Optical Coherence Tomography and Eye Care

This NEJM editorial chronicles the invention, engineering foundation, and transformative clinical impact of optical coherence tomography (OCT) in ophthalmology. OCT leverages low-coherence interferometry to generate micrometer-scale cross-sectional images of the retina and other ocular tissues. Since its 1991 debut by Huang, Swanson, and Fujimoto, OCT has enabled noninvasive, layered visualization of retinal microanatomy revealing edema, atrophy, and pathologic changes from conditions like diabetic macular edema and neovascular age-related macular degeneration (AMD). It uses near-infrared light and a Michelson interferometer setup to measure tissue reflectivity with high dynamic range and subcellular resolution. OCT angiography now detects vascular flow without contrast agents. Portable and intraoperative OCT systems extend access to pediatric and surgical settings, including 3D visualization during retinal maneuvers. Artificial intelligence is increasingly used to interpret OCT scans for diagnosis, disease staging, and treatment response. OCT has also begun transforming cardiology through intravascular implementations. Its 2023 Lasker-DeBakey Award win underscores its profound impact on clinical imaging and precision medicine.

This NEJM editorial chronicles the invention, engineering foundation, and transformative clinical impact of optical coherence tomography (OCT) in ophthalmology. OCT leverages low-coherence interferometry to generate micrometer-scale cross-sectional images of the retina and other ocular tissues. Since its 1991 debut by Huang, Swanson, and Fujimoto, OCT has enabled noninvasive, layered visualization of retinal microanatomy revealing edema, atrophy, and pathologic changes from conditions like diabetic macular edema and neovascular age-related macular degeneration (AMD). It uses near-infrared light and a Michelson interferometer setup to measure tissue reflectivity with high dynamic range and subcellular resolution. OCT angiography now detects vascular flow without contrast agents. Portable and intraoperative OCT systems extend access to pediatric and surgical settings, including 3D visualization during retinal maneuvers. Artificial intelligence is increasingly used to interpret OCT scans for diagnosis, disease staging, and treatment response. OCT has also begun transforming cardiology through intravascular implementations. Its 2023 Lasker-DeBakey Award win underscores its profound impact on clinical imaging and precision medicine.