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A research team led by the Department of Ophthalmology, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong (HKUMed), alongside partners from the Faculty of Medicine, Chinese University of Hong Kong ( CU Medicine) and local and international partners, have developed a novel ROTA (Retinal nerve fiber layer Optical Texture Analysis) technology to unveil the optical texture and trajectories of axonal fiber bundles on the retina.

So far, ROTA has exceeded current clinical standards, achieving 15.0% to 28.4% higher sensitivity in detecting early optic nerve damage in glaucoma – the leading cause of irreversible blindness. The research has been published in Nature Biomedical Engineering.

The most common form of neurodegenerative disease is glaucoma. While a clinical diagnosis of the disease relies on the measurement of the retinal nerve fiber layer (RNFL) thickness, which is usually determined via a non-invasive digital imaging device – optical coherence tomography (OCT) – false positives and false negatives are common.

Thus, it is difficult even for glaucoma specialists to obtain a clinical interpretation of OCT results. This is supported by a meta-analysis reporting that the sensitivities of the best performing OCT parameters for detecting RNFL thickness abnormalities were only 65% ​​to 75% at specificities of 90% to 95%.

ROTA is a patented algorithm (US Patent No. 10,918,275) that integrates RNFL thickness and RNFL reflectance measurements obtained from standard OCT scans to discern the optical texture and trajectories of axonal fiber bundles and reveal the RNFL defects.

The technology can detect RNFL focal defects that are missed by standard clinical tests. Compared to OCT, ROTA can increase the sensitivity of detecting early optic nerve damage in glaucoma by 15-22%. At 95% specificity, the sensitivity of ROTA was 97.3-98.4% for detecting early glaucoma, 15.0%-28.4% higher than current clinical standards.

HKUMed works with the University of California, San Diego (UCSD), USA to apply ROTA in research and patient care, while patients can find the application of ROTA at HKU Eye Center and the Southern District Hong Kong Eye Survey.

The CUHK Eye Center of CU Medicine conducted a diagnostic study and examined 177 healthy people and 363 patients with glaucoma. They found that ROTA achieved significantly higher sensitivity and specificity than conventional RNFL OCT thickness analysis for detecting glaucoma1. Additionally, ROTA was able to identify axonal fiber bundle damage in optic neuritis, ischemic optic neuropathy, and compressive optic neuropathy.

Professor Christopher Leung Kai-shun, Chairman and Clinical Professor of the Department of Ophthalmology at the School of Clinical Medicine, HKUMed, said the team’s next steps include recruiting patients from Queen Mary Hospital, Grantham Hospital and Hong Kong Eye Hospital for longitudinal studies to examine the effectiveness of ROTA for detecting glaucoma progression, as well as collaborating with OCT industry partners to deploy ROTA in care clinics. Additionally, HKU Eye Center welcomes patients with a questionable diagnosis of glaucoma for a ROTA evaluation.

Meanwhile, Professor Clement Tham Chee-yung, Chairman of the Department of Ophthalmology and Visual Sciences and SH Ho Professor of Ophthalmology and Visual Sciences, CU Medicine, noted that glaucoma can lead to irreversible vision loss s not diagnosed and treated early. In Hong Kong, about 25% of irreversible blindness is caused by glaucoma, and there are more than 100,000 glaucoma patients with varying levels of visual impairment.

It was added that it is essential to obtain an earlier diagnosis of glaucoma and to detect its progression through advanced imaging technologies.

Clinical applications

ROTA underpins a highly sensitive and specific technique to advance the diagnosis of glaucoma and optic neuropathies. ROTA will be deployed on the Advanced Nerve and Glaucoma Imaging Network (ANGI Network), which includes ophthalmologists, neuro-ophthalmologists and clinical researchers from around the world.

ANGI Network committee members include world renowned institutions in glaucoma research such as HKU, Asan Medical Center (Korea), Stanford University Beyer Eye Institute (USA), Moorfields Eye Hospital (Kingdom United States), NTU Langone’s Eye Center (United States), and University College London (United Kingdom).


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