Optical Coherence Tomography (OCT) has revolutionized the diagnosis and management of retinal diseases, offering high-resolution, cross-sectional imaging that aids in early detection and continuous monitoring. However, traditional OCT devices are limited to clinical settings and require a technician to operate, which poses accessibility challenges such as a lack of appointment availability, patient and family burden of frequent transportation, and heightened healthcare costs, especially when treatable pathology is undetected. With the increasing global burden of retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy, there is a critical need for improved accessibility in the detection of retinal diseases. Advances in biomedical engineering have led to innovations such as portable models, community-based systems, and artificial intelligence-enabled image analysis. The SightSync OCT is a community-based, technician-free device designed to enhance accessibility while ensuring secure data transfer and high-quality imaging (6 × 6 mm resolution, 80,000 A-scans/s). With its compact design and potential for remote interpretation, SightSync widens the possibility for community-based screening for vision-threatening retinal diseases. By integrating innovations in OCT imaging, the future of monitoring for retinal disease can be transformed to reduce barriers to care and improve patient outcomes. This article discusses the evolution of OCT technology, its role in the diagnosis and management of retinal diseases, and how novel engineering solutions like SightSync OCT are transforming accessibility in retinal imaging.

This study evaluated the feasibility, image quality, and referral accuracy of a patient-operated optical coherence tomography (OCT) device (SightSync) compared with technician-acquired Heidelberg OCT. This study was conducted in a Veterans Affairs retina clinic (Cleveland, Ohio), resulting in a predominantly male (98%) study population representative of the local veteran demographics. One hundred patients attempted self-administered OCT imaging after brief instruction, yielding 118 successful scans (59% of eyes) with no significant association between scan success and age, visual acuity, or diagnosis. Quantitative analysis of 142 paired images showed that SightSync produced interpretable scans with comparable sharpness to Heidelberg OCT, though signal- and intensity-based metrics (signal-to-noise ratio; SNR, contrast-to-noise ratio; CNR, entropy, pixel intensity; p90) were lower, consistent with hardware differences between a compact patient-operated prototype and a clinical-grade system. Among 121 high-quality SightSync scans, referral decisions demonstrated strong agreement with Heidelberg OCT, with a sensitivity of 83.9%, specificity of 75.6%, and a negative predictive value of 93.2%, indicating reliable exclusion of clinically significant pathology. These findings demonstrate that patients can independently acquire clinically interpretable OCT images and that SightSync provides safe, conservative triage performance—supporting its potential as a scalable community-based retinal imaging solution—while a review of unsuccessful scans has identified prototype modifications expected to further improve device feasibility.

SIGNIFICANCE: There is a lack of knowledge on myopic progression in patients with moderate to high astigmatism, which has been compounded by their exclusion from myopia control studies. This study found increased myopia that was linearly associated with age, emphasizing the importance of understanding myopia control treatments in this population. PURPOSE: Moderate to high amounts of astigmatism cause visual blur and may affect myopic progression. However, there is little information as to the effect of cylinder on change in myopia, and the vast majority of myopia control studies have excluded children with significant astigmatism. The purpose of this study was to assess myopic and cylinder changes in children with moderate to high astigmatism. METHODS: Retrospective review of children (2 to 15 years) who presented with astigmatism (>2.00D) and myopic spherical equivalent refraction (SER) to a tertiary care pediatric hospital. Best corrected visual acuity and cycloplegic refraction changes over at least 2 years of follow‐up were analyzed. Patients with confounding ocular disease, history of myopia control, or Trisomy 21 were excluded. RESULTS: Two hundred twenty‐seven patients presented at 6.6 years (IQR 5.2, 9.1) with a median 0.00D (IQR −2.00, 0.50) sphere, −3.00D (IQR −4.25, −2.50) cylinder, and −1.75 (IQR −3.75, −0.99) SER. Twenty‐four percent of patients had amblyopia and 46% had strabismus. At final exam (4.9 [IQR 3.0, 6.7] years), patients were more myopic and had greater cylinder (p<0.001). Hispanic patients were disproportionately represented (64%) but had no difference in refractive parameters versus non‐Hispanic patients. Initial age was linearly associated with sphere and SER, and the rate of change in sphere and SER over 2 to 3 years of follow‐up. Initial J ₀ was linearly associated with myopic and cylindrical progression. CONCLUSIONS: Children with moderate to high levels of astigmatism showed myopic and cylindrical progression at follow‐up. Amblyopia and strabismus were common in our cohort, but neither amblyopia nor strabismus affected the rates of myopic or cylindrical progression. Patients with moderate astigmatism (−2.00 to −3.00D) had more myopic and cylindrical progression compared with those with higher levels of astigmatism.