RV Paul Chan, MD, MSc, MBA, FACS (00:16):
Hi, I'm Paul Chan, co-director of the Aspen Retinal Detachment Society meeting here live in Snowmass Village. I'm here speaking today with Dr. Lucia Sobrin, who is very dear to my heart because she was a year above me in fellowship. She gave a great talk today on advancing diagnostics on ocular fluids for uveitis and ophthalmitis. Dr. Sobrin is a professor of ophthalmology at Harvard Medical School, Mass Eye and Ear. Dr. Sobrin, great talk. Thank you. And if you can just give us an overview around NextGen sequencing and the work that you're doing.

Lucia Sobrin, MD, MPH (00:52):
Sure. So what we're doing is really because as we know for our patients today, the two things we have to diagnose infections are culture and PCR and they are not perfect. They take a long time. They don't always give us the answer we need. And we have the ability to make patient care better by using technologies that are now available to us. So I talked about two technologies. One is next generation sequencing, which you mentioned, which is when we take the patient sample and we just sequence everything in it, take out all the human and see what we find. And that is really exciting because it can teach us things that we're not even thinking about. We're not telling the test what to look for. The test tells us what it finds. The downside of that is that we're going to find some stuff that really doesn't make sense and probably is a lot of noise.

(01:36):
And then the other panel that we talked about is creating a panel where in one sitting with one small fluid sample, 50 microliters or 100 microliters, we can test for 48 things at once. And that was the nanostring technology we talked about. And there, we are going to catch most things, more than 90% of ocular infections with one small sample and with really high sensitivity. And so that's better than ordering several PCR tests or ordering different culture plates, all in one sensitive testing. So those are the two exciting technologies that can make us better at diagnosing our patients.

RV Paul Chan, MD, MSc, MBA, FACS (02:11):
Great. So what are the limitations of these technologies?

Lucia Sobrin, MD, MPH (02:14):
So in the first one, the panel, the limitation is it's limited by our knowledge, right? These are the 90% plus these pathogens cover about 90% of infections that happen in the eye, but it doesn't help us to find new things that we don't know about yet. So it's very good and it's fast. We can get it in 12 to 24 hours and that's pretty good for turnaround. So that's not a limitation, that's a positive. But the limitation is that it doesn't teach us things we don't know. With next generation sequencing, the positives are that we learn new things, but the negative is that we're going to find a lot of false positives. We're going to find a lot of stuff that doesn't really correlate with what we're seeing in the patient and we have to really use our brains to interpret it and not just take the result at face value and really ask, does this make sense for this patient or is this just the noise that we're going to get with next generation sequencing?

RV Paul Chan, MD, MSc, MBA, FACS (03:05):
So thank you, Dr. Sobrin. Great having you here and wonderful discussion and talk at the Aspen Retinal Detachment Society meeting.

Lucia Sobrin, MD, MPH (03:13):
Thank you for having me.