Michael Patella, OD, FAAO, is VP, Professional Affairs, Carl Zeiss Meditec, Inc., and a senior member of Zeiss Meditec Ophthalmology Innovation Team. He received BS degrees in Physiological Optics, Meteorology and Physics before earning his OD degree from UC Berkeley. In addition to private clinical practice, Patella was a systems engineer for the NASA Skylab project and a U.S. Air Force meteorology officer. He has also published numerous scientific articles and co-authored books advancing the science of glaucoma diagnosis and management.
Richard Clompus: Dr. Patella, you’ve had significant impact on the development of computerized diagnostic instruments that stretches back to the original Humphrey Visual Field Analyzer (HFA). This instrument made it possible for clinicians to obtain standardized field tests with powerful algorithms to better manage their patients. Can you share your role in the development of the HFA?
Michael Patella: My role might be characterized as one of leading the integration of clinical, scientific and engineering ideas into a practical and reliable automated perimeter that came to be known as the HFA. I have been able to assume this role because I came to optometry from the world of aerospace engineering. Simply put, few people are presented with the opportunity to understand clinical, scientific and engineering issues well enough to put it all together. I was just lucky to be in the right place at the right time.
A host of people contributed””and continue to contribute””to the development of the HFA, including engineers, clinicians and scientists at Carl Zeiss Meditec, as well as optometrists, ophthalmologists and academics from all over the world. The path forward seldom was obvious. For instance, we had to invent new statistical methods that were not yet in textbooks in order to detect perimetric progression events. We also had to learn how to run international multi-center clinical trials in the days when such efforts were not yet being widely attempted.
RC: ZEISS recently introduced the HFA3. What new technologies were implemented in this instrument?
MP: In my view, the primary goals for HFA3 were to provide improved clinical workflow while exactly preserving the standardized Humphrey tests that doctors have come to depend upon, all in a 21st century platform suitable for ongoing development of improved testing methods. One example of a workflow improvement is HFA3’s electronically adjustable liquid trial lens that for most patients eliminates the need for conventional trial lenses. I am presently involved in three projects which seek to develop faster, more reproducible and more clinically effective visual field tests. These new methods will require a modern platform for clinical deployment, and HFA3 was designed to be that platform.
RC: In a short period of time, optical coherence tomography (OCT) has become a critical diagnostic instrument in primary care optometry. The CIRRUS HD-OCT provides multiple ways to visualize pathology. What are the latest developments in OCT from ZEISS?
MP: CIRRUS OCT development continues on multiple fronts and in the context of two wonderful facts: a) Fourier Domain OCT has now reached critical mass in optometry and ophthalmology clinics worldwide, and b) CIRRUS is the world’s most commonly used OCT. Our goal is to provide improved clinical performance that cost-effectively adds value to patient care. For example, we may be on the brink of expanding the availability of ophthalmic angiography into primary eyecare, especially in the management of diabetes but maybe also in addressing age-related macular degeneration and glaucoma. This expansion will be fueled by the rapid deployment of injectionless OCT Angiography, for which ZEISS recently became the first company to receive FDA clearance. We also are learning how to use already-existing OCT progression event analyses as part of an early glaucoma detection strategy. This approach has the potential of changing how glaucoma suspects are managed, allowing us to better and more effectively triage patients and to diagnose disease earlier.