I am Dr Zhanhan Tu – an ophthalmologist, researcher and teacher based in the Ulverscroft Eye Unit at the University of Leicester. For the last ten years I have been working on normal and pathological eye development in infants and children, using optical coherence tomography (OCT). Following a pilot project in 2017/18, I am very excited to have finally started our research project using OCT to help decision-making about retinoblastoma treatments at the Royal London and Birmingham Children’s Hospitals.
You may have seen OCT in your high street opticians. Imagine that taking an image is just like taking a photo of the top of a cake. OCT can take pictures of the back of the eye (the retina) at a nearly microscopic level within 2 seconds. The OCT image is just like a picture where the cake has been cut through, allowing us to see all the layers of the retina. These extremely detailed retinal images allow us to detect tiny tumours before the tumour can be seen using the standard ophthalmoscope examination and on a fundus photo. Hand-held OCT can also monitor treatment response, vitreous seeds and tumour recurrence.
This is a fascinating study, but more importantly, hand-held OCT can immediately impact the clinical treatment plan. For example, we have an 8-month-old baby who had a tumour in one eye. He had laser treatment on the tumour and systemic chemotherapy. Although the scar post-laser presents as stable under clinical examination, OCT found the sign of fast growth of recurrence. Since we started this OCT study in the Rb services in November 2021, the OCT images have changed the treatment plans, compared to the pre-OCT clinical plans, in 25% of all OCT sessions.
The next stage of this study would be to produce guidelines for clinicians on what time of Rb cases would benefit from OCT scans; the methodology of OCT scans for patients with Rb; and also how to monitor and guide clinical decisions using OCT (clinically invisible tumours, recurrence, invasion and vitreous seeds). We hope that in time OCT will be available to Rb patients as part of the standard service in future.
Travelling six hours a day down to London for a whole-day Rb theatre session is exhausting, but it is the most rewarding research project that I am leading so far. It means a lot to me as a doctor, researcher and also the mother of two young children.