Optical Coherence Tomography (OCT)-Guided Ultrafast, Nonthermal Laser Microablation for Non-invasive Vitreoretinal Surgery

PROJECT SUMMARY Photonics research has substantially advanced ophthalmology by introducing precise diagnostic and treatment methods that have enhanced eye health and vision outcomes. Thermal lasers have revolutionized the treatment of posterior segment conditions such as diabetic retinopathy, age-related macular degeneration, and retinal detachments; however, their application is limited near the macula—the central part of the retina—due to the risk of irreversible loss of vision from collateral thermal damage. This project aims to develop the next generation of surgical techniques by evaluating the usability of ultrafast (femtosecond) nonthermal lasers for treating vitreoretinal and posterior segment disorders of the eye. Ultrafast lasers are widely used in anterior segment LASIK and cataract operations, yet their application in vitreoretinal cases remains unexplored. In the U.S., around 250,000 pars plana vitrectomies (PPV) are performed annually, serving as the standard treatment for most vitreoretinal conditions. While effective, PPV is a delicate and time-consuming operation, carrying the risk of potential iatrogenic complications. The use of nonthermal femtosecond lasers as a “laser scalpel” presents the exciting possibility to enable rapid and highly precise surgery with significantly less error-prone manual operations within the eye. Changes in the vitreous gel's properties either due to normal aging processes or pathological sequelae of common chronic disorders, such as diabetic retinopathy, can lead to anomalous scar tissue or epiretinal membrane (ERM) formation on the vitreoretinal interface. These changes cause significant vision distortions and can lead to mechanical vitreomacular traction (VMT), which commonly leads to retinal holes and tears. The central hypothesis is that the integration of ultrafast nonthermal laser ablation, guided by real-time optical coherence tomography (OCT) imaging and an artificial intelligence (AI)-enhanced interface, will facilitate noninvasive, non-thermal interventions for VMT and ERM, presenting an alternative to PPV which can more reliably preserve the integrity of adjacent critical retinal structures. Aim 1: Characterization of ultrafast laser ablation effects on ex vivo vitreous and retinal tissues and development of integrated OCT-laser system. Aim 2: Development of 3D segmentation AI algorithms and a surgical operator interface for guiding treatment. Aim 3: Validation of the integrated system through testing on whole ex vivo porcine and cadaver human eyes. These studies pave the way for revolutionary advancements in the minimally invasive treatment of vitreoretinal disorders. This training plan’s focus on laser and imaging techniques integrates well with a career goal of becoming an ophthalmologist-scientist with a focus on developing novel biophotonics-based diagnostic and therapeutic techniques.