Impact case study database

The advancement of en-face and laser technology by the University of Kent’s AOG has led to: (1) impact on commerce and the economy (for OPTOS, NKT, Optovue, DTU/Norblis); (2) impact on health and wellbeing, with millions of people benefiting from advancements in en-face OCT and several thousand people benefiting from enhanced laser technology.

Advancing en-face OCT: Development of new medical devices, driving diagnostic standards and improving identification and treatment of occult diseases

In 2011, OPTOS bought OPKO and thus acquired Kent’s OCT/SLO, the first combined Scanning Laser Ophthalmoscopes (SLO) and OCT instruments designed to provide retinal images in the en-face orientation for the diagnosis of eye diseases [P1]. En-face gradually became the standard imaging modality in hospitals (with competitors such as Zeiss and Optovue also having started to develop en-face orientation technology). OPTOS continued to sell the original OCT/SLO device to clinics around the world until 2016 [a]. As part of its R&D plan, OPTOS continues to maintain many of the ‘two dozen patents and patent applications [protecting the original OCT/SLO technology, which name Kent inventors]’ [a].

The collaboration between the University of Kent’s AOG and Rosen [R1], Vice-Chair of Ophthalmology Research, Surgeon Director at the New York Eye and Ear Infirmary (NYEEI), advanced en-face OCT technology further still, and led to OCTA being implemented in the clinical context. OCTA offers additional benefits because it is the first non-invasive imaging technique that enables visualisation of vascular networks in the human retina, choroid, skin, etc. Since 2015, this ‘landmark discovery’ [b, c] has enabled an even ‘more accurate identification of occult diseases’ [b]. OCTA has ‘revolutionized the clinician’s access to non-invasive 3-dimensional vascular beds as a quantitative tool for management of diabetic retinopathy, age-related macular degeneration, and glaucoma’ [b]. This is significant, given how widespread these diseases are. The projected number of people with age-related macular degeneration alone is 196 million in 2020, increasing to 288 million in 2040.

OCTA has inspired other groups across the globe to develop similar instruments, thus making multimodal images a new standard in the field [b]. Rosen further states that Prof. Podoleanu’s work ‘has inspired a whole new generation of young clinicians’ [b], and that it ‘has been a crucial stimulus for our own research and clinical missions at NYEEI_MS as well as our partner organizations’ [b]. The joint work between the University of Kent’s AOG and the NYEEI ‘has helped to improve the diagnosis prospects for millions of patients since we began in 2000 to the current day’ [b].

The CEO at Optovue, an industry-leading ophthalmic company based in California, has also testified to the importance of the AOG’s work. With regards to product development and determining a business strategy, the company has been ‘guided by the enface OCT images and the combined display of enface OCT with angiography images initially demonstrated by Podoleanu and Rosen’ [c]. Optovue became the first company to launch and commercialise OCTA instruments, and started to sell their AngioVue instrument in 2014. ‘This was a major change in our market strategy that paid off, with the AngioVue installed in more than 1600 ophthalmic practices worldwide’ [c]. It is estimated that one machine can diagnose 1,000 patients per year, meaning that 1.6 million people were benefiting from the AngioVue on an annual basis by 2020. By 2020, Optovue had in addition to this launched Solix, another new OCTA machine that comes with increased scanning speed. ‘Solix is the latest in a range of OCTA instruments which we have been commercialising since 2014, and which owe their existence to the original discovery work of the en-face imaging collaboration of Prof. Adrian Podoleanu and Dr Richard Rosen since 2000.’ [c]

Furthermore, Centervue has ‘contributed to the costs for prosecution of the patents protecting Kent’s Master Slave OCT’, a powerful and paradigm-changing technology that enables direct en-face real-time displays [d], showing that significant interest in the exploitation of AOG-developed technology is continuing.

OCT and laser technology: improving skin cancer diagnostics

Sustained and increasing collaboration between the AOG and NKT Photonics has increased NKT’s understanding of the OCT market, and since 2014 helped to steer research at NKT [e]. Senior Research Scientist Patrick Bowman stated that joint research programs are important not only because they ‘drive state-of-the-art research into next-gen lasers for OCT’ [e], but also because they enable the company to receive knowledge with regards to how to improve products and indications as to which technical improvements to lasers will be important to OCT in the future. ‘As a niche laser supplier, with a small revenue compared to the overall size of the OCT market, the latter is critical for NKT to decide whether or not to compete in certain areas’ [e].

Joint work between the AOG and NKT provided NKT with a unique commercial advantage, enabling them ‘to progress the supercontinuum technology to ultra-high resolution optical coherence tomography’ [e]. As a consequence, NKT could enhance their lasers and improve their access to the OCT market valued at $1bn USD [e]. In parallel, AOG, NKT, and the Danish Technical University (DTU) advanced the technology of photo-acoustics [e]. This is another significant, growing market. ‘To give estimates, the value of photo-acoustic imaging in its pre-clinical stage in 2018 was $35M USD. Now on the cusp of wide- spread clinical testing, it is estimated to reach a market value of $240M USD by 2022’ [e].

Collaborations between the AOG, DTU, and NKT have led to the training of 5 PhD students (2014-18) in an industrial setting, and enabled NKT ‘to extend our collaborators to OPTOS and G&H, and clinical practitioners such as Northwick Park Hospital, London and Moorfields Eye Hospital (Institute of Ophthalmology), London’, as well as various hospitals in Denmark [e]. Ear, Nose, and Throat surgeons at Northwick Park have benefited from ‘having the opportunity to directly guide the development of new technology to suit requirements for some of our surgical interventions’, while ‘Post-doctorate and PhD students have been hosted both from The University of Kent and Imperial College London as part of our Trust’s applied optical imaging programme’ [h]. It also led DTU ‘to pay more attention to the OCT field’ [g], to continue collaborating with Podoleanu and the AOG, to diversify their involvement with OCT, and to create their spin-out company Norblis (2018), which makes imaging equipment using broadband lasers in mid-IR [g].

The most significant clinical impact resulting from the various collaborations between AOG and DTU was achieved with Bispebjerg Hospital in Copenhagen. This collaboration [R2-R4] enabled Bispebjerg Hospital to obtain images of skin cancer with ‘unprecedented resolution’ [f]. As Mette Mogensen’s (Chief Physician at Bispebjerg) letter proves, medical practitioners are now embracing high-resolution OCT as ‘novel systems with improved imaging performance’ [f]. Mogensen stated that the collaboration with DTU and Kent ‘improved the diagnostic prospects for thousands of patients’ [f], and that discussions with Professor Podoleanu ‘have had a significant impact on our understanding of diagnostic imaging and technical limitations and benefits’ [f].