The oldest surviving photographs were captured in the 1820s using bitumen, a light-sensitive petroleum tar. Subsequent technical improvement and imaginative photographers, including Ansel Adams, redefined the way we see the world. The first human fundus photograph was published in 1886, captured with a 2.5-minute exposure, our first revolution.
Our second revolution in retinal imaging was fluorescein angiography. Two medical students at Indiana University published the technique in the journal Circulation in 1961 after the American Journal of Ophthalmology rejected it. Donald Gass, MD, the father of macular diseases, and others then applied such imaging to retinal diseases common and obscure, opening our eyes to retinal and choroidal physiology in ways previously only imagined.
Our third revolution in imaging was optical coherence tomography (OCT). Carmen Puliafito, MD, our great orator who co-invented and developed OCT, told me, “OCT changed everything.” Indeed it did. Modern-day longitudinal management of macular diseases is absolutely dependent on OCT. Dr. Puliafito has summarized many of our clinical practices with, “I don’t get OCT on all my patients; just 99.9 percent of them.”
When was the last time you applied your macula contact lens to a patient’s cornea outside of your laser-suite? While providing incredible optical clarity, seldom does it provide information we cannot get with non-contact binocular viewing of the retina, for example with a 78-D lens, coupled with spectral domain OCT. Innovators continue to expand the limits of OCT, as authors Ted Leng, MD, Vikram Makhijani, DO, and Brandon Lujan, MD, report in this edition (pages 20 and 26).
What will be our fourth retinal imaging revolution? OCT-based advances like OCT-angiography or swept-source OCT? Photoacoustic imaging? My vote is for the more obscure adaptive optics (AO), which Mina Chung, MD, reports on in these pages (page 23). While current modalities are expensive, cumbersome, time-consuming to interpret and critically limited by a very narrow depth of field, technological advances will overcome these shortcomings. Through visualization of individual photoreceptors, and eventually other cell types, including retinal pigment epithelium cells, AO may bridge the gap between anatomic and truly functional imaging.