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Barti Software raises $12M Series A for AI-powered electronic health records for eye care

Jeremiah Tao highlights essential safety strategies in oculofacial surgery, emphasizing cost-effective techniques to prevent complications and enhance patient care.

Avoiding disasters and oculofacial surgery

A study of the progression of sensitivity loss in GA over time using inferred data

Recapping the Heidelberg Engineering International SPECTRALIS Symposium—and Beyond.

The future of imaging is out of this world

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Ophthalmology Times – Clinical Insights for Eye Specialists

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Glaucoma

1rem

Study designed to identify patterns in abnormalities and differences characteristic of disease.


FAF shedding light on patterns related to disease chronicity in CSC

Investigators find value in screening for macular disease in preoperative evaluation


Macular OCT imaging is vital in work-up of cataract surgery patients

AI enhances home OCT imaging to track wet AMD disease activity, enabling personalized patient management and improved treatment response monitoring.

Study finds value in home OCT monitoring

identifeye HEALTH launches retinal screening platform

Advanced imaging and awareness of systemic risk factors are essential.


Seeing the unseen: Improving early detection for patients with MacTel

Ophthalmology celebrates 50 years of groundbreaking innovations, highlighting anti-VEGF therapies, OCT imaging, and future advancements in eye care.

From blindness to breakthrough: Milestones that changed ophthalmology forever

CCOI sets the stage for global ophthalmic innovation at Stanford Summit on July 23

On the eve of the CCOI-Stanford Summit, to be held July 23, 2025, at Stanford University, Joel S. Schuman, MD, President of the Collaborative Community on Ophthalmic Innovation (CCOI), outlined the mission and vision of the organization’s evolution and purpose. “The CCOI is the Collaborative Community on Ophthalmic Innovation,” Schuman explained, “and it was started several years ago…by Mark Blumenkranz.”

Originally focused on imaging, the group recently rebranded to reflect its broadened mission. “We changed our name… to drive innovation in ophthalmic medical products worldwide,” Schuman said. The CCOI has grown from 6 to 17 working groups, tackling areas from artificial intelligence and interoperability to disease-specific initiatives in glaucoma, age-related macular degeneration, diabetic retinopathy, and ocular oncology. “These work groups are all led by world-class individuals,” he added, underscoring the global nature of the leadership.

The CCOI functions as a nonprofit 501(c)(3), bringing together a wide array of stakeholders across academia, industry, regulatory agencies, and patient advocacy groups. “The mission of the CCOI is to convene a cohesive but diverse group of key stakeholders… and advance innovation through consensus,” said Schuman. Leading the organization alongside him is Malvina Eydelman, MD, who serves as Chief Executive Officer and brings decades of regulatory expertise from her leadership role at the FDA.

One of its structural cornerstones is the stakeholder council, comprising over 80 members. “The council brings together diverse members… to identify and overcome key obstacles to ophthalmic medical product innovation.” This year’s summit represents a milestone in CCOI’s work to “enhance collaboration across the ophthalmic landscape.”

As Schuman noted, “We are very excited about what is happening at CCOI”—and the summit at Stanford promises to be a pivotal gathering in shaping the future of ophthalmic innovation.

Videos

President Joel S. Schuman, MD, highlights the group’s mission and vision for the future—uniting 17 working groups and over 80 stakeholders.



NeuroOp Guru: Using OCT to forecast outcomes in ethambutol optic neuropathy

, host Andrew G. Lee, MD, discusses with Drew Carey, MD, how optical coherence tomography (OCT) may help predict visual outcomes in ethambutol optic neuropathy.

 Ethambutol, a cornerstone tuberculosis medication, can cause optic neuropathy with unpredictable visual prognosis.

Carey highlighted the need to stop ethambutol as soon as the diagnosis is made and acknowledged the challenge of counseling patients who often ask, “Am I going to go blind? Is my vision going to get better after I stop this medication?”

Carey reviewed a single-center, retrospective study of 64 eyes from 32 patients with ethambutol optic neuropathy. OCT scans were obtained within 3 months of visual loss, examining peripapillary retinal nerve fiber layer (RNFL) thickness and ganglion cell–inner plexiform layer (GCIPL) thickness as prognostic indicators at 1-year follow-up. “That has a 100% sensitivity for having a good visual outcome,” Carey explained, for patients with RNFL greater than or equal to 83 µm or GCIPL greater than or equal to 74 µm at baseline OCT.

These data can be especially useful in clinical practice. For patients presenting early with preserved RNFL and GCIPL measurements, practitioners can reassure them: “You can stop the medication now. We don’t have to worry about you losing vision down the line.” Conversely, in cases with lower thicknesses, providers can set realistic expectations for long-term visual recovery.

Although ethambutol-induced optic neuropathy is relatively rare in the United States, these findings support the utility of OCT in follow-up. Carey noted that “if you see a patient with clear ethambutol toxicity, OCT can help make sure that we’re going to get paid for using OCT for monitoring these types of patients.” However, he cautioned against using OCT for routine baseline screenings in all ethambutol patients: “I don’t think it’s been validated as a screening exam,” he said.

Carey noted that “it can help us predict who’s going to have a good vision at 1 year,” making OCT a valuable prognostic tool once ethambutol-associated visual impairment is evident.

Kang MC, Eun HW, Park KA, Oh SY. Optical coherence tomography parameters and optimal cut-off values for predicting visual prognosis in ethambutol-induced optic n neuropathy. 

. 2024;44(4):559-564. doi:10.1097/WNO.0000000000002092

Andrew G. Lee, MD, and Drew Carey, MD, discuss how baseline optical coherence tomography parameters can help ophthalmologists counsel patients and make more informed decisions after ethambutol-associated optic neuropathy.

Anat Loewenstein, MD, shares insights on the real-world results of remote retinal imaging

Anat Loewenstein, MD, co-chaired the retina session and presented in the distributed care session at this year’s Heidelberg 2025 International SPECTRALIS Symposium — And Beyond (ISS), held June 13-14 in Heidelberg, Germany. She is the director of the division of ophthalmology at Tel Aviv Medical Center in Israel.

Prof Loewenstein commented on trends in the contemporary imaging landscape, a key segment of her ISS presentation on home monitoring. “Something that comes up loud and clear is we need to find ways to correlate between function and morphology,” Prof Loewenstein said. “Everyone looks for imaging that will show biomarkers that are predictive of progression.”

Prof Loewenstein said that, along with optical coherence tomography (OCT), advanced technologies like OCT angiography and fluorescence lifetime imaging ophthalmoscopy are quickly changing what is possible in diagnostics. That's good news for patients with age-related macular degeneration, geographic atrophy, and other retinal pathologies. However, she warned that technology alone is not enough to improve and preserve patients’ health outcomes.

“You cannot use remote monitoring as a standalone [tool]. Everyone wants to use AI and remote monitoring, but you need to coordinate with your health system,” she advised. “[Remote monitoring] needs to be supported by the community of retina physicians and of ophthalmologists, so the healthcare system and the payers will be in agreement with the need to use it in our system.”

Advanced monitoring strategies are overcoming significant obstacles in retinal care, as highlighted at the 2025 International SPECTRALIS Symposium — And Beyond (ISS).

Canonical

FLIO and the brain: Making the invisible visible with Robert Sergott, MD

Fluorescence lifetime imaging ophthalmoscopy (FLIO) is emerging as a transformative imaging modality in ophthalmology, offering a metabolic lens into retinal and neurodegenerative diseases. Robert C. Sergott, MD, of Wills Eye Hospital, highlighted FLIO’s potential to redefine both diagnostics and therapeutic monitoring in his presentation at the Heidelberg 2025 International SPECTRALIS Symposium – And Beyond (ISS), held June 13-14 in Heidelberg, Germany. “While we're sitting here, we're fluorescing,” Sergott said, drawing an analogy to lightning bugs to illustrate the body’s fluorescence as a biomarker of health and disease.

FLIO is to optical coherence tomography (OCT) what positron emission tomography (PET) was to magnetic resonance imaging (MRI)—ushering clinicians from structural to functional imaging, he noted. By capturing real-time changes in retinal metabolism, FLIO reveals insights at the molecular level, particularly in mitochondrial function. “The theme of our Annesley EyeBrain Center at Jefferson, partnered with Wills Eye Hospital, is to make the invisible visible,” Sergott emphasized. With over 400 patients imaged to date, the center is uncovering patterns of mitochondrial dysfunction and protein misfolding—hallmarks of neurodegenerative diseases like Alzheimer, Parkinson, and multiple sclerosis.

What makes FLIO compelling is its promise for early diagnosis—before symptom onset. “By the time patients have symptoms, quite bluntly, half the brain is dead,” Sergott noted, underlining the critical window for intervention. Changes in retinal FLIO signatures are being correlated with advanced MRI findings, reinforcing the retina’s role as a surrogate for brain health.

The integration of FLIO with stem cell-derived retinoids and organoids offers further promise, enabling personalized disease modeling and drug testing. FLIO’s origins in rare retinal diseases, such as macular telangiectasia, have already supported FDA approvals. “Now we're going to be able to get to the subcellular and molecular basis of disease,” Sergott said. FLIO may become central to bridging neuro-ophthalmology and medical retina, transforming both fields in the process, he added.

This noninvasive imaging tool reveals early brain pathology through the eye, promising faster and more accurate diagnoses as highlighted at the Heidelberg 2025 International SPECTRALIS Symposium – And Beyond (ISS).

Structure-function correlates using high-res OCT images with Karl Csaky, MD, PhD

Karl Csaky, MD, PhD, shared insights into the relationship between retinal structure and function in dry age-related macular degeneration, focusing on patients with geographic atrophy (GA), at the Heidelberg 2025 International SPECTRALIS Symposium — And Beyond (ISS), held June 13-14 in Heidelberg, Germany. “There’s been a lot of interest in looking at structure-function relationships,” Csaky explained, especially in the central 1 mm of the retina, where cone function plays a critical role in preserving vision and quality of life.

Using Heidelberg high-resolution OCT, Csaky’s team studied 15 to 17 eyes from patients with GA who maintained 20/80 or better vision. The improved axial resolution “clearly defines certain structures better,” allowing for a more detailed view of the retina. The goal was to identify anatomical features that may correlate more closely with visual performance, since current functional tests like BCVA, contrast sensitivity, and microperimetry often provide variable and subjective results.

“Clearly, the noise tends to come on the functional side,” Csaky noted, highlighting the challenges of relying solely on psychophysical testing. By integrating multiple functional measures with sharper anatomical imaging, the team hopes to uncover more reliable correlations between retinal structure and visual capacity.

He also discussed the increasing role of artificial intelligence in analyzing OCT data. “We are on the cusp of using AI on a more frequent basis to analyze normal OCT images,” he said. As high-resolution imaging adds complexity, AI may offer a valuable tool for managing and interpreting the larger and more detailed datasets, though validation remains essential.

Reflecting on current anti-GA treatments, Csaky noted that while anatomical benefits are evident, “many of those benefits did not translate to the types of visual function benefits that we were expecting.” He suggested that advancing imaging capabilities may offer new opportunities to better align therapeutic strategies with both structural and functional outcomes.

Findings presented at the Heidelberg 2025 International SPECTRALIS Symposium — And Beyond (ISS) suggest detailed structural data could better inform therapeutic targeting and monitoring.

SriniVas Sadda, MD, on high-res OCT of atrophic and precursor lesions in AMD

SriniVas R. Sadda, MD, FARVO, shared insights into the utility of high-resolution optical coherence tomography (OCT) in characterizing atrophic and precursor lesions in age-related macular degeneration (AMD) at the Heidelberg 2025 International SPECTRALIS Symposium – and Beyond (ISS), June 13-14, in Heidelberg, Germany. “We’ve spent a lot of years trying to establish the pathway to the development of atrophy in AMD,” Sadda said, emphasizing the significance of OCT-derived biomarkers like subretinal drusenoid deposits, hyperreflective foci, acquired vitelliform lesions, and thick basal laminar deposits.

These biomarkers are crucial not only for understanding AMD progression but also for identifying candidates for early intervention trials. “Identifying these biomarkers has proven to be quite important… these biomarkers are very important to recognize,” Sadda noted.

A central focus of the presentation was comparing high-resolution OCT with standard-resolution imaging. High-res OCT, with its improved axial resolution, enhances the ability to distinguish key features: “With standard-res OCT you can easily confuse them. With high-res they have a very distinct appearance.” This is especially useful in differentiating true hyperreflective foci from retinal vasculature, as well as in distinguishing between iRORA and cRORA—critical for clinical trial endpoints and real-world risk stratification.

“The brilliance of high-res OCT is that the RPE and Bruch’s membrane are really resolved in tremendous detail,” Sadda said. This resolution allows better assessment of residual RPE cells and basal laminar deposits, aiding in nuanced diagnosis and monitoring.

He also highlighted novel findings, including partial RPE preservation over calcific drusen and visualization of Bruch’s membrane dehiscences: “We’re able to see Bruch's membrane cracks, maybe before the development of neovascularization.”

Sadda added: “This type of risk stratification based on biomarkers… I use this in my clinical practice now.” 

Improved axial resolution allows clearer visualization of early atrophic changes, including iRORA vs cRORA differentiation, as shared at the Heidelberg 2025 International SPECTRALIS Symposium – And Beyond (ISS).

Christine Curcio, PhD, shares histology update supporting review software and revised nomenclature for <3 μm OCT

Christine A. Curcio, PhD, delivered an update on histology and its critical role in advancing <3 μm optical coherence tomography (OCT) interpretation at the Heidelberg 2025 International SPECTRALIS Symposium – And Beyond (ISS), held June 13-14 in Heidelberg, Germany. "Histology is the study of tissue sections by microscopes that range in magnification and resolution themselves, and so the microscopy really has to be matched to the signal source in OCT,” said Curcio, emerita professor of ophthalmology and visual sciences at the University of Alabama at Birmingham Heersink School of Medicine. 

With OCT now able to visualize reflectivity at subcellular levels, Curcio and her team are leveraging volume electron microscopy to correlate high-resolution tissue data with OCT B-scans. “We saw a complete RPE cell for the first time,” she noted—an achievement with major implications for understanding AMD and inherited retinal diseases.

A central theme of her talk was how new histologic techniques are informing refined software tools and a revised OCT nomenclature. “We built on the success of the 2014 international OCT consensus by Staurenghi et al,” Curcio explained, referencing a landmark framework that introduced terms like the ellipsoid zone and interdigitation zone. Among key additions in the updated system is the inclusion of the RPE basal lamina, which had been excluded from the original RPE-Bruch’s complex. This extracellular matrix thickens in AMD and forms basal laminar deposit (BLamD), which must be distinguished from neovascular structures. “BLamD, in turn, must be differentiated from type 1 macular neovascularization so that patients do not undergo anti-VEGF injections that will not be effective.”

Curcio also highlighted the need for anatomical precision in defining the foveal center, particularly in clinical trial design. “Attention to precision is really essential,” she concluded, underscoring how these advances will support both mechanistic insight and therapeutic development in outer retinal disease.

From basal laminar deposits to foveal centering, a new framework refines what clinicians see—and what they treat—in outer retinal disease, as presented at the Heidelberg 2025 International SPECTRALIS Symposium – And Beyond (ISS).

ARVO 2025 Danielle Gauthier

At ARVO 2025, in Salt Lake City, Utah, Danielle Gauthier talked about her poster on autosomal dominant Alzheimer's disease in relation to optic nerve head drusen.

Editor's note: The below transcript has been lightly edited for clarity.

Hello. My name is Danielle Gauthier, I'm a lab technician with Doheny Eye Institute. I'm also a research fellow with Dr Alfredo Sadun, who is affiliated with UCLA David Geffen School of Medicine. And I'm here today to talk about my poster, which is on autosomal dominant Alzheimer disease in relation to optic nerve head drusen. Our main thing was we wanted to look to see if optic nerve head drusen is associated with or may be caused by autosomal dominant Alzheimer disease. So I'll be calling it ADAD. So we had a very rare case of homozygous ADAD, a postmortem tissue that we stained for three types of staining. GFAP, neurofilament protein, and Aβ. So the main thing is, we wanted to see whether or not the neurotoxicity associated with ADAD could cause optic nerve head drusen to form. So that was the main reason why we looked at and stained these three stains.

For instance, GFAP, this is mainly staining glial fibulary acidic proteins. This is associated with astrocytes. Astrocytes tend to come in whenever there's injury to the eye. And so with this stain, we did find that it was positive, and we found it in a heterogeneous pattern. So it's leading us to the idea, or maybe the conclusion, that maybe axonal injury is caused by the inheritance of ADAD. Which, again, it's an Alzheimer disease, but it's known to come around when you're 30 to 60 [years old], so a lot younger than what you typically are seeing.
So it's a very rare tissue, and that's why we only have one, unfortunately. We hope, maybe in the future, to get more, but it's very rare. So while we have many controls, we only had one tissue to look at.

Then we also looked at neurofilament protein, which stains your axons in neurons. So when we were looking at this, you could see in the neurofilament protein, it's as if there was like a big circle–in neurofilament protein you can think of it as, like the structure, the support structure of the cell. And so in it, typically it should kind of look like lines in the picture, but instead we see like a big circle. That's where the drusen is. So the drusen comes in and causes injury to occur, and it causes the cell to kind of burst. So you see, like a big, like plaque aggregate formed in there. So, you know, okay, this, this is not normal. So again, we saw staining for that. So we are assuming that there is some neurodegeneration or axonal injury. We're not sure the etiology. It's not explained in the literature what causes optic nerve head drusen. So we're starting from, we know that drusen is calcified deposits, but we're not completely sure what causes it. So that was the main point to stain for those two stains.

Then the last one was Aβ, which we saw a strong presence with. And the main thing is we saw amyloid plaques, this accumulates between the cells, and it's formed by when amyloid precursor protein clumps together and accumulates. So we saw that as well. Typically with optic drusen, you see it on the retinal side. So optic nerve had drusen is a bit different. We're seeing this in the like pre-lamina cribrosa, so it's a bit different. And typically, when you're looking at like drusen, you're seeing it being scanned on the OCT, there's not a lot of postmortem tissue staining. Everything when you're being diagnosed with drusen, it's all like OC T based, because you can see it when you're doing a scan of the retina. So typically you'll hear retinal drusen, versus optic nerve head drusen is a bit different. It's more if you were to look at the optic nerve head, it's a little bit more so by the lamina cribrosa, which is where we found the association.

We're not sure whether drusen is associated with ADAD. And that was the main point on why we want to stain, to try to see is there an association. Because our further steps in the future, is to stain for cytochrome c, which it stains essentially for cytochrome c oxidase, which is used in high mitochondrial activity. So we want to know, okay, does ADAD cause this drusen. Which we can't make that conclusion based on just one case, but hopefully in the future, we can get more eyes and do further staining to kind of test whether or not there's a link to it.

I would say that if there were to be in postmortem tissue, drusen found it would be interesting to know whether or not what the disease, like any precursor disease that they had. For instance, it would be interesting to look if someone had drusen in Lebers or drusen in in dominant optic atrophy, because we want to know whether this genetic inheritance of a disease can lead to this, like if there's a neurotoxic link, or a neurodegeneration can cause drusen to form. Because there hasn't been really that association linked yet, because, again, it is difficult to kind of–correlation isn't causation. So you kind of need more tissues to form that link to see if there could be an association. I think this would be great to look at in regular Alzheimer's disease eyes. But again, we have to find that drusen first. We were lucky in that in the first slice of this tissue, we saw the drusen immediately, but again, you need to see the drusen to be able to test and stain whether there's a link to it.

At ARVO 2025, in Salt Lake City, Utah, Danielle Gauthier talked about her poster on autosomal dominant Alzheimer disease in relation to optic nerve head drusen.

ARVO 2025: Association between autosomal dominant Alzheimer disease and optic nerve head drusen

Retina World Congress 2025: Imaging discussion with Alan J. Franklin, MD, PhD

Alan J. Franklin, MD, PhD spoke with the Ophthalmology Times team at Retina World Congress 2025. This meeting is taking place in Fort Lauderdale, Florida, from May 8-11, 2025. 

In this conversation, Franklin discussed a research study on intraoperative fluorescein angiography in surgical procedures, highlighting significant advancements in surgical visualization and patient outcomes. The key research finding centers on using fluorescein angiography during surgery to identify and laser areas of fluorescein leakage or occult neovascularization. By targeting these specific areas, the team demonstrated a substantial reduction in postoperative vitreous hemorrhage rates and notable improvements in patient visual acuity during the first 3 months after surgery. 

The technique's historical development is briefly traced, starting with Dr. Charles's initial work on operating microscopes, which initially struggled with wide-angle visualization. This was advanced for heads-up surgery, and the current research team further streamlined the process using retinal machines and heads-up displays. Franklin emphasized that while compelling visual imagery is important, the ultimate goal is demonstrating tangible patient benefits. 

Drawing from personal fellowship training experience, he also noted the historical difference between fellows and attending physicians in surgical visualization with the experienced surgeons traditionally able to better identify and navigate surgical pathologies. Modern digital imaging systems now provide enhanced tissue visualization, allowing for more precise surgical interventions. The research aimed to formally compare surgical outcomes between patients who underwent intraoperative fluorescein angiography and those who did not. The study's action items include:

Analyzing data on intraoperative fluorescein angiography's impact

The research represents a significant advancement in surgical techniques, leveraging technological improvements to potentially improve surgical precision and patient outcomes.

In this conversation, Franklin discussed a research study on intraoperative fluorescein angiography in surgical procedures, highlighting significant advancements in surgical visualization and patient outcomes. 

RWC 2025: Alan J. Franklin, MD, PhD on the use of intraoperative fluorescein angiography

NeuroOp Guru: When eye findings should prompt neuroimaging in suspected neuro-Behcet disease

, Andrew G. Lee, MD, and Andrew Carey, MD, discuss the overlap between Behcet uveitis and neurologic involvement in Behcet disease, emphasizing the importance of coordinated care between uveitis and neuro-ophthalmology specialists. Behcet is a multisystem autoimmune disease that commonly affects the skin, vasculature, GI tract, and eyes. While uveitis is a hallmark finding, neuro-Behcet—though less common—is potentially life-threatening.

 discussed in the episode examined whether ocular signs and symptoms could predict CNS involvement. Key clinical red flags included persistent headaches (especially with meningeal signs), seizures, cranial nerve deficits (eg, diplopia, facial palsy), and optic neuritis. Less common were motor and cerebellar signs; sensory or cognitive symptoms were rare.

Importantly, even in the absence of overt neurologic symptoms, optic disc staining and leakage on fluorescein angiography increased the odds of neuro-Behcet (OR 5.4). This suggests that subtle optic nerve involvement seen during uveitis evaluation should prompt MRI consideration.

However, routine MRI for all patients with Behcet disease is discouraged due to the rarity of neuro involvement, imaging delays, and risks of incidental findings. Instead, imaging should be reserved for patients with neurologic symptoms, optic nerve signs, or high-risk fluorescein findings.

MRI findings may include venous sinus thrombosis, pachymeningitis, parenchymal enhancement, or white matter lesions mimicking multiple sclerosis. Enhancing or large white matter lesions are more concerning than age-related, non-enhancing changes.

Borelli A, Behr J, Ruggeri M, Han M, Zhou Y, Foster CS. Indications for magnetic resonance imaging in patients with Behcet uveitis. 

. 2024;44(4):473-477. doi:10.1097/WNO.0000000000002018

In cases with optic nerve hyperfluorescence or neurologic symptoms, prompt neuroimaging is warranted to rule out neuro-Behcet disease and guide multidisciplinary management.

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