smartOCT: a low-cost technology to detect and monitor glaucoma in outpatient and primary care centers

ABSTRACT: Glaucoma is the leading cause of irreversible vision loss globally. Nearly 52.7 million people will
be affected in 2020, and that number will grow to ~79.8 million by 2040. The prevalence varies by ethnicity,
and the rates of undiagnosed primary open angle glaucoma are alarmingly high (50-85%) in white, black and
Latino patients. The challenge in glaucoma detection lies in the asymptomatic nature of its early stage:
damage to the optic nerve occurs in an unnoticeable manner that slowly deteriorates the peripheral vision. By
the time many patients seek evaluation, the disease has reached a late stage and it is a challenge to preserve
the limited remaining central vision. Importantly, early treatment to decrease intraocular pressure (IOP), the
only modifiable risk factor for glaucoma, can reduce the rate of progression by 50%, but large population-
based studies have confirmed that screening based on IOP is clinically ineffective.
Optical coherence tomography (OCT) is central technology for glaucoma screening in standard ophthalmology
services. However, the cost and size of clinical OCT systems limits access to the technology by underserved
populations, who are simultaneously more likely to be affected with glaucoma-inducing conditions (e.g.,
diabetes) and less likely to have access to adequate eye care, vision insurance and ability to travel for
additional appointments. The availability of low-cost, portable and user-friendly technologies that are
deployable in non-specialist outpatient settings (e.g., primary care clinics, endocrinology offices)
where high-risk patients present most often is a critical barrier to widespread implementation of
effective glaucoma screening programs.
We propose a new paradigm for OCT imaging – smartOCT – that leverages the small form factor and ubiquity
of smartphones (SPs) to yield a low-cost, lightweight, small-footprint device that facilitates capture, processing,
visualization and interpretation of OCT data in outpatient services. Our innovative strategy targets
comprehensive integration of OCT with the built-in sensors of smartphones to lower the critical barriers to
mass deployment of OCT in clinics. We will demonstrate the feasibility of this technology and clinical workflow
through the following specific aims: Aim 1) Finalize a smartOCT prototype for low-cost optic nerve imaging.
Aim 2) Confirm the repeatability of smartOCT and comparison to conventional OCT in a pilot clinical study (n =
60). Aim 3) Evaluate the preliminary effectiveness for outpatient services in a pilot study (n = 40) with primary
care. If successful, our work will suggest a clear path to broaden access to the OCT technology needed to
detect glaucoma and to inspire equip new paradigms and contexts for effective glaucoma screening (e.g.,
clinics, health fairs, telemedicine). Successful implementation of smartOCT technology will also blaze a trail for
the OCT research community to consider new form factors and new scanning mechanisms that can be
implicated to study other clinical diseases and/or used in other resource-limited contexts (e.g., global health).

Grant Number: 5R01EY032670-04
NIH Institute/Center: NIH
Principal Investigator: Audrey Bowden