Macular holes

Macular holes

A macular hole is an opening in the retina (the layer at the back of the eye that is sensitive to light) that develops at the fovea (the part of the eye that is responsible for sharp vision) and causes a small dark spot in the central vision. Often preventing those with the condition from recognising very small objects, particularly from reading ordinary print and possibly being fit to drive.

For people over the age of sixty idiopathic macular holes are an important cause of visual loss. In this population 0.5% will have macular holes and about two thirds of these are women. While most people only develop a macular hole in one eye there is a 10 to 15% chance of developing a macular hole in the other eye as well.

Macular Hole 1

Problems with measuring macular holes

Current macular hole measures are typically made using a single two-dimensional (2D) slice of a horizontal optical coherence tomography (OCT) image and measured by a human grader using callipers. This is known to be prone to high intra and inter-observer error and vulnerable to further error from off- centre scan location.

When studied in three dimensions (3D) macular holes are found to have significant asymmetry in all dimensions. Human measurements in 2D of these asymmetric macular holes have considerable inter-observer variability and fail to represent key parameters of the macular hole accurately. Intogral is used by retinal eye surgeons and could be used by ophthalmologists. It gives reliable macular hole measurements and a better understanding of what the macular hole looks like in 3D, so that they can quantify the hole better.

The care pathway for macular holes

When a patient has been diagnosed as having a macular hole they will have degraded eyesight in that eye. A retinal eye surgeon will usually operate to close the macular hole to prevent further deterioration of eyesight and possibly allow for visual imporovement. Intogral software applied to OCT images displays accurate size parameters to be used by retinal eye surgeons for improved management planning, outcome prediction and communication with patients.

Almost all macular holes are successfully closed, if there is visual improvement this can help restore independence.

The current care pathway is broadly as follows:

A patient, with vision difficulty in an eye, visits a GP, an optometrist or sometimes an emergency eye hospital, where it is identified that that there may be a problem that needs specialist attention. Upon referral to an ophthalmologist the patient’s eye is scanned using an OCT scanner which produces 2D scans. If a macular hole is confirmed, the patient is referred to a retinal eye surgeon who will repeat the OCT scan. Even though the macular hole is asymmetric in 3D, looking at the 2D horizontal line scans the surgeon must judge which slice has the minimum linear diameter (MLD). The measurement is important because research suggests that the MLD correlates with the final patient outcome and possibly the degree of visual improvement.

Macular Hole 2

Intogral software

Intogral utilises Deep Learning, cutting-edge research in Artificial Intelligence (AI), to learn from the expertise of experienced clinicians. These expert clinicians, with decades of experience help our software to learn how to spot diseases in high-resolution medical images, augmenting the ability of clinicians to diagnose and treat their patients.

Our 3D deep learning models produce rapid and high-quality 3D image data, using Intogral's cloud-based Image Annotation Platform.

Intogral's Platform is accessed through a User Interface (UI) which keeps in the style of existing OCT viewers that clinicians will be familiar with and introduces a brand-new 3D view along with 3D measurements. Retinal eye surgeons can use these enhanced measurements to improve the management planning and outcome prediction for the treatment of macular holes.