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Poh SSJ, Sia JT, Yip MYT, Tsai ASH, Lee SY, Tan GSW, Weng CY, Kadonosono K, Kim M, Yonekawa Y, Ho AC, Toth CA, Ting DSW. Artificial Intelligence, Digital Imaging, and Robotics Technologies for Surgical Vitreoretinal Diseases. Ophthalmol Retina 2024; 8:633-645. [PMID: 38280425 DOI: 10.1016/j.oret.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE To review recent technological advancement in imaging, surgical visualization, robotics technology, and the use of artificial intelligence in surgical vitreoretinal (VR) diseases. BACKGROUND Technological advancements in imaging enhance both preoperative and intraoperative management of surgical VR diseases. Widefield imaging in fundal photography and OCT can improve assessment of peripheral retinal disorders such as retinal detachments, degeneration, and tumors. OCT angiography provides a rapid and noninvasive imaging of the retinal and choroidal vasculature. Surgical visualization has also improved with intraoperative OCT providing a detailed real-time assessment of retinal layers to guide surgical decisions. Heads-up display and head-mounted display utilize 3-dimensional technology to provide surgeons with enhanced visual guidance and improved ergonomics during surgery. Intraocular robotics technology allows for greater surgical precision and is shown to be useful in retinal vein cannulation and subretinal drug delivery. In addition, deep learning techniques leverage on diverse data including widefield retinal photography and OCT for better predictive accuracy in classification, segmentation, and prognostication of many surgical VR diseases. CONCLUSION This review article summarized the latest updates in these areas and highlights the importance of continuous innovation and improvement in technology within the field. These advancements have the potential to reshape management of surgical VR diseases in the very near future and to ultimately improve patient care. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Stanley S J Poh
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Josh T Sia
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Michelle Y T Yip
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Gavin S W Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Christina Y Weng
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | | | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Departments of Ophthalmology and Biomedical Engineering, Duke University, Durham, North Carolina
| | - Daniel S W Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Byers Eye Institute, Stanford University, Palo Alto, California.
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Talcott KE, Knapp AN, Amine R, Matar K, Srivastava SK, Rachitskaya A, Sharma S, Singh RP, Yuan A, Reese JL, Ehlers JP. Comparing Three-Dimensional Digitally Enabled Intraoperative OCT With Conventional Microscope-Integrated OCT in Vitreoretinal Surgery: A Post Hoc Analysis of the Discover Study. Ophthalmic Surg Lasers Imaging Retina 2024:1-8. [PMID: 38648428 DOI: 10.3928/23258160-20240206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVE This study compared the surgeon experience between conventional microscope-integrated intraoperative optical coherence tomography (iOCT) and digitally enabled microscope-integrated iOCT in vitreoretinal surgery. PATIENTS AND METHODS This is a post hoc case-control analysis of the DISCOVER study. Conventional microscope-integrated iOCT (Rescan 700, Zeiss) was compared with digitally enabled iOCT (Artevo 800, Zeiss). Compared variables included surgical field-based visualization (ie, ocular heads-up display in the conventional group; three-dimensional screen-based visualization in the digital iOCT group) and non-surgical field-based visualization (ie, review on the external two-dimensional monitor). RESULTS A total of 200 patients were included. Surgical field-based visualization of iOCT was significantly higher in the digitally enabled group (P < 0.0001). Required endoillumination level was significantly lower in the digital iOCT group (P < 0.0001). Surgeons reported "significant" back discomfort and headache more frequently when using conventional iOCT (P = 0.003 and P = 0.001, respectively). CONCLUSIONS Digitally enabled iOCT resulted in greater surgical visualization efficiency, appeared to require a lower illumination level, and may provide advantages for ergonomic-related discomfort. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Parolini B, Ripa M, Frisina R, Matello V, Motta L. The Role of the Intraoperative Optical Coherence Tomography for Vitreoretinal Surgery in a Real-Life Setting. Life (Basel) 2023; 13:1813. [PMID: 37763217 PMCID: PMC10533019 DOI: 10.3390/life13091813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND To descriptively report the advantages and the feasibility of microscope-integrated intraoperative optical coherence tomography (i-OCT) in managing different vitreoretinal diseases in a real-life setting. METHODS We conducted an observational retrospective study involving 265 eyes that underwent elective retinal surgery and intraoperative OCT between 1 September 2018 and 1 October 2022 at Eyecare Clinic (Brescia, Italy). RESULTS 52 epiretinal membranes, 30 retinal detachments, 60 high myopic eyes, 30 choroidal transplants, 40 macular holes, and 32 vitreo-proliferative retinopathies underwent vitreoretinal surgery and intraoperative OCT scans. The i-OCT was a useful diagnostic exam for all cases and significantly influenced our surgical management. CONCLUSIONS i-OCT is a helpful surgical tool in ophthalmic surgery as it provides real-time feedback of tissue anatomy to surgeons, thereby guiding decision-making. Moreover, it provides additional information on the microarchitectural changes after instrument-tissue interactions, further guiding procedures when necessary and possibly reducing unessential surgical maneuvers.
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Affiliation(s)
- Barbara Parolini
- Department of Ophthalmology, Eyecare Clinic, 25124 Brescia, Italy (V.M.)
| | - Matteo Ripa
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
| | - Rino Frisina
- Ophthalmology Unit of Surgery, Department of Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Veronika Matello
- Department of Ophthalmology, Eyecare Clinic, 25124 Brescia, Italy (V.M.)
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
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5
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Brodie FL, Feng H, Raynor W, Li JD, Vajzovic L, Izatt JA, McNabb RP, Toth CA. NOVEL METHOD FOR VISUALIZING PERIPHERAL RETINAL STRUCTURES WITH MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY. Retin Cases Brief Rep 2023; 17:380-383. [PMID: 37364197 PMCID: PMC10293752 DOI: 10.1097/icb.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND/PURPOSE Visualization of peripheral retinal structures with optical coherence tomography (OCT) can be challenging but can offer valuable clinical information. We describe a method for intraoperative OCT of the peripheral retina. METHODS An investigational microscope-integrated OCT system with real-time 4D volumetric imaging was used in conjunction with a Goldmann style mirrored contact lens intraoperatively to capture peripheral images in three patients. RESULTS We identified retinoschisis, a retinal break, and areas of focal retinal detachment using our peripheral OCT method. CONCLUSION Use of a Goldmann lens in conjunction with intraoperative OCT offers surgeons the ability to resolve peripheral pathology that cannot be easily evaluated with OCT otherwise.
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Affiliation(s)
| | | | | | | | | | - Joseph A Izatt
- Departments of Ophthalmology, and
- Biomedical Engineering, Duke University, North Carolina
| | | | - Cynthia A Toth
- Departments of Ophthalmology, and
- Biomedical Engineering, Duke University, North Carolina
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6
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Trout RM, Viehland C, Li JD, Raynor W, Dhalla AH, Vajzovic L, Kuo AN, Toth CA, Izatt JA. Methods for real-time feature-guided image fusion of intrasurgical volumetric optical coherence tomography with digital microscopy. BIOMEDICAL OPTICS EXPRESS 2023; 14:3308-3326. [PMID: 37497493 PMCID: PMC10368056 DOI: 10.1364/boe.488975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 07/28/2023]
Abstract
4D-microscope-integrated optical coherence tomography (4D-MIOCT) is an emergent multimodal imaging technology in which live volumetric OCT (4D-OCT) is implemented in tandem with standard stereo color microscopy. 4D-OCT provides ophthalmic surgeons with many useful visual cues not available in standard microscopy; however it is challenging for the surgeon to effectively integrate cues from simultaneous-but-separate imaging in real-time. In this work, we demonstrate progress towards solving this challenge via the fusion of data from each modality guided by segmented 3D features. In this way, a more readily interpretable visualization that combines and registers important cues from both modalities is presented to the surgeon.
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Affiliation(s)
- Robert M. Trout
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - Christian Viehland
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - Jianwei D. Li
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - William Raynor
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Al-Hafeez Dhalla
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
| | - Lejla Vajzovic
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Anthony N. Kuo
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Cynthia A. Toth
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
- Department of Ophthalmology, Duker University Medical Center, 2351 Erwin Road, Durham, NC 27705, USA
| | - Joseph A. Izatt
- Department of Biomedical Engineering, Duke University, 101 Science Drive, Durham, NC 27708, USA
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7
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Zhou M, Hennerkes F, Liu J, Jiang Z, Wendler T, Nasseri MA, Iordachita I, Navab N. Theoretical error analysis of spotlight-based instrument localization for retinal surgery. ROBOTICA 2023; 41:1536-1549. [PMID: 37982126 PMCID: PMC10655674 DOI: 10.1017/s0263574722001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Retinal surgery is widely considered to be a complicated and challenging task even for specialists. Image-guided robot-assisted intervention is among the novel and promising solutions that may enhance human capabilities therein. In this paper, we demonstrate the possibility of using spotlights for 5D guidance of a microsurgical instrument. The theoretical basis of the localization for the instrument based on the projection of a single spotlight is analyzed to deduce the position and orientation of the spotlight source. The usage of multiple spotlights is also proposed to check the possibility of further improvements for the performance boundaries. The proposed method is verified within a high-fidelity simulation environment using the 3D creation suite Blender. Experimental results show that the average positioning error is 0.029 mm using a single spotlight and 0.025 mm with three spotlights, respectively, while the rotational errors are 0.124 and 0.101, which shows the application to be promising in instrument localization for retinal surgery.
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Affiliation(s)
- Mingchuan Zhou
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
| | - Felix Hennerkes
- Chair for Computer Aided Medical Procedures and Augmented Reality, Computer Science Department, Technische Universität München, Munchen, Germany
| | - Jingsong Liu
- Chair for Computer Aided Medical Procedures and Augmented Reality, Computer Science Department, Technische Universität München, Munchen, Germany
| | - Zhongliang Jiang
- Chair for Computer Aided Medical Procedures and Augmented Reality, Computer Science Department, Technische Universität München, Munchen, Germany
| | - Thomas Wendler
- Chair for Computer Aided Medical Procedures and Augmented Reality, Computer Science Department, Technische Universität München, Munchen, Germany
| | - M Ali Nasseri
- Augenklinik und Poliklinik, Klinikum rechts der Isar der Technische Universität München, München, Germany
| | - Iulian Iordachita
- Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Computer Science Department, Technische Universität München, Munchen, Germany
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8
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Iordachita II, de Smet MD, Naus G, Mitsuishi M, Riviere CN. Robotic Assistance for Intraocular Microsurgery: Challenges and Perspectives. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:893-908. [PMID: 36588782 PMCID: PMC9799958 DOI: 10.1109/jproc.2022.3169466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Intraocular surgery, one of the most challenging discipline of microsurgery, requires sensory and motor skills at the limits of human physiological capabilities combined with tremendously difficult requirements for accuracy and steadiness. Nowadays, robotics combined with advanced imaging has opened conspicuous and significant directions in advancing the field of intraocular microsurgery. Having patient treatment with greater safety and efficiency as the final goal, similar to other medical applications, robotics has a real potential to fundamentally change microsurgery by combining human strengths with computer and sensor-based technology in an information-driven environment. Still in its early stages, robotic assistance for intraocular microsurgery has been accepted with precaution in the operating room and successfully tested in a limited number of clinical trials. However, owing to its demonstrated capabilities including hand tremor reduction, haptic feedback, steadiness, enhanced dexterity, micrometer-scale accuracy, and others, microsurgery robotics has evolved as a very promising trend in advancing retinal surgery. This paper will analyze the advances in retinal robotic microsurgery, its current drawbacks and limitations, as well as the possible new directions to expand retinal microsurgery to techniques currently beyond human boundaries or infeasible without robotics.
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Affiliation(s)
- Iulian I Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Marc D de Smet
- Microinvasive Ocular Surgery Center (MIOS), Lausanne, Switzerland
| | | | - Mamoru Mitsuishi
- Department of Mechanical Engineering, The University of Tokyo, Japan
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9
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Muijzer MB, Schellekens PA, Beckers HJM, de Boer JH, Imhof SM, Wisse RPL. Clinical applications for intraoperative optical coherence tomography: a systematic review. Eye (Lond) 2022; 36:379-391. [PMID: 34272509 PMCID: PMC8807841 DOI: 10.1038/s41433-021-01686-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
In this systematic review, we provide an overview of the current state of intraoperative optical coherence tomography (iOCT). As iOCT technology is increasingly utilized, its current clinical applications and potential uses warrant attention. Here, we categorize the findings of various studies by their respective fields, including the use of iOCT in vitreoretinal surgery, corneal surgery, glaucoma surgery, cataract surgery, and pediatric ophthalmology. The trend observed in recent decades towards performing minimally invasive ophthalmic surgery has caused practitioners to recognize the limitations of using a conventional surgical microscope for intraoperative visualization. Thus, the superior visualization provided by iOCT can improve the safety of these surgical techniques and promote the development of new minimally invasive ophthalmic surgeries. Landmark prospective studies found that iOCT can significantly affect surgical decision making and can cause a subsequent change in surgical strategy, and the use of iOCT has potential to improve surgical outcome. Despite these advantages, however, iOCT is still a relatively new technique, and beginning users of iOCT can encounter limitations that can preclude their reaching the full potential of iOCT and in this respect several improvements are needed.
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Affiliation(s)
- Marc B. Muijzer
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter A.W.J. Schellekens
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henny J. M. Beckers
- grid.412966.e0000 0004 0480 1382University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joke H. de Boer
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia M. Imhof
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert P. L. Wisse
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Brodie F, Repka M, Burns SA, Prakalapakorn SG, Morse C, Schuman JS, Duenas MR, Afshari N, Pollack JS, Thorne JE, Vitale A, Sen HN, Myung D, Blumenkranz MS, Tu E, Hammer DX, Tarver M, Cunningham B, Kagemann L, Sadda S, Sarraf D, Jaffe GJ, Eydelman M. Development, Validation, and Innovation in Ophthalmic Laser-Based Imaging: Report From a US Food and Drug Administration-Cosponsored Forum. JAMA Ophthalmol 2021; 139:113-118. [PMID: 33211074 DOI: 10.1001/jamaophthalmol.2020.4994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In April 2019, the US Food and Drug Administration, in conjunction with 11 professional ophthalmic, vision science, and optometric societies, convened a forum on laser-based imaging. The forum brought together the Food and Drug Administration, clinicians, researchers, industry members, and other stakeholders to stimulate innovation and ensure that patients in the US are the first in the world to have access to high-quality, safe, and effective medical devices. This conference focused on the technology, clinical applications, regulatory issues, and reimbursement issues surrounding innovative ocular imaging modalities. Furthermore, the emerging role of artificial intelligence in ophthalmic imaging was reviewed. This article summarizes the presentations, discussion, and future directions.
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Affiliation(s)
- Frank Brodie
- Byers Eye Institute, Stanford University, Stanford, California.,Now with Vitreoretinal Surgery Fellowship Program, Duke Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Michael Repka
- American Academy of Ophthalmology, San Francisco, California
| | | | - S Grace Prakalapakorn
- American Association for Pediatric Ophthalmology and Strabismus, San Francisco, California
| | - Christie Morse
- American Association for Pediatric Ophthalmology and Strabismus, San Francisco, California
| | | | | | - Natalie Afshari
- American Society of Cataract and Refractive Surgeons, Fairfax, Virginia
| | - John S Pollack
- American Society of Retinal Specialists, Chicago, Illinois
| | | | | | - H Nida Sen
- American Uveitis Society, Birmingham, Alabama
| | - David Myung
- Byers Eye Institute, Stanford University, Stanford, California
| | | | - Elmer Tu
- Cornea Society, Fairfax, Virginia
| | - Daniel X Hammer
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
| | - Michelle Tarver
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
| | - Bradley Cunningham
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
| | - Larry Kagemann
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
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11
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Tang N, Fan J, Wang P, Shi G. Microscope integrated optical coherence tomography system combined with augmented reality. OPTICS EXPRESS 2021; 29:9407-9418. [PMID: 33820369 DOI: 10.1364/oe.420375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
One of the disadvantages in microscope-integrated optical coherence tomography (MI-OCT) systems is that medical images acquired via different modalities are usually displayed independently. Hence, surgeons have to match two-dimensional and three-dimensional images of the same operative region subjectively. In this paper, we propose a simple registration method to overcome this problem by using guided laser points. This method combines augmented reality with an existing MI-OCT system. The basis of our idea is to introduce a guiding laser into the system, which allows us to identify fiducials in microscopic images. At first, the applied voltages of the scanning galvanometer mirror are used to calculate the fiducials' coordinates in an OCT model. After gathering data at the corresponding points' coordinates, the homography matrix and camera parameters are used to superimpose a reconstructed model on microscopic images. After performing experiments with artificial and animal eyes, we successfully obtain two-dimensional microscopic images of scanning regions with depth information. Moreover, the registration error is 0.04 mm, which is within the limits of medical and surgical errors. Our proposed method could have many potential applications in ophthalmic procedures.
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12
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[Biomarkers in full-thickness and lamellar defects of the macula]. Ophthalmologe 2021; 118:321-336. [PMID: 33646383 DOI: 10.1007/s00347-021-01340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Biomarkers are characteristic biological measurable signs and objective parameters to detect the state of health. Besides functional and temporal factors, imaging biomarkers play an increasingly important role. In full-thickness and lamellar defects of the macula numerous imaging parameters have been described. This knowledge resulted in new classifications for both clinical pictures, which are based on important biomarkers of these clinical pictures and characteristic features of described subtypes. METHODS Imaging biomarkers for full-thickness and lamellar macular defects are described with respect to the classification and their functional prognostic importance. The importance of these biomarkers is presented. RESULTS The current classification of full-thickness and lamellar macular defects is based on structural biomarkers. Biomarkers are important for prognostic and therapeutic evaluation and they have an impact on the surgical strategy. There are various surgical strategies for treatment of full-thickness macular holes depending on the size of the foramen and other biomarkers. The inverted ILM flap technique improves the closure rate of large macular holes. In lamellar macular holes showing signs of progression an early surgical intervention results in a good anatomical and functional prognosis. CONCLUSION Multimodal diagnostics provide important preoperative, intraoperative, and postoperative features for macular holes and lamellar macular holes, which are essential biomarkers for the exact classification, the therapeutic strategy and for assessment of the prognosis.
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13
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Laíns I, Wang JC, Cui Y, Katz R, Vingopoulos F, Staurenghi G, Vavvas DG, Miller JW, Miller JB. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Prog Retin Eye Res 2021; 84:100951. [PMID: 33516833 DOI: 10.1016/j.preteyeres.2021.100951] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited. In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.
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Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Jay C Wang
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Ying Cui
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA.
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