In 2008, Cynthia Toth, MD, was an accomplished ophthalmologist, retinal surgeon, and clinician-scientist. She had been involved since the 1990s in the early development of optical coherence tomography (OCT), a technology that bounces light waves off different parts of the eye, providing a finely detailed look inside the eye’s tissues. In fact, at the time, OCT research from Toth and others had already changed how sight-robbing macular degeneration in older adults was diagnosed and treated, by revealing retinal tissue that could be measured in images and used to guide treatment and predict the course of the disease.
By contrast, in the nursery, Toth saw her colleagues looking at babies with “ancient technology” developed in the 1850’s and refined in the 1940s (the indirect ophthalmoscope, worn on the ophthalmologist’s head). “In pediatric work, we had nothing like we had for adults,” Toth said.
Children under five didn’t benefit from OCT because they were unable to cooperate and sit still for imaging with the slow-moving device.
Toth set out to change that. She aimed to adapt OCT into a handheld device that could be used to better diagnose and treat retinal diseases in children, especially retinopathy of prematurity, the most common cause of blindness in young children.
But all of her experience was in adults. “Shifting to pediatrics was risky, because I didn’t have assured funding,” Toth said.
The Hartwell Foundation took a chance on her ideas, she said. She received a Hartwell Individual Biomedical Research Award in 2008 to develop a faster and more effective technology, called spectral domain OCT, to get OCT images from children’s eyes without using sedation. “Hartwell’s support really gave me the confidence to move forward with this, and their structure helped me focus on concrete goals that were worth publishing and that convinced others,” Toth said.
The annual meetings of Hartwell investigators were also key. “Hartwell really helped me learn and grow as a scientist,” Toth said. “It was invaluable to get to meet with peers doing the same type of work and learn how they solved problems. Fred Dombrose is part of the heart and soul of the scientific leadership of the foundation, and he was very much a career mentor for me.”
Toth, Joseph A.C. Wadsworth Distinguished Professor of Ophthalmology at Duke, is now recognized as the founder of pediatric OCT. For infants and children, her multidisciplinary team has published dozens of papers demonstrating novel eye findings that are visible only with OCT imaging and that are often associated with brain disease or challenges of brain development. “The retina is a window to the brain,” Toth said. “When you’re looking at or working on the retina, you’re interacting with tissue that does the work of changing light signals into signals that communicate with the brain.” OCT plays a vital role in pediatric retina diagnosis, often revealing unrecognized retinal disorders and connections to brain injury, disease, and delayed neurodevelopment. For example, for the first time, infant OCT has been included in the latest update of the international classification of retinopathy of prematurity (called ICROP3).
“It was The Hartwell Foundation that really helped me to take my first steps to change eye care for kids,” Toth said. “The Hartwell Foundation changed my life. Their support and early encouragement allowed me to find the joy in this pediatric work. It is amazing to see that Mr. Smead chose such a useful and focused application of his foundation to make a difference.”
“It was The Hartwell Foundation that really helped me to take my first steps to change eye care for kids,” Toth said. “The Hartwell Foundation changed my life. Their support and early encouragement allowed me to find the joy in this pediatric work. It is amazing to see that Mr. Smead chose such a useful and focused application of his foundation to make a difference.”
Toth is eager to point out, “You know, the first and only handheld OCT system to be FDA-cleared for preterm infant and neonate use (in 2012), was the one used in my first Hartwell Foundation grant.” To provide imagers and doctors with a practical guide, Toth wrote the “Handbook of Pediatric Retinal OCT and the Eye-Brain Connection,” published by Elsevier in 2019. In 2018, Duke Eye Center opened an imaging center designed for pediatric patients and their families.
While the original handheld OCT device is used in pediatric care worldwide, now, 10 years later, Toth and colleagues see its limitations. Toth’s research group continues to partner with Duke biomedical engineers to make their handheld OCT system lighter, better, and faster for use in NIH studies and other research studies of infant eyes. Toth and two engineering colleagues have also created a company, Theia Imaging, to further develop a streamlined commercial system and seek FDA approval for clinical use.
“All of this work follows on the path of what Hartwell started,” Toth said. “The kids need the help so much. Hartwell support put me on a path that is making a huge difference.”
September 2022