The concept of using echoes of light to see inside biological tissue was proposed more than 40 years ago by Michel Duguay at AT&T Bell Laboratories. In fact, OCT had its origins in femtosecond optics. Optical coherence tomography is often described as the optical analog of ultrasound, generating images using the time delay and magnitude of light echoes. Finally, we summarize the impact of OCT in healthcare, economics, and job creation, commenting on the return on investment. The vision of entrepreneurs and business leaders accelerated the introduction of OCT by as much as a decade, preventing vision loss for millions of patients as well as advancing understanding of pathogenesis and facilitating development of new therapies. The road to clinical acceptance is long and especially difficult for companies that are pioneers because they must develop and fund both technology and market development, while navigating the regulatory process. Fundamental researchers, clinician scientists, engineering experts, and business leaders all played critical roles the development of OCT. We describe key contributions from trainees, demonstrating that it is possible to make powerful advances at an early career stage. We also highlight the importance of multidisciplinary collaboration, with the critical role of clinician scientists as well as advanced engineering to bridge the gap between academic research and clinical feasibility studies. Optical coherence tomography was also fortunate to benefit from advances in fiber optical communications, which created technologies and ideas that were translated to biomedical optics. We describe how pure science (femtosecond optics) contributed to the origin of OCT and the complex path of research, where multiple evolutionary advances can become revolutionary. The process that we recount is long and challenging, but it is our hope that it might inspire early career professionals in science, engineering, and medicine, and that the clinical and research community will find this review of interest. We introduce the concept of an “ecosystem” consisting of research, government funding, collaboration and competition, clinical studies, innovation, entrepreneurship and industry, and impact – all of which must work synergistically. Critical advances were made by early career researchers, clinician scientists, engineering experts, and business leaders, which enabled OCT to have a worldwide impact on health care. Optical coherence tomography had its origin in femtosecond optics, but used optical communications technologies and required advanced engineering for early OCT prototypes, clinical feasibility studies, entrepreneurship, and corporate development in order to achieve clinical acceptance and clinical impact. We review the early history of OCT describing how research and development evolves and the important role of multidisciplinary collaboration and expertise. Optical coherence tomography also has applications in multiple clinical specialties, fundamental research, and manufacturing. Optical coherence tomography has become a standard of care in ophthalmology, providing real-time information on structure and function – diagnosing disease, evaluating progression, and assessing response to therapy, as well as helping to understand disease pathogenesis and create new therapies. This review was written for the special issue of IOVS to describe the history of optical coherence tomography (OCT) and its evolution from a nonscientific, historic perspective.
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