OCT also looks particularly promising in the field of the study[2]. The OCT based Oximetry may also be considered as one of the possibilities in the future treatment of the defects. Considering the speed of the development of the OCT research, there is actually a room for the similar development. The blood flow will be regarded as just a surrogate for the function that is to be served in the various tissues in which one of the key functions is the oxygen delivery.
Figure 2:OCT scanning equipment[3]
Although it’s only been published for a few years, where do you think this “Emerging” work will have impact, in the next few years and further into the future?
The new technologies of the imaging like the polarization sensitive optical coherence tomography may allow for the estimation of the above listed factors for each and every patient. The other issue that should be given the consideration is the spatial correspondence. The measurements of the structure and the functions are done at different locations and there is need to define the exact locations and subsequently provide the definition of the relation. This normally becomes a problem whenever there is need to do a correlation[12]. The function and the structure do not progress simultaneously. This has been making the analysis very difficult. This is the aspect that affects greatly the clinical applications. If as suggested by multiple studies, the change in the structure will proceed the functional change. This provides a perfect opportunity to identify the expected progression prior to the damage functional results. Although the correlation and the structural function practice have been very difficult in the therapies of glaucoma and it seems very unfeasible, the use of the OCT alongside other adaptive features will guarantee progress in the future. The diffusion of the technological information by the “Emerging” work is expected to make major contribution in the field of medicine in terms of the technical aspect.
Conclusion:
The technological evolution that is related to the optical coherence tomography has been gradually but radically changing the management and diagnostic approach to the glaucoma. The detections that are done earlier allows for the prediction of the operational consequences. It is evident that the physiological structure-function relationship is unique alongside the basis of the management of the glaucoma. The technologies that are available for the diagnosis of this disease are actually far from the perfect. The latest developments indicate that threshold for the damage detection is actually low as compared to the structural imaging which is present within the standard automated perimetry. The effect of structural documentation on the decisions of the therapy has actually not been seen so great in the past though it will become very important with high sensitivity and specify of the emerging technologies[1]. The currently developed technology of the OCT will actually be able to detect the glaucomatous abnormalities before the current functional technologies of the measurements be able to perform the same detection. Although there has been appraisal for the significant steps that have been made, a lot need to be done.
References:
[1]Bronzino, J.D. ed., 2014. Management of medical technology: a primer for clinical engineers. Butterworth-Heinemann.
[2]Goodship, V. and Stevels, A. eds., 2012. Waste electrical and electronic equipment (WEEE) handbook. Elsevier.
[3]Hui, R.S.Y. and Chen, W., City University of Hong Kong (CityU), 2017. Apparatus and methods of operation of passive LED lighting equipment. U.S. Patent 9,717,120.
[5]Larkin, D.Q., Nixon, T.R. and Mintz, D.S., Intuitive Surgical Operations Inc, 2017. Tool position and identification indicator displayed in a boundary area of a computer display screen. U.S. Patent 9,718,190.
[6]Laroussi, M., Kong, M.G., Morfill, G. and Stolz, W. eds., 2012. Plasma medicine: applications of low-temperature gas plasmas in medicine and biology. Cambridge University Press.
[8]Lupu, R.G. and Ungureanu, F., 2013. A survey of eye tracking methods and applications. Buletinul Institutului Politehnic din Iasi, Automatic Control and Computer Science Section, 3, pp.72-86.
[9]MacLachlan, R.A., Becker, B.C., Tabarés, J.C., Podnar, G.W., Lobes Jr, L.A. and Riviere, C.N., 2012. Micron: an actively stabilized handheld tool for microsurgery. IEEE transactions on robotics: a publication of the IEEE Robotics and Automation Society, 28(1), p.195.
[10]Salvendy, G., 2012. Handbook of human factors and ergonomics. John Wiley & Sons.
Sharma, N. and Gedeon, T., 2012. Objective measures, sensors and computational techniques for stress recognition and classification: A survey. Computer methods and programs in biomedicine, 108(3), pp.1287-1301.
[11]Shirmohammadi, S. and Ferrero, A., 2014. Camera as the instrument: the rising trend of vision based measurement. IEEE Instrumentation & Measurement Magazine, 17(3), pp.41-47.
[12]Trapnell, C., Roberts, A., Goff, L., Pertea, G., Kim, D., Kelley, D.R., Pimentel, H., Salzberg, S.L., Rinn, J.L. and Pachter, L., 2012. Differential gene and transcript expression analysis of RNA-seq experiments with TopHat and Cufflinks. Nature protocols, 7(3), p.562.
[13]Yin, L. and Reale, M., Research Foundation of State University of New York, 2014. Real time eye tracking for human computer interaction. U.S. Patent 8,885,882.
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