This invited review by Eric A. Swanson and James G. Fujimoto, two of the original inventors of optical coherence tomography (OCT), on the history of OCT provides a unique perspective on the development of this technique over the past 25 years. Specifically, the authors made a comprehensive list of all the major factors that, in their opinion, were essential to achieve the commercial success of this technology that enabled the translation of OCT from fundamental research to clinical and commercial success, resulting in ~30 million OCT imaging procedures performed worldwide every year and an OCT system market approaching $1B per year. On top of its commercial success, OCT is continuously improving healthcare for millions of patients where it is used to increase diagnostic performance and make therapeutic decisions, as well as to advance clinical and scientific knowledge for the benefit of future patients and society at large. To back their claims, the authors present quantitative and qualitative data associated with the commercialization of OCT in four major medical fields — ophthalmology, cardiovascular imaging, dermatology, and gastroenterology — and its economic impact, including an exceptional return on government investment.
The ecosystem that was a key to the tremendous success of the OCT consisted of these seven major factors, each essential for the current success of the technology:
 1. Unique physical properties of OCT, which enabled high performance and scalability;
 2. Sustained government funding for fundamental and clinical research;
 3. Academic competition and collaboration;
 4. Innovation in related commercial fields such as fiber optics, software, and computers;
 5. Addressing real clinical needs to improve patient care and simultaneously lower costs;
 6. The role of entrepreneurism and venture capital investment; and
 7. The ultimate clinical, economic, and scientific impact.
I agree with the authors’ assessment that the future of the OCT ecosystem to foster innovation and provide societal benefits looks as bright as ever. On the technology side, there are numerous frontiers with new imaging devices, system concepts, integrated optics, light sources, and multimodality that will power the technology far into the future. On the funding side, there is continuing funding from governments to explore new ideas as well as a substantial OCT industrial base of R&D funding. On the application side, OCT will continue to expand in the clinical and non-medical markets, including numerous yet untapped markets in both developed and developing economies. These markets will require continued risk taking, clever engineering, clinical validation studies, and regulatory and reimbursement approval on a specialty-by-specialty basis.

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