Umnia Ahmed
The second day of the Manchester Imaging and Ophthalmology Symposium, held at Manchester University Business School, explored advances in ophthalmic imaging through expert presentations and practical demonstrations. As a foundation year doctor with limited exposure to ophthalmology, the symposium provided a valuable introduction to how imaging is a valuable diagnostic aid with ongoing advancements.
Professor Tariq Aslam opened with “OCT-A: Far and Wide”, laying the foundations for interpreting OCT angiography. Key retinal structures, including the superficial and deep vascular plexuses, outer retina and choriocapillaris, were reviewed. A useful approach to interpretation was to consider abnormalities as loss, gain or change. Common artefacts including projection, masking, motion and segmentation errors were addressed hence correlating OCT scans with B scans and en-face images is key. The evolution from conventional 5 × 5 mm OCT scans towards widefield and ultra-widefield (up to 27x31mm) imaging was particularly interesting, especially the potential for detecting peripheral pathology not previously appreciated which could redefine diabetic retinopathy classification particularly for the early stages of the disease course.
Dr Serene Siying Lin explored the phenotypic spectrum of inherited retinal disease, highlighting conditions that should not be missed, including ABCA4-associated retinopathy, Usher syndrome, CLN3-associated Batten disease, RPE65-associated Leber congenital amaurosis and RPGR-associated retinal dystrophies. The genotype-phenotype relationship in RPGR disease demonstrated how genetic variation can result in different clinical presentations based on the locus of the variation. The availability of gene therapy (Luxturna) for selected patients with RPE65 mutations also illustrated how advances in molecular diagnosis are increasingly influencing treatment.
Advanced Clinical Optometrist Mo Abid discussed imaging in central serous chorioretinopathy (CSCR). While acute CSCR is usually self-limiting, chronic disease may require treatment such as photodynamic therapy or micropulse laser. Enhanced-depth OCT can assess the choroid, while fundus autofluorescence provides information about retinal pigment epithelial health and disease chronicity. This reinforced the importance of multimodal imaging in both diagnosis and management.
During the break we had the opportunity to experience a virtual-reality headset visual field assessment, providing insight into how the evolution of technology can lead to a more seamless patient journey with less time needed to conduct these tests.
Specialist Neuro-Optometrist Lorcan Butler addressed papilloedema and pseudopapilloedema, highlighting the potential consequences of misdiagnosis, including unnecessary invasive investigations. OCT findings in true papilloedema include increased thickness in the optic nerve head volumes, retina, and peripapillary retinal nerve fibre layer, while ultrasound B scans can show a crescent sign representing fluid accumulation. Optic disc drusen are an important cause of pseudopapilloedema and may appear as hyperreflective bodies on OCT. This presentation emphasised the value of combining imaging modalities to improve diagnostic accuracy.
A particularly memorable presentation was delivered by Chloe Joyner, founder of Usher Kids, focusing on the lived experience of children with Usher syndrome. The profound psychological and social impact of progressive hearing and visual impairment was explored, alongside approaches to supporting children and communicating their diagnosis in a neutral tone. The statement that “parents make the weather” highlighted how children can develop negative or positive perceptions of their condition based on the environment created. This was an important reminder that ophthalmic care extends beyond diagnosis, but a holistic approach should be taken.
The role of imaging in ocular oncology was demonstrated by Consultant Ophthalmologist Dr Guillerma De La Mata. Various imaging techniques work in synergy when assessing lesions such as choroidal naevi and melanomas: while ultrasound scans can assess lesion thickness and internal characteristics, OCT can identify subretinal fluid, fundus autofluorescence detects orange pigment, and fundus photography allows assessment and monitoring of lesion size.
Tim Cole, head of clinical education at Heidelberg, explored the past, present and future of retinal angiography, comparing fluorescein angiography and indocyanine green angiography with OCTA. Standard angiography remains valuable for assessing dynamic retinal blood flow, leakage and perfusion, while OCTA offers non-invasive and rapid acquisition with new generation analytics. OCTA should therefore be viewed as an addition to established techniques. Developments in high-resolution OCTA may further improve visualisation of retinal structures with potentially new layers not seen before.
The day concluded with “Revealing the Invisible: Adaptive Optics in Modern Ophthalmology”, presented by Darren Hargreaves, a research ophthalmic practitioner. Adaptive optics, originally developed in astronomy to compensate for optical aberrations, is being adapted to ophthalmic imaging to provide high-resolution images of retinal structures with vessels used as the landmarks.
Conclusion
Overall, the symposium provided an engaging perspective into ophthalmology through the diagnostic tools of imaging. The symposium covered a breadth of topics with good learning points into the interpretation of imaging as well as the pearls and pitfalls of various imaging techniques.
As a foundation doctor, the sessions on papilloedema, inherited retinal disease and ocular oncology were particularly valuable, demonstrating how imaging is used to improve diagnostic accuracy in an applied clinical setting. The symposium also reinforced that technological advances should enhance existing tools as well as the efficiency of the clinicians involved.