Exploring new horizons in eye research: CRATER 2023 Conference summary

CRATER 2023 is a unique event prepared by ICTER as a place to exchange ideas, disseminate research results, and explore the latest achievements related to the most important of our senses: vision.

Since 2019, scientists at the International Centre for Translational Eye Research (ICTER) have been working on breakthrough technologies for imaging and diagnosing eye diseases, facilitating procedures to save or restore vision. The research is interdisciplinary and covers biology, chemistry, physics, and computer science. A summary of the first period of ICTER’s activity was CRATER – Conference on Recent Advances in Translational Eye Research 2023 – which took place in the heart of Warsaw, at the Copernicus Science Center, on September 7-8, 2023. For the implementation of the event, a grant of PLN 320,000 was obtained under the “Excellent Science – Support for Scientific Conferences” program, financed by the Ministry of Education and Science. The event was co-organized by the Candela Foundation, whose statutory activity focuses on supporting the development of optics and photonics in Poland.

The conference aimed to bring together experts from various fields dealing with the process of vision in one place and enable them to exchange scientific ideas, as well as to create a bridge between the scientific world and industry. The conference focused on the latest achievements in the field of vision research, as well as new technologies and diagnostic tools, as well as methods of treating eye diseases. The range of topics covered was wide and included, among others: optogenetics, OCT optical tomography, two-photon imaging, structural biology, bioinformatics, electrophysiology, and the medical use of artificial intelligence (machine learning and deep learning).

Extraordinary guests and extraordinary conversations at CRATER 2023

Anna Clunes, British Ambassador to Poland, inaugurated the conference. During CRATER 2023, there were many interesting presentations in which experts from various specializations shared their knowledge. The conference was graced by the presence of such names as Pablo Artal, Chris Dainty, Francesca Fanelli, Arie Gruzman, Alison Hardcastle, Karl-Wilhelm Koch, Serge Picaud, and Olaf Strauss. Topics covered include the function of the retinal pigment epithelium (RPE), the possibility of restoring vision, the aging process of cells in the retinal vessels or the mechanisms of geographic atrophy (GA), the advanced stage of the dry form of age-related macular degeneration (AMD).

Parallel sessions covered, among others: the modeling of hereditary retinal diseases, processing of visual information, protection of light-sensitive cells (cones and rods), and the potential use of rhodopsin conformational modulators. All of these presentations offered a comprehensive overview of the latest developments in the field of vision research.

During CRATER 2023, prizes were awarded for the best-presented posters containing descriptions of scientific research. Lynn Kandakji, representing the UCL Institute of Ophthalmology, was honored for her poster titled “Subclinical Keratoconus Detection Using Deep Learning on Raw Anterior-Segment Optical Coherence Tomography Imaging.” Wiktor Kulesza from ICTER also received a distinction for his poster titled “Hemodynamics Monitoring in Mouse Retinal Vessels via Ultrafast Volumetric Spatio-Temporal Optical Coherence Tomography (STOC-T) Imaging”.

Success has many names

The conference provided a unique opportunity for those outside the eye research community to gain a concise and understandable overview of ICTER’s scientific achievements. Łukasz Kornaszewski, Deputy Director for Intellectual Property at ICTER, said:

Our industrial partners had the opportunity to see us in a natural environment. This event was an unusual and very effective way for non-specialists to understand the depth of our scientific achievements. We prepared informative and concise content, which made it accessible to a wider audience.

Looking at this event from yet another perspective and analyzing the impact of the CRATER conference through the lens of medicine, Piotr Chaniecki, Advisor to the ICTER Management Board for Ophthalmology, shared his observations:

This year’s CRATER conference was like a compass that showed the direction of development in global ophthalmology. Fascinating lectures and poster sessions showed how new technologies will help patients keep their eyes healthy. Soon, ophthalmologists will likely have powerful diagnostic and therapeutic tools at their disposal. For me, the great value lies in learning about technologies that will speed up the diagnosis of certain diseases, giving patients a chance to recover.

Maciej Wojtkowski, director of ICTER, emphasized the importance of the conference:

CRATER provided an important opportunity for ICTER to engage with the global eye research knowledge community. Thanks to the conference, we know where we are and where we are going. This exchange of knowledge allowed us to gain valuable experience and contacts that will bear fruit in the future.

Something more than an ordinary conference

The success of CRATER 2023 can also be measured in numbers. The event was attended by 168 people who represented a variety of environments and organizations. A survey conducted after the conference showed that participants were very satisfied with CRATER 2023. When asked to rate the conference, over 60% of respondents rated it a full 10 points out of 10.

CRATER 2023 was more than just an ordinary conference; was a celebration of the relentless pursuit of scientific and technological advancements in the field of vision research.

During the conference, two videos were recorded containing participants’ statements about the future of research and the event itself. These films undoubtedly reflect the atmosphere of the event. Links to videos below:

Summary: https://www.youtube.com/watch?v=5o2ekqTSF1U&ab_channel=IChFPAN.

Interviews: https://www.youtube.com/watch?v=4BvXBZTGrsY&ab_channel=IChFPAN.

Detailed information about CRATER can be found at: https://crater.icter.pl/.

Text: Anna Przybyło-Józefowicz and Marcin Powęska.

Content review: CRATER Organizing Comittee.


As dusk falls, ICTER carries the light. Breakthrough in the diagnosis of eye diseases

We have a pair of eyes, with up to 6 million cones and 120 million rods, gifts from nature for our entire lives. It often happens that one of these elements starts to malfunction – the earlier we detect this, the better the chances of a cure. Diagnostic tools in ophthalmology are well-developed, but they can be improved and scientists at the International Centre for Translational Eye Research (ICTER) are contributing to this.

The eye is nature’s unique “window” that opens in two different ways, leading to entirely different realms. On the one hand, it allows us to observe the external world, and on the other, it enables us to peer inside – into the depths of our bodies, spotting the signs of developing diseases. Unfortunately, more than 280 million people worldwide suffer from malfunctioning eyes. Aging, air pollution, poor hygiene, injuries, and genetic predispositions gradually close our window to the world.

“The human eye is an extraordinary organ, which by its complexity is unmatched by anything on Earth and probably in the Universe. However, it is such a sensitive organ that sooner or later, each of us will experience some problems with it,” says Prof. Dr. hab. Maciej Wojtkowski, Chair of the International Centre for Translational Eye Research (ICTER).

Medical progress has allowed us to manage vision disorders like cataracts or glaucoma quite effectively, but in the case of many vascular diseases, we are still vulnerable. Conditions such as age-related macular degeneration (AMD), diabetic retinopathy, or retinal vascular obstruction still mean a verdict for patients. There is a glimmer of hope carried by scientists from ICTER.

Precision tool for ophthalmologists

One of the most fundamental and accurate tests used in eye disease diagnostics is optical coherence tomography (OCT). It allows the individual eye structures to be viewed in detail, but when used for early detection of subtle pathological changes, it becomes much more challenging.

The team of scientists at ICTER decided to change that by introducing a new imaging method derived from OCT. This led to the creation of even more advanced spatio-temporal optical coherence tomography (STOC-T), which suppresses noise and enables the acquisition of precise images, thereby facilitating the diagnosis of early-stage disease changes. One of the applications of the STOC-T technology is Optoretinography (ORG).

The solution developed by ICTER is fundamental for advancing our understanding of ocular disease diagnostics. Instead of scanning the eye with coherent light (as in traditional OCT), STOC-T uses several hundred different laser patterns to illuminate the retina within nanoseconds, capturing the reactions to this light with a superfast camera. This process is explained in detail in the video “ICTER: Brightening Up Life”: https://youtu.be/Z5VoDjg-JB4.

Through the computational analysis of gigantic datasets, doctors receive more precise and sophisticated information about the eye’s condition. This method significantly improves the visualization of retina and choroid images, which until now was not possible.

“I’m conducting research aimed at finding methods for treating blindness. Eye function is more critical than structure because often in the course of a disease, we first observe changes in function preceding changes in structure. Therefore, highly sensitive measurements of eye function are crucial for monitoring and detecting pathological changes in tissue,” says Professor Olaf Strauss, an experimental biologist at Charité – Universitätsmedizin Berlin.

A Breakthrough in Eye Diseases Diagnosis

This technology will allow ophthalmologists to diagnose eye diseases much faster and efficiently than today. Most importantly, the patient examination itself will take only one-hundredth of a second (compared to several minutes for current OCT examinations). An ultra-fast camera, capturing 100,000 frames per second, sends gigantic data sets to a computer and allows the receptors’ response to light to be observed.

ICTER’s software processes this data and creates an image that can be compared to what a microscope provides. Currently, ICTER is studying the specific receptor movements associated with certain diseases. This will enable rapid and more precise diagnoses of many eye diseases, as well as post-therapy monitoring.

“Early diagnosis of these conditions would potentially limit their negative effects in about 90% of cases. By employing the STOC-T research method, we provide the opportunity for in-vivo studies of pharmacological therapies, supplying essential information about the quality and efficacy of proposed eye disease treatments,” explains Professor Maciej Wojtkowski, Chair of ICTER.

With STOC-T technology, a clinical research market for cutting-edge eye therapies, including gene therapies, could emerge. Furthermore, the STOC-T diagnostic equipment is compact and portable, making it suitable for any ophthalmology clinic once commercialized.

What the ICTER is?

The International Centre for Translational Eye Research (ICTER) is a research and development centre created to develop state-of-the-art technologies to support the diagnosis and treatment of eye diseases, facilitating the rapid implementation of new therapies. It is a subunit of the Institute of Physical Chemistry of the Polish Academy of Sciences in Warsaw, where five research groups work on the same topic from various perspectives, continually exchanging ideas and results to achieve a high level of synergy and interdisciplinary research.

ICTER’s overarching scientific objective is to thoroughly study the dynamics and plasticity of the human eye, leading to the development of new therapies and diagnostic tools. ICTER collaborates with some of the most prestigious ophthalmological institutions in Europe and North America, including the Institute of Ophthalmology at University College London and the Gavin Herbert Eye Institute at the University of California, Irvine. ICTER was founded by Prof. Dr. hab. Maciej Wojtkowski, a laureate of the International Research Agendas program conducted by the Foundation for Polish Science.

The Project International Centre for Translational Eye Research (MAB/2019/12) is carried out under the International Research Agendas programme by the Foundation for Polish Science, co-financed from the European Union’s European Regional Development Fund.

Press release: editor & journalist Marcin Powęska.

Scientific proofreading: Dr. Karol Karnowski.

Media Contact:
Dr. Anna Przybyło-Józefowicz
Tel: +48 694 605 398 / E-mail: aprzybylo-jozefowicz@ichf.edu.pl.


ICTER’s Overview Report 2019-2023

We are pleased to present the ICTER’s Overview Report for the years 2019-2023.

This report offers an insightful look into our organization:

  • Discover our dedicated team and their collaborative spirit.
  • Explore our unwavering mission to advance global eye health.
  • Learn about the funding that fuels our initiatives.
  • Gain insights into our impactful grant projects.
  • Trace our journey through a brief overview of our history.
  • Delve into our contributions to the field through publications.
  • Understand our communication and outreach strategies.
  • Explore our fruitful collaborations with industry.
  • Connect with our network and ecosystem.
  • Meet our diverse research groups and their focus areas.
  • Stay informed about our hosted events and notable visitors.
  • Join us in celebrating the recognition and awards received.

Discover the report and join us in our ongoing mission to make a positive impact on eye health globally.


ICTER: Brightening Up Life (video about the activity of the International Centre for Translational Eye Research)

Scientists from the International Centre for Translational Eye Research (ICTER) have undertaken the challenge of creating diagnostic technology that could prove to be fundamental for the understanding of eye diseases. Their solution will aid in the rapid diagnosis of conditions such as age-related macular degeneration (AMD), inherited blindness, diabetic retinopathy, or retinal vascular occlusion.

The team of scientists at ICTER introduced a new functional imaging method called flicker-based Optoretinography (ORG). With this technique, nanometer-long changes in the length of photoreceptors associated with the vision process are recorded. The baseline technology behind our ORG is Spatio-Temporal Optical Coherence Tomography (STOC-T). ORG will enable ophthalmologists to diagnose diseases much faster and more effectively than today. Most importantly, the examination involving the patient will take just one-hundredth of a second.


Film production: nFinity agency

Director: Radek Furmanek

Screenplay and title: Piotr Chaniecki, PhD MD

Animation: Ramona Visuals

Special guest appearance in the film: Prof. Olaf Strauss

Scientific coordination: Dr. Karol Karnowski

Optimization: Anna Salamończyk

Project coordination: Anna Przybyło-Józefowicz

Support: ICTER PR Team


Thank you to all ICTER employees for their commitment to the film production process.


ICTER – a research centre with a mission to save sight. Press conference on May 10, 2023

An interdisciplinary team of world-class scientists at the International Centre for Translational Eye Research (ICTER), operating at the Institute of Physical Chemistry of the Polish Academy of Sciences (IPC PAS) in Warsaw, is working on technologies that will revolutionize the diagnosis and treatment of the most challenging eye diseases. On May 10, 2023, journalists were able to learn about the centre’s achievements and talk with researchers. Ambassador of the United Kingdom of Great Britain and Northern Ireland to Poland Anna Clunes was the event’s guest of honor.

The International Centre for Translational Eye Research (ICTER) was established thanks to European funds from the Intelligent Development Program (POIR) awarded by the Foundation for Polish Science (FNP) under the International Research Agendas (MAB) program. The research carried out in MABs is interdisciplinary in nature and the results will enable the development of new technologies to serve society in the future.

– “ICTER is one of 14 International Research Agendas. It is the only such program in Poland, which allows the creation of new research units led by outstanding scientists” – explained FNP Vice President Dr. Tomasz Perkowski, adding: – “The aim of the International Research Agendas program is to strengthen the quality of science in Poland, develop international cooperation and attract talent, and support the creation of innovative, internationally competitive solutions in a given field.”

Dr. Tomasz Perkowski – Vice-President of the Foundation for Polish Science.

Researchers at the centre are working on breakthrough technologies for imaging eye processes and facilitating procedures to save or restore vision. Research is interdisciplinary in nature and involves areas such as biology, chemistry, physics and computer science. At ICTER, one-third of the scientific staff are foreigners. – “For centuries, treating blindness was considered a miracle. Now there are emerging opportunities to treat even people who have been blind since birth. This shows how far we can go in treating eye diseases” – said Prof. Maciej Wojtkowski, director of the ICTER – IPC PAS.

Some of the technologies developed at the ICTER are at the implementation stage. One of them is an innovative method that allows imaging of the retina using so-called fluorescence with two-photon excitation. It allows, on the smallest, chemical scale, to check whether the cells responsible for the vision process are working properly. Another method is optoretinography, which allows precise measurement of the response of photoreceptors present in the retina to light. Both techniques can be used to diagnose visual disorders, but they also make it possible to analyze whether implemented therapies are having the intended effect. In the case of optoretinography, the technique requires previously unimaginable precision – measuring devices must detect the elongation of light-sensitive eye cells by 1 nanometer, despite the movement of the entire organ.

Prof. Maciej Wojtkowski – Chair of ICTER.

ICTER collaborates with the world’s leading eye research institutes, including University College London – the centre’s strategic partner – as well as London’s Moorfields Eye Hospital and the University of California, Irvine. – “International scientific collaboration is key to advancing science and innovation, as well as to solving global health, climate or security challenges. Scientific cooperation across borders allows for the expansion of knowledge by additional elements, exchange of experience and competencies, access to research infrastructure and technology transfer” – said Anna Clunes, Ambassador of the United Kingdom of Great Britain and Northern Ireland to Poland, adding: – “The UK is an active partner of Poland in the field of scientific research. I am pleased that British centres and ICTER maintain close cooperation in research on the eye and its diseases. This is an important area for improving the quality of life for millions of people around the world. I hope that this cooperation will grow and benefit all countries.”

Anna Clunes, Ambassador of the United Kingdom of Great Britain and Northern Ireland to Poland and Prof. Maciej Wojtkowski.

The support of the Foundation for Polish Science in the implementation of the International Research Agendas program is not only an opportunity for the development of domestic science – in perspective, it means an increase in innovation in the Polish economy. Technologies being developed and tested in MABs today, in a few years’ time, may have a significant impact on various branches of our economy, and this will translate into concrete benefits for society. In the case of ICTER, the new devices will be used to test innovative therapies for, among others, patients with diabetic retinopathy, which is the first cause of vision loss in people of working age, or with age-related macular degeneration (AMD), the most common cause of vision loss in people over 50 in developed countries.

Director Kinga Słomińska, Foundation for Polish Science.


The Foundation for Polish Science has existed since 1991 and is an independent, self-funded, non-profit, non-governmental institution with a mission to support science. It is the largest non-budgetary source of science funding in Poland. FNP’s statutory goals include supporting outstanding scientists and research teams and working to transfer scientific achievements to economic practice. The Foundation pursues them by awarding individual prizes and scholarships for scientists, granting subsidies for the implementation of scientific achievements into economic practice, other forms of support for important undertakings serving science (such as: publishing programs, conferences). The Foundation is also committed to supporting international scientific cooperation and enhancing the scientific independence of the younger generation of scientists.


Pictures from the event: Nel Gwiazdowska

PR coverage of the media conference: Pełka and Partners agency


Press contact:

Dominika Wojtysiak-Łańska, Foundation for Polish Science: tel. 698 931 944, wojtysiak@fnp.org.pl

ICTER Communications and PR Division: Anna Przybyło-Józefowicz, aprzybylo-jozefowicz@ichf.edu.pl


Become a part of the CRATER Conference! September 7-8, 2023 in Warsaw

The Conference on Recent Advances in Translational Eye Research 2023 (CRATER 2023) is a platform for all researchers, investors, and entrepreneurs whose interests focus on the eye, to meet and discuss frontiers of the research, commercialization, and translation of the studies. The first edition of the CRATER, prepared by members of the ICTER community, will be held in Warsaw on 7-8 September 2023 in Copernicus Science Center.

The conference will provide space for discussion between specialists from different fields who are united in their pursuit to understand better the challenges of eye imaging, the process of vision, and formation of eye diseases. During this international and interdisciplinary event, participants will discuss frontiers of research on new methods and tools enabling diagnosis and treatment of eye diseases and also ideas on how to facilitate rapid implementation of new eye therapies.

The conference is chaired by Andrew Dick (Institute of Ophthalmology University College of London, UK), Krzysztof Palczewski (University of Irvine, USA) and Maciej Wojtkowski (International Centre for Translational Eye Research, Poland). Their work is supported by the International Scientific Committee comprising luminaries of the eye-related research community: Pablo Artal, Chris Dainty, Francesca Fanelli, Arie Gruzman, Alison Hardcastle, Karl-Wilhelm Koch, Serge Picaud and Olaf Strauss.

Detailed information on the conference’s, including a list of invited speakers, is available on the conference webpage – crater.icter.pl.

Registration for the Conference on Recent Advances in Translational Eye Research 2023 which is organised by ICTER is already open, with early registration fee available until 30 June 2023. You can contribute to the program and present your research results – the call for abstracts is open until 13 May 2023 (extended deadline).


Interview with Anna M. Ambroziak, MD, Scientific Director of the Ophthalmology Center Świat Oka in Warsaw

Dr. Anna Ambroziak is an ophthalmologist specializing in eye diseases with 27 years of professional experience and an Assistant professor at the Faculty of Physics, University of Warsaw. Dr. Ambroziak is a member of the Polish Society of Ophthalmology (PTO) and the Society of Polish Ophthalmic Surgeons (SCOP). Dr. Ambroziak is also the Polish representative in the European Contact Society of Ophthalmologists (ECLSO), lecturer at the European Studies in Ophthalmic Optics and Optometry, and editor of the position paper of the Polish Expert Group of the Academy of Ocular Surfaces.

Dr. Ambroziak has more than 200 publications to her credit. She promotes the idea of interdisciplinary cooperation. She adheres to the philosophy of a holistic approach to the patient. Under her leadership, the Ophthalmic World Eye Center in Warsaw (Centrum Okulistyczne Świat Oka) has won the Health Ambassador Award for its expertise, experience and improvement in patients’ quality of life.

Based on the clinical studies conducted by Dr. Ambroziak, a therapeutic lens made of lotrafilcon A was registered by the US FDA. She is the winner of the ECLSO “Kersley Lecture” grand prize and the Medical University of Warsaw Scientific Award.

Dr. Anna M. Ambroziak

We present an interview with Dr. Anna Maria Ambroziak conducted by the Physical Optics and Biophotonics group at ICTER.

In recent years, the development of cooperation between ophthalmology and optometry in Poland has been noted. ICTER brings together specialists from the fields of optics, optometry, engineering, physics, biochemistry, mathematics to create specific tools and solutions that can translate into improved patient care. How do you think the collaboration of those involved in vision science has been changing in Poland over the past decades?

So, to begin with, a little bit of my personal memories, which will shed some light on the history of optometry in Poland. That is, a few words about how Optometry became the foundation of Ophthalmology in the country on the Vistula River.

In ’98, as a member of the Board of Directors of the Contact Lens Section of the Polish Ophthalmological Society, I organize a meeting, and a few months later a contactology symposium. That’s a little over a year after the first year of optometry postgraduates graduate from the K. Marcinkowski Medical University. The following years saw more conferences. Among the guests invited to the symposium were world-renowned optometrists, contactology experts – including Brian Holden, Lyndon Jones, Philip Morgan, Keith Edwards, Dwight Akerman, Brian Tompkins, Eric Papas and myself – a young ophthalmologist ready to change the world. Since the beginning of my career, I have been involved in the education and development of optometrists. I have been working at the University of Warsaw since 2011, for more than 10 years served as deputy editor-in-chief of the medical journal Contactology and Ophthalmic Optics. I took an active part in such events as the introduction of the world’s first silicone hydrogel lens to the Polish market. My love for contactology exploded suddenly and turned into a mature, fulfilling relationship. Scientific research on the effects of prolonged contact lens wear on the ocular surface became the subject of my doctoral dissertation defended with distinction at WUM. On the basis of clinical studies conducted by me, a therapeutic lens made of lotrafilcon A was registered by the US FDA.  To paraphrase a classic, it was worth looking at such a map of the world which includes utopia. For me, there was no dilemma, problem or division. The more I know, the more questions I ask and the more joyfully I share knowledge. In this natural environment of broadly understood vision care, we should work together to best serve each other and our patients. There is no room for divisions here, we are one compatible, integral creation and naturally work together.  For a wise scientist, the other person is an opportunity for development and cooperation, and if also for competition – it is only for the positive and constructive one. Years of work and creation of this ideal world have allowed us to raise new generations of specialists, these new generations work with each other and learn from each other. The Ophthalmic Center Świat Oka is a scientific and research & science clinic with modern training facilities, where optometry and medical students learn and work under the supervision of specialists, where clinical trials of drugs and technologies are carried out, and papers and publications are produced, including many on rules of procedure and ophthalmic-optometric cooperation. I strongly recommend this model. There is much work ahead of us, but let’s remember that changing the world should always start with ourselves. I have been supporting the development of Optometry in Poland since the beginning, working as an assistant professor at the Faculty of Physics at the University of Warsaw. In the academic environment of Warsaw, I was the first ophthalmologist to start teaching new generations of optometrists – teaching the younger generations at a proper level should be the primary goal for eye care specialists. I execute the plan according to which the Ophthalmologist and the Certified Optometrist work together on one level. This cooperation is not possible without the presence of scientists from the fields of optics, physics or mathematics, biology and chemistry. Education and Science is the future not only for this country, but for the whole world.

What are the most troublesome diagnostic limitations and needs of a modern ophthalmology center? If you could “conjure up” the equipment of your dreams, what would it diagnose (or what other function would it perform) and how?

Our tears are a vast, still tentatively explored, wealth of knowledge about our organisms enabling us the insight into more than just our genomics, and this is one of the directions I dream of.

Our brains are the realm where perception happens and where reality is created, and we can extend it using artificial intelligence; this is another important signpost for female and male wizard scientists.

The power of now shows, at the same time, a great need to monitor the progression and development of myopia. We know more and more about the effectiveness of the available solutions and are oriented towards polytherapies. We know more and more about new optical designs for eyeglasses and contact lenses, and about the long-standing results of meta-analyses of the use and clinical evaluation of these products. We are definitely vocal about the need to measure the axial length of the eyeball, the need to monitor and treat pre-myopia, and the impact of the pupil width on monitoring the development and progression of myopia. The power of now is also the power of creation, so we keep track of what science brings to practice. For example: Transplantation of embryonic human stem cells into the retinal pigment epithelium (RPE) is happening before our eyes – now in the cases of age-related macular degeneration, but soon in myopic maculopathy. The M1 molecule promotes the regeneration of retinal ganglion cell axons which means the potential to restore the activity of target neurons and thus restore visual function in cases of both maculopathy and neuropathy.

Do you think the demand for devices and techniques for visual system diagnostics will grow in the near future? Why?

The eyesight is the most important sense, but it is subject to a series of involutionary processes and the influence of exo- and endogenous factors. The increase in life expectancy has made the estimation numbers in epidemiology unequivocally indicate the imminent scale of the challenge. Returning to the example of myopia, we know that soon half of the world’s general population will be myopic and thus the number of myopia-related complications will increase, including the most serious and severe myopia-related maculopathy, which does not exclude the coincidence of age-related changes. Prevention based on modern, reproducible, minimally invasive and highly specific diagnostics is the basis of ophthalmology. In addition to the pandemic of myopia, often the same patients due to being overweight and obese add to a growing group of patients burdened with diabetes. In this group, the rise of maculopathy is also a critical challenge.

Online doctor consultations are already exploiting algorithm and data analyses today. Diagnostic tests and therapeutic regimens are becoming more precise, new previously unknown solutions and materials are being used. Technologies using virtual reality are already the foundation of our practice in vision therapy.

Artificial intelligence in the daily work of an eye care specialist involves much more than just monitoring fundus changes or the screening programs we are already familiar with nowadays and that are particularly advanced in the prevention of diabetic changes. The pandemic has brought us new challenges, new goals and new experiences.

Dr. Anna M. Ambroziak with a patient.

Are there eye diseases whose pathogenesis we have yet to understand?  Do they occur frequently – affect many people?

As I mentioned, the time of SARS-COV-2 is an acceleration of the development of the implementation of technological innovation and artificial intelligence in medicine. For us, this time is also the intersection of the myopia pandemic, diabetic eye syndrome and digital visual fatigue, with numerous challenges ahead.

The foundation of Science and Humanity is to develop and provide open-ended answers.

The pathogenesis of most ophthalmic conditions is based on genetic and environmental risk factors yet a shift in the importance of genotype versus phenotypic expression under the influence of external and internal causes of an individual definitely took place.

If we use the example of intelligence, as my “genetic masters” Prof. Ewa Bartnik and Prof. Wojciech Dragan say, when we analyze the entire population (from a newborn to the oldest person) the level of heritability of intelligence is 50%, and differences in the influence of genes on intelligence depend on the activity of the environment.

Genetic variances and environmental variances are constantly modifying our pathogenetic cocktails. If we analyze the non-modifiable and modifiable substrates, the last decades and years, in addition to the positive aspects such as extending our lifespan , and remember that age is the primary risk factor for diseases of all kinds, risk factors such as climate change, environmental pollution, changing educational and working conditions, food modifications, widespread consumption of excess calories, especially in the form of highly processed, sweetened products are now critical health challenges,  also for the organ of  the visual system.

Psychology and especially psychosomatics are also of increasing importance.

Visual perception is another area being explored and tamed.

In a world of artificial intelligence, we still lack an integral view, and currently, all technologies absolutely require reason and humility, and human knowledge. Soon, refractive lens and corneal surgery will move toward modifying the cornea and implanting specific lenses that will adapt their optical properties to our visual requirements, varying lighting, different contrast and dynamic visual work distances. We are very privileged that such a huge technological leap has taken place before our eyes. Education, thanks to new tools and especially the use of the metaverse world, will also be decidedly friendlier.

We have shifted the boundaries of senior age and the age of 40-65 is called maturity and we increasingly speak of old age only after the age of 80.

We mature, develop, age, we are subject to involutionary changes and multiple factors from the day we are born and even throughout our fetal life. This applies to all structures of the eye, but especially significantly to the retina and lens, which processes known as presbyopia are associated with. Keep in mind that it is not a disease, but many conditions can accelerate and intensify this process.

The lens of the human eye is an intraocular structure whose main tasks are active participation in accommodation, refracting light and maintaining clarity. A normal lens, outside of fetal life, is devoid of blood vessels and nerves and is completely transparent. The lens of the eye is a unique structure, and its growth is caused by the addition of new cells inside the surrounding capsule. The new fibers become thickened and fuse with those previously formed. Older cells are not discarded or removed, but placed in its center. This is necessary to maintain the metabolic viability of the outer cortex (and thus the entire organ) and to produce the refractive properties necessary to focus images on the retina and reduce spherical aberration. With age, however, this brings undesirable consequences, including the development and progression of presbyopia.

Presbyopia is not a refractive defect, it is a peculiar indisposition of near vision manifested >40 years of age resulting from widespread involutionary processes. It is caused by physiological anatomical and functional changes occurring in the intraocular lens, especially its capsule, and functional changes in the ligamentous apparatus, resulting in decreasing amplitude of accommodation, i.e. reduced/insufficient ability to sharpen the image of close objects. Interestingly, the strength and work of the ciliary muscle is not affected, thus the full contraction and diastole of this muscle induces adequate changes in the tension of the ligamentous system, and only these forces are met with an altered susceptibility of the lens capsule and the lens itself to respond to a given accommodative stimulus. Such a condition calls for support, i.e. optical correction for nearsightedness. Its recommendation should not be delayed, as procrastination may result in causing symptoms of asthenopia and impaired nearsightedness in the future.

Let’s give our organ of the visual system the best possible correction, let’s use all possible solutions. Our brains like to be given tasks, they like to learn, and if we feed them properly, they will help us use more and more precise, higher resolution correction methods for years to come, as long as we make sure that the plasticity of our brain is preserved.

Dr. Anna M. Ambroziak talks with an invited expert during an interview series entitled “Let’s talk about sight” (#PorozmawiajmyoWzroku) at the Ophthalmology Center Świat Oka in Warsaw.

Can we guard against age-related retinal degeneration? What can we do in this area and, in your opinion, is such knowledge generally available?

The basis of ophthalmology is prevention and age-related maculopathy is a classic example of this. If we have a positive family history and other risk factors besides age, such as nicotinism, atherosclerosis, carbohydrate-lipid disorders, among others, then we should not delay screening and perform it systematically. Age-related macular degeneration (AMD) is the most common cause of so-called “practical blindness” in developed countries, occurring most often in people over 50. It is believed that the incidence of AMD will increase as a result of global population aging. AMD is a degenerative disease that destroys the retina in the place that is the most critical to the vision process – the macula, most often through atrophy of the pigment epithelium, choriocapillaries and photoreceptors and the development of pathological neovascularization. The pathogenetic mechanisms of the disease, described in detail, are indirectly responsible for its early and correct diagnosis. Knowledge of the processes that occur in aging tissues, as well as complex processes caused by external factors and genetic conditions, allow specialists to differentiate the degenerative changes that arise and classify them into different stages of disease development. A number of risk factors, which are divided into modifiable and non-modifiable ones, are subject to analysis both to assess the risk of the onset of the condition and its subsequent progression. Ongoing research on these factors is focusing the attention of specialists on their potential use in prevention and therapy. An interview based on these risk factors provides important information about the patient’s overall health and predisposition to develop maculopathy. In the diagnosis of AMD, there is no single rigid regimen of management, since the disease is not homogeneous and is characterized by a very wide spectrum of symptoms. Among the diagnostic methods described, imaging studies predominate, which can be divided into invasive studies – advanced vascular studies performed by ophthalmologists, and non-invasive studies – imaging degenerative changes, performed by both teams of specialists. Early diagnosis of age-related macular degeneration offers the possibility of preserving the patient’s normal visual function. The progression of untreated disease promotes the development of symptoms whose effects are irreversible.

AMD is an example of a disease in which a holistic view of the entire body is critical. The patient should therefore take full responsibility for his or her health and ensure proper diet and physical activity and not delay a visit to a specialist. Education level is insufficient in every dimension of our physical, mental and social well-being.

One of the world’s most popular imaging diagnostic techniques is optical tomography OCT. Recent research conducted at the International Centre for Translational Eye Research (ICTER) under the supervision of Professor Maciej Wojtkowski have allowed the development of an improved method called Spatio-Temporal Optical Coherence Tomography (STOC-T) that enables imaging of the retina with preserved high-resolution at any depth in the frontal section. The use of STOC-T for retinal imaging makes it possible to reconstruct the morphology of the cones in the human eye. From your point of view, why is retinal imaging important? Which diseases would imaging of the morphology of the cones be crucial for?

OCT is a widely used technology in ophthalmology and allows imaging of all structures of the eyeball, both anterior and posterior, but the greatest research and scientific achievement is in imaging the retina in the central, or macular, area.

Imaging of the morphology of the cones opens a kind of gateway to eternity by enabling anatomical and functional monitoring of photoreceptors that receive visual stimuli and thus informs the first changes leading to, and long before, the onset of maculopathy. It thus provides us with a range of variables for monitoring and modifying perceptual processes, including particularly promising prospects for detecting dementia-like changes and thus accurately assessing cognitive and executive functions.

The key to the future is to capture the state in which the physiological changes that occur in the aging process of eye tissues transform into pathologies.

Dr. Anna M. Ambroziak

For the diagnosis of retinal diseases, not only structural, but also functional changes are important. The group of functional methods includes a precise variant of visual field testing – microperimetry. A novel method is being developed at ICTER: two-photon microperimetry, which takes advantage of the two-photon vision effect occurring when the retina is illuminated by a femtosecond infrared laser pulse. Physics shows that the longer the wavelength of light, the weaker it scatters in the medium. Therefore, in your opinion, can the use of infrared for functional vision testing expand the applicability of microperimetry?

Absolutely yes.

Both in terms of screening in at-risk groups and the broad prevention of macular disease, as well as the standards of management of myopia and glycemic/diabetic disorders.

Comprehensive diagnostic measures performed by ophthalmologists and optometrists are the cornerstone of their daily practice. Complementary examinations performed by both teams are the basis for proper and early diagnosis of many diseases of the visual system and implementation of effective treatment. In the diagnosis of retinal diseases, the range of examinations is very wide and includes both invasive methods and increasingly popular non-invasive examinations, which are expanding the standards of ophthalmic-optometric examinations.

Our research shows that two-photon microperimetry has better repeatability than traditional microperimetry. In your opinion, could this be important for diagnosing eye diseases or tracking their progress?  If so, for which diseases in particular?

Absolutely yes.

Precise assessment of the progression of changes over time and high sensitivity and specificity of central perimetry parameters are the greatest challenges of current diagnostics.

Each of the broad spectrum of entities in the maculopathy family requires reproducible data, but myopic maculopathy should definitely be highlighted in this group.

Let’s return to imaging methods by staying with two-photon effects: we are also developing a two-photon variant of fluorescence scanning laser ophthalmoscopy. A standard fluorescence scanning ophthalmoscope (SLO) uses a beam from the visible range, with a wavelength of typically around 480 nm (blue). This wavelength allows to excite the fluorescence of lipofuscin deposits in the pigment epithelium, but not of pigments involved in visual cycle transformations, such as retinyl esters. They are excited with shorter wavelengths, absorbed in the cornea, so it is impossible to detect them with such a standard SLO. The two-photon variant of this device that we are developing at ICTER circumvents this limitation. Do you think this could be an interesting tool for ophthalmologists?

Absolutely yes for the third time. The two-photon effect, as in perimetry, totally changes the perspective and raises the level of reliability of the examinations carried out, which is particularly justified in combination with SLO technology, since it makes it possible to detect changes at the cellular level in the period before the formation of functional changes, such as perimetric changes.

What are the available methods of keratoconus examination? What are their limitations?

First: genetics has entered diagnostics.

Second: imaging is giving us a new generation of tools with increasingly higher resolution and precision.

Corneal cone (Keratoconus, KC) is a bilateral, albeit asymmetric, condition that involves progressive thinning and convexity of the cornea, leading to irregular astigmatism. Keratoconus usually develops in the second or third decade of life. The condition affects all ethnic groups and both sexes. The prevalence and incidence rates of keratoconus can vary by geographic location and age of onset.

Approximately 73% (16 of 22) of human autosomal chromosomes are associated with KC , and 59% of these can be considered to show statistically significant associations (8 of 63). Studies suggest that it may be a polygenic disease, meaning that two or more affected genes are required for the development of keratoconus.

Keratoconus is a multifactorial disease and many genetic factors, along with various external factors, influence phenotypic expression and its development.

And what do we know from the Polish research I have been doing for many years?  That is, what do we know about the KC-related protein?

The ALDH3A1 protein is important in maintaining corneal physiology and protecting the eye from UV damage. However, no genome-wide association study has shown that the ALDH3A1 locus is associated with keratoconus. In this study, we investigated the potential role of ALDH3A1 variants as risk factors for the onset and severity of KC in a large group of Polish patients with keratoconus. In the first step, we analyzed the sequence of the coding region of ALDH3A1 in the KC subgroup. We then genotyped three selected ALDH3A1 variants in a larger group of KC patients (n=261) and healthy controls (n=317). We found that the minor A allele of rs1042183 is a risk factor for keratoconus in the dominant model. Genotypes of the rs2228100 variant appear to be associated with an earlier age of KC diagnosis in the Polish population (p=0.055 for the comparison of the three genotypes and p=0.022 for the dominant inheritance model). We showed that the rs1042183 variant in the ALDH3A1 gene is associated with predisposition to keratoconus in the Polish population. The allele frequency of ALDH3A1 variants associated with KC varies in different populations, which may be partly responsible for the difference in KC prevalence worldwide.

Early studies that diagnosed keratoconus were based mainly on symptoms seen on retinoscopy, non-standardized keratometry measurements and subjective assessment of clinical symptoms. Another diagnostic parameter is pachymetry, or corneal thickness assessment. We use different technologies and base the measurements on specific maps.

Until the development of technology and the advent of the ability to diagnose keratoconus with topography and high-resolution optical coherence tomography, information about corneal curvature was provided by keratometry.

Both pachymetry and keratometry are an essential part of the examination performed by an ophthalmologist or optometrist. The measurements obtained during the examination with an autorefractometer, should be the starting point of a comprehensive diagnosis.

Optical coherence tomography is a non-contact and non-invasive method of receiving and then processing an optical signal. It uses superluminescent diodes, which are a source of low-energy infrared light, to image high-resolution structures of the anterior segment of the eye. It is a Swept Source (SS-OCT) device that uses a long-wavelength light source with a central wavelength of 1310 nm and has a speed of 30,000 axial scans per second. The use of long-wavelength light, reduces unwanted scatter, and this results in a greater ability of the light to penetrate opaque structures, i.e. through the sclera or opaque cornea.

The device, performing qualitative analysis of the collected data, forms various types of tomographic and topographic maps of the anterior surface of the eye, the device generates a report respecting the percentage of similarity of the examined patient’s cornea to a typical cone eye model (ESI – Ectasia Screening Interpreted). Anterior corneal curvature and anterior and posterior astigmatism are significantly elevated in a person diagnosed with keratoconus; these parameters are not particularly useful in differentiating subclinical keratoconus from healthy eyes.

Epithelial criteria are the current diagnostic trend.

In daily practice, the usefulness of posterior corneal measurements continues to be emphasized, as changes in the posterior surface of the cornea can be one of the first clinically detectable signs of keratoconus. These measurements could not previously be obtained from traditional reflection-based topographers; they are measured using Scheimpflug imaging and anterior segment optical coherence tomography (AS OCT). By comparing topography maps taken over months and years, a trend curve of the condition is generated, e.g., the Cone Trend Analysis report, which is a key element in assessing the progression of keratoconus repression. A limitation, and thus a diagnostic challenge, is the detection of preclinical cases (pre-KC).

Dr. Anna M. Ambroziak and the Świat Oka Center in Warsaw.

What fields will develop in the next 10 years? What are the biggest challenges for scientists in the field of optics, optometry, ophthalmology and for medical staff specializing in the diagnosis and treatment of eye disorders?

New optics and the use of artificial and augmented intelligence are among the trends, simultaneously, we know more and more about our brain and are pushing the limits of neuroregenerative abilities. Still, the most common cause of decreased visual acuity is uncorrected inaccuracy. The visual organ allows us to perceive stimuli from the surrounding world. Visual sensory fibers have the largest brain representation among our senses, the information transmitted through them, however, requires a very precise receptor. More than half of European adults are diagnosed with refractive errors (myopia≤-0.50, hyperopia ≥+0.75, astigmatism ≥0.75). Everyone over the age of 40, regardless of the type and level of non-massive refraction, needs nearsightedness-support, i.e. correction of presbyopia. Still, despite such modern tools, very often the visual defect is not corrected or is only partially corrected. According to estimates, at least one in two adults should use glasses or contact lenses or another form of correction, but this is not the case. This fact has strong economic implications, both individually and socially, and is a potential cause of decreased productivity and quality of life. I am pointing to significant differences in the assessment of most functions, from overall quality of vision to mental health.

Most of us believe that the primary symptom of an uncorrected vision defect is blurred vision. We see with our brains. The brain selects sharp images, and the eye, thanks to its ability to accommodate, can sharpen the image provided by the impulse. This explains in some cases the ability to read despite the lack of proper correction.

A patient with an uncorrected visual impairment subconsciously seizes the opportunity to minimize the discomfort of a blurry retinal image and squints. Narrowing the eyelid crevice restricts the access of rays that run off-axis through the optical system of the eye. Light rays that enter the receptors in the retina when the eyelids are closed run axially and have a much smaller effect on blurring the image than off-axis rays. By squinting, a person with a refractive defect makes the image they see clearer, but is still subject to the typical symptoms of asthenopia, which is a reaction of the visual system to increased visual effort caused by an uncorrected refractive defect, most often hyperopia and astigmatism. Other causes of asthenopia can be phoria, which is a misalignment disorder of binocular vision, convergence or accommodative disorders.

There are a number of mechanisms in the human visual system that offset the discomfort caused by visual defects or disorders of the visual system, including fusiform vergence or accommodations. These mechanisms can become impaired during illness, under stress or as a result of intensive visual work at close distances.

The discomforts associated with uncorrected or undercorrected visual impairment are usually not sudden in nature and do not cause ocular signs for a long time. Their occurrence is often read in terms of somatic disorders manifested, for example, by general fatigue, irritability, dizziness or headaches. We should discuss this with our patients. Adequate optimization of retinal and cerebral images expands the doors of perception and thus future possibilities for intraocular correction and neuroadaptation to modern optics.

Let us take care of the psyche and help the brain refine the senses.

My dream is education, education addressed to us – specialists, education of our patients, education of their families, education of officials and decision-makers. My dream is for patients to benefit and be aware of the need for prevention. I know this sounds like utopia to realists, but this is my reality, and I want to share it. We are the ones who create reality! If only we start with small steps, with small things, with examples, with ourselves and our own backyard and realize this ideal world. Just as in Świat Oka we showed the space for eye care professionals to work together. This is the only way we can change our reality. First of all, the environment! Our polluted world is the starting point for autoimmune diseases, and diseases on the spectrum are not only ophthalmic and ocular surface. Our contaminated air, water and soil and the lack of natural light for our young people, our children and teenagers means obesity and being overweight, it means myopia. These diseases already affect half the population of young people and their numbers are increasing dramatically. Psychosomatic diseases constitute now about 70-80% of diseases, autoimmune diseases similarly. The number of people requiring vision correction and vision therapy is similar and so few, far less than half, benefit from it. The majority of parents (more than 80%) believe, and this is us who is responsible for this educational error, that children only require vision control when they start going to school. Many still do not understand that a full Optometric and Ophthalmic examination is the basis, and we are not talking about any exceptionally high standards. At least two hours in natural light and dietary changes are the basis for holistic management of our patients of all ages. Digital eye fatigue along with disorders of the ocular surface, disorders of convergence, accommodation, with visual defects. including pseudo-short-sightedness simply require attentiveness, awareness of here and now, and willingness. No exceptional solutions or finances are needed there. Our dream for the present is for us to get examined and undergo corrections when needed. We will then be able to let our tired and irritated minds rest. The next step is modern diagnosis and treatment of ophthalmic conditions.

Eye screening programs are still needed both in developing countries and here in the center of Europe, where preventive care in ophthalmology still does not happen realistically.


Interview questions prepared by: Marta Mikuła-Zdańkowska, PhD and Oliwia Kaczkoś, MSc.

Expert supervision: senior researcher Katarzyna Komar, PhD.

Additional contribution: Anna Salamończyk.



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