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Morgan JIW, Chui TYP, Grieve K. Twenty-five years of clinical applications using adaptive optics ophthalmoscopy [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:387-428. [PMID: 36698659 PMCID: PMC9841996 DOI: 10.1364/boe.472274] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 05/02/2023]
Abstract
Twenty-five years ago, adaptive optics (AO) was combined with fundus photography, thereby initiating a new era in the field of ophthalmic imaging. Since that time, clinical applications of AO ophthalmoscopy to investigate visual system structure and function in both health and disease abound. To date, AO ophthalmoscopy has enabled visualization of most cell types in the retina, offered insight into retinal and systemic disease pathogenesis, and been integrated into clinical trials. This article reviews clinical applications of AO ophthalmoscopy and addresses remaining challenges for AO ophthalmoscopy to become fully integrated into standard ophthalmic care.
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Affiliation(s)
- Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Contributed equally
| | - Toco Y. P. Chui
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
- Contributed equally
| | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
- Contributed equally
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2
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Li J, Wang D, Pottenburgh J, Bower AJ, Asanad S, Lai EW, Simon C, Im L, Huryn LA, Tao Y, Tam J, Saeedi OJ. Visualization of erythrocyte stasis in the living human eye in health and disease. iScience 2022; 26:105755. [PMID: 36594026 PMCID: PMC9803835 DOI: 10.1016/j.isci.2022.105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/25/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Blood cells trapped in stasis have been reported within the microcirculation, but their relevance to health and disease has not been established. In this study, we introduce an in vivo imaging approach that reveals the presence of a previously-unknown pool of erythrocytes in stasis, located within capillary segments of the CNS, and present in 100% of subjects imaged. These results provide a key insight that blood cells pause as they travel through the choroidal microvasculature, a vascular structure that boasts the highest blood flow of any tissue in the body. Demonstration of clinical utility using deep learning reveals that erythrocyte stasis is altered in glaucoma, indicating the possibility of more widespread changes in choroidal microvascular than previously realized. The ability to monitor the choroidal microvasculature at the single cell level may lead to novel strategies for tracking microvascular health in glaucoma, age-related macular degeneration, and other neurodegenerative diseases.
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Affiliation(s)
- Joanne Li
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dongyi Wang
- Bioimaging and Machine Vision Laboratory, Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Jessica Pottenburgh
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew J. Bower
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric W. Lai
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Caroline Simon
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lily Im
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laryssa A. Huryn
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yang Tao
- Bioimaging and Machine Vision Laboratory, Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Johnny Tam
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Osamah J. Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author
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3
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Liu Z, Zhang F, Zucca K, Agrawal A, Hammer DX. Ultrahigh-speed multimodal adaptive optics system for microscopic structural and functional imaging of the human retina. BIOMEDICAL OPTICS EXPRESS 2022; 13:5860-5878. [PMID: 36733751 PMCID: PMC9872887 DOI: 10.1364/boe.462594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 05/02/2023]
Abstract
We describe the design and performance of a multimodal and multifunctional adaptive optics (AO) system that combines scanning laser ophthalmoscopy (SLO) and optical coherence tomography (OCT) for simultaneous retinal imaging at 13.4 Hz. The high-speed AO-OCT channel uses a 3.4 MHz Fourier-domain mode-locked (FDML) swept source. The system achieves exquisite resolution and sensitivity for pan-macular and transretinal visualization of retinal cells and structures while providing a functional assessment of the cone photoreceptors. The ultra-high speed also enables wide-field scans for clinical usability and angiography for vascular visualization. The FDA FDML-AO system is a powerful platform for studying various retinal and neurological diseases for vision science research, retina physiology investigation, and biomarker development.
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Affiliation(s)
- Zhuolin Liu
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Furu Zhang
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
- Co-first author
| | - Kelvy Zucca
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Anant Agrawal
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Daniel X. Hammer
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
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4
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Widespread subclinical cellular changes revealed across a neural-epithelial-vascular complex in choroideremia using adaptive optics. Commun Biol 2022; 5:893. [PMID: 36100689 PMCID: PMC9470576 DOI: 10.1038/s42003-022-03842-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractChoroideremia is an X-linked, blinding retinal degeneration with progressive loss of photoreceptors, retinal pigment epithelial (RPE) cells, and choriocapillaris. To study the extent to which these layers are disrupted in affected males and female carriers, we performed multimodal adaptive optics imaging to better visualize the in vivo pathogenesis of choroideremia in the living human eye. We demonstrate the presence of subclinical, widespread enlarged RPE cells present in all subjects imaged. In the fovea, the last area to be affected in choroideremia, we found greater disruption to the RPE than to either the photoreceptor or choriocapillaris layers. The unexpected finding of patches of photoreceptors that were fluorescently-labeled, but structurally and functionally normal, suggests that the RPE blood barrier function may be altered in choroideremia. Finally, we introduce a strategy for detecting enlarged cells using conventional ophthalmic imaging instrumentation. These findings establish that there is subclinical polymegathism of RPE cells in choroideremia.
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5
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Giannini JP, Lu R, Bower AJ, Fariss R, Tam J. Visualizing retinal cells with adaptive optics imaging modalities using a translational imaging framework. BIOMEDICAL OPTICS EXPRESS 2022; 13:3042-3055. [PMID: 35774328 PMCID: PMC9203084 DOI: 10.1364/boe.454560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 05/18/2023]
Abstract
Adaptive optics reflectance-based retinal imaging has proved a valuable tool for the noninvasive visualization of cells in the living human retina. Many subcellular features that remain at or below the resolution limit of current in vivo techniques may be more easily visualized with the same modalities in an ex vivo setting. While most microscopy techniques provide significantly higher resolution, enabling the visualization of fine cellular detail in ex vivo retinal samples, they do not replicate the reflectance-based imaging modalities of in vivo retinal imaging. Here, we introduce a strategy for imaging ex vivo samples using the same imaging modalities as those used for in vivo retinal imaging, but with increased resolution. We also demonstrate the ability of this approach to perform protein-specific fluorescence imaging and reflectance imaging simultaneously, enabling the visualization of nearly transparent layers of the retina and the classification of cone photoreceptor types.
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Pankova N, Baek DSH, Zhao X, Wang H, Reyad MM, Liang H, Joshi R, Boyd SR. Evolving Patterns of Hyperfluorescent Fundus Autofluorescence Accompany Retinal Atrophy in the Rat and Mimic Atrophic Age-Related Macular Degeneration. Transl Vis Sci Technol 2022; 11:3. [PMID: 35254423 PMCID: PMC8914569 DOI: 10.1167/tvst.11.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Complex two-dimensional (2D) patterns of hyperfluorescent short-wave fundus autofluorescence (FAF) at the border of geographic atrophy (GA) can predict its expansion in patients with late non-exudative “dry” AMD. However, preclinical models do not phenocopy this important feature of disease. We sought to describe the spatiotemporal changes in hyperfluorescent FAF patterns that occur following acute oxidative stress, potentially in association with GA expansion. Methods Sprague Dawley rats (n = 54) received systemic sodium iodate (25–45 mg/kg, n = 90 eyes) or saline (n = 18 eyes) and underwent serial full fundus imaging by confocal scanning laser ophthalmoscopy, including blue FAF and delayed near-infrared analysis. Composite images of the fundus were assembled, and the 2D patterns were described qualitatively and quantitatively. A subset of eyes underwent tissue analysis, and four underwent optical coherence tomography (OCT) imaging. Results Reproducibly changing, complex patterns of hyperfluorescent FAF emerge at the borders of toxin-induced damage; however, in the absence of GA expansion, they percolate inward within the region of retinal pigment epithelium loss, evolving, maturing, and senescing in situ over time. Unexpectedly, the late FAF patterns most closely resemble the diffuse tricking form of clinical disease. A five-stage classification system is presented. Conclusions Longitudinal, full-fundus imaging of outer retinal atrophy in the rat eye identifies evolving, complex patterns of hyperfluorescent FAF that phenocopy aspects of disease. Translational Relevance This work provides a novel tool to assess hyperfluorescent FAF in association with progressive retinal atrophy, a therapeutic target in late AMD.
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Affiliation(s)
- Natalie Pankova
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - David Sung Hyeon Baek
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Xu Zhao
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Hai Wang
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Matthew-Mina Reyad
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Huiyuan Liang
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Rahul Joshi
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Shelley Romayne Boyd
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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7
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Liu J, Shen C, Aguilera N, Cukras C, Hufnagel RB, Zein WM, Liu T, Tam J. Active Cell Appearance Model Induced Generative Adversarial Networks for Annotation-Efficient Cell Segmentation and Identification on Adaptive Optics Retinal Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2820-2831. [PMID: 33507868 PMCID: PMC8548993 DOI: 10.1109/tmi.2021.3055483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Data annotation is a fundamental precursor for establishing large training sets to effectively apply deep learning methods to medical image analysis. For cell segmentation, obtaining high quality annotations is an expensive process that usually requires manual grading by experts. This work introduces an approach to efficiently generate annotated images, called "A-GANs", created by combining an active cell appearance model (ACAM) with conditional generative adversarial networks (C-GANs). ACAM is a statistical model that captures a realistic range of cell characteristics and is used to ensure that the image statistics of generated cells are guided by real data. C-GANs utilize cell contours generated by ACAM to produce cells that match input contours. By pairing ACAM-generated contours with A-GANs-based generated images, high quality annotated images can be efficiently generated. Experimental results on adaptive optics (AO) retinal images showed that A-GANs robustly synthesize realistic, artificial images whose cell distributions are exquisitely specified by ACAM. The cell segmentation performance using as few as 64 manually-annotated real AO images combined with 248 artificially-generated images from A-GANs was similar to the case of using 248 manually-annotated real images alone (Dice coefficients of 88% for both). Finally, application to rare diseases in which images exhibit never-seen characteristics demonstrated improvements in cell segmentation without the need for incorporating manual annotations from these new retinal images. Overall, A-GANs introduce a methodology for generating high quality annotated data that statistically captures the characteristics of any desired dataset and can be used to more efficiently train deep-learning-based medical image analysis applications.
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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9
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Lu R, Aguilera N, Liu T, Liu J, Giannini JP, Li J, Bower AJ, Dubra A, Tam J. In-vivo sub-diffraction adaptive optics imaging of photoreceptors in the human eye with annular pupil illumination and sub-Airy detection. OPTICA 2021; 8:333-343. [PMID: 34504903 PMCID: PMC8425240 DOI: 10.1364/optica.414206] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/08/2021] [Indexed: 05/18/2023]
Abstract
Adaptive optics scanning light ophthalmoscopy (AOSLO) allows non-invasive visualization of the living human eye at the microscopic scale; but even with correction of the ocular wavefront aberrations over a large pupil, the smallest cells in the photoreceptor mosaic cannot always be resolved. Here, we synergistically combine annular pupil illumination with sub-Airy disk confocal detection to demonstrate a 33% improvement in transverse resolution (from 2.36 to 1.58 μm) and a 13% axial resolution enhancement (from 37 to 32 μm), an important step towards the study of the complete photoreceptor mosaic in heath and disease. Interestingly, annular pupil illumination also enhanced the visualization of the photoreceptor mosaic in non-confocal detection schemes such as split detection AOSLO, providing a strategy for enhanced multimodal imaging of the cone and rod photoreceptor mosaic.
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Affiliation(s)
- Rongwen Lu
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Nancy Aguilera
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Tao Liu
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Jianfei Liu
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - John P. Giannini
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Joanne Li
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Andrew J. Bower
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, California 94305, USA
| | - Johnny Tam
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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10
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Bower AJ, Liu T, Aguilera N, Li J, Liu J, Lu R, Giannini JP, Huryn LA, Dubra A, Liu Z, Hammer DX, Tam J. Integrating adaptive optics-SLO and OCT for multimodal visualization of the human retinal pigment epithelial mosaic. BIOMEDICAL OPTICS EXPRESS 2021; 12:1449-1466. [PMID: 33796365 PMCID: PMC7984802 DOI: 10.1364/boe.413438] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 05/03/2023]
Abstract
In vivo imaging of human retinal pigment epithelial (RPE) cells has been demonstrated through multiple adaptive optics (AO)-based modalities. However, whether consistent and complete information regarding the cellular structure of the RPE mosaic is obtained across these modalities remains uncertain due to limited comparisons performed in the same eye. Here, an imaging platform combining multimodal AO-scanning light ophthalmoscopy (AO-SLO) with AO-optical coherence tomography (AO-OCT) is developed to make a side-by-side comparison of the same RPE cells imaged across four modalities: AO-darkfield, AO-enhanced indocyanine green (AO-ICG), AO-infrared autofluorescence (AO-IRAF), and AO-OCT. Co-registered images were acquired in five subjects, including one patient with choroideremia. Multimodal imaging provided multiple perspectives of the RPE mosaic that were used to explore variations in RPE cell contrast in a subject-, location-, and even cell-dependent manner. Estimated cell-to-cell spacing and density were found to be consistent both across modalities and with normative data. Multimodal images from a patient with choroideremia illustrate the benefit of using multiple modalities to infer the cellular structure of the RPE mosaic in an affected eye, in which disruptions to the RPE mosaic may locally alter the signal strength, visibility of individual RPE cells, or even source of contrast in unpredictable ways.
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Affiliation(s)
- Andrew J. Bower
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tao Liu
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nancy Aguilera
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Joanne Li
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jianfei Liu
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rongwen Lu
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - John P. Giannini
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Laryssa A. Huryn
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, CA 94303, USA
| | - Zhuolin Liu
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA
| | - Daniel X. Hammer
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA
| | - Johnny Tam
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
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11
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Abstract
Adaptive optics (AO) is a technique that corrects for optical aberrations. It was originally proposed to correct for the blurring effect of atmospheric turbulence on images in ground-based telescopes and was instrumental in the work that resulted in the Nobel prize-winning discovery of a supermassive compact object at the centre of our galaxy. When AO is used to correct for the eye's imperfect optics, retinal changes at the cellular level can be detected, allowing us to study the operation of the visual system and to assess ocular health in the microscopic domain. By correcting for sample-induced blur in microscopy, AO has pushed the boundaries of imaging in thick tissue specimens, such as when observing neuronal processes in the brain. In this primer, we focus on the application of AO for high-resolution imaging in astronomy, vision science and microscopy. We begin with an overview of the general principles of AO and its main components, which include methods to measure the aberrations, devices for aberration correction, and how these components are linked in operation. We present results and applications from each field along with reproducibility considerations and limitations. Finally, we discuss future directions.
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12
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Liu J, Han YJ, Liu T, Aguilera N, Tam J. Spatially Aware Dense-LinkNet Based Regression Improves Fluorescent Cell Detection in Adaptive Optics Ophthalmic Images. IEEE J Biomed Health Inform 2020; 24:3520-3528. [PMID: 32750947 DOI: 10.1109/jbhi.2020.3004271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Retinal pigment epithelial (RPE) cells play an important role in nourishing retinal neurosensory photoreceptor cells, and numerous blinding diseases are associated with RPE defects. Their fluorescence signature can now be visualized in the living human eye using adaptive optics (AO) imaging combined with indocyanine green (ICG), which motivates us to develop an automated RPE detection method to improve the quantitative evaluation of RPE status in patients. This paper proposes a spatially-aware, Dense-LinkNet-based regression approach to improve the detection of in vivo fluorescent cell patterns, achieving precision, recall, and F1-Score of 93.6 ± 4.3%, 81.4 ± 9.5%, and 86.7 ± 5.7%, respectively. These results demonstrate the utility of incorporating spatial inputs into a deep learning-based regression framework for cell detection.
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13
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Current Choroidal Imaging Findings in Central Serous Chorioretinopathy. Vision (Basel) 2020; 4:vision4040044. [PMID: 33081096 PMCID: PMC7712239 DOI: 10.3390/vision4040044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Central serous chorioretinopathy (CSCR) is a chorioretinal disease affecting mostly middle age males. It is marked by the serous detachment of the neurosensory layer at the macula. This review of the literature provides a framework of the current characteristic/relevant imaging findings of CSCR. Although the pathogenesis of CSCR is unclear, the choroid plays a major role and its changes are fundamental to the diagnosis and treatment of CSCR. Methods: A systematic literature search focusing on current multimodal imaging for CSCR was performed. Only articles reporting on original clinical data were selected, studies in a language other than English were included only if an English abstract was provided. Additional sources included articles cited in the references list of the first selected articles. We deduced imaging findings based on current and relevant literature on the topic. Results: We found that sub foveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were greater in eyes with acute CSCR than in eyes with chronic CSCR or normal eyes. There was increased choroidal thickness (CT) in the macula compared to peripapillary region. In healthy eyes, the highest CVI was found in the nasal region followed by the inferior, temporal, and superior quadrant. The area with the least CVI was the macula. In eyes with CSCR, 100% had asymmetric dominant vortex veins compared to 38% in normal eyes. Conclusion: Choroidal imaging has advanced the diagnosis of CSCR. This has led to numerous imaging biomarkers like CVI, CT, and hyper-reflective dots for early detection and possible prognostication of CSCR. More techniques like wide field scans and en face imaging are being employed to characterize the choroid in CSCR.
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14
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Mustafi D, Saraf SS, Shang Q, Olmos de Koo LC. New developments in angiography for the diagnosis and management of diabetic retinopathy. Diabetes Res Clin Pract 2020; 167:108361. [PMID: 32745697 DOI: 10.1016/j.diabres.2020.108361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The most common microvascular complication of diabetes is diabetic retinopathy, the leading cause of blindness in adults of working age. Our understanding of the vascular changes in diabetic retinopathy was enhanced by the demonstration of fluorescein angiography (FA) in the human retina for the first time in 1961. It was subsequently integrated with digital fundoscopic imaging to become an invaluable technique in evaluation of the retinal vasculature. The recent development of OCT-angiography (OCT-A) has revolutionized the clinician's ability to examine the retinal vasculature without the need for injection of a contrast dye. By coupling OCT, which can provide noninvasive cross-sectional imaging of the central retina, with angiography in OCT-A, one can reveal retinal perfusion by allowing visualization of the depth-resolved retinal capillary plexus. OCT-A has allowed for more precise delineation of changes in the retinal microvasculature, specifically the alterations of retinal vasculature and loss of capillary perfusion from chronic microvascular occlusion in diabetic retinopathy.
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Affiliation(s)
- Debarshi Mustafi
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA
| | - Steven S Saraf
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA
| | - Qing Shang
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA
| | - Lisa C Olmos de Koo
- Department of Ophthalmology, University of Washington Eye Institute, Seattle, WA, USA.
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15
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Singh SR, Chhablani J. Imaging the Choroid. Vision (Basel) 2020; 4:vision4030038. [PMID: 32824300 PMCID: PMC7558177 DOI: 10.3390/vision4030038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Institute, University of California, San Diego, La Jolla, CA 92093-0021, USA;
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Eye and Ear Institute, Pittsburgh, PA 15213, USA
- Correspondence: ; Tel.: +1-412-377-1943
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16
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Karst SG, Beiglboeck H, Scharinger R, Meyer EL, Mitsch C, Scholda C, Schmidt-Erfurth UM. Retinal and Choroidal Perfusion Status in the Area of Laser Scars Assessed With Swept-Source Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2019; 60:4865-4871. [PMID: 31747687 DOI: 10.1167/iovs.19-27977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the perfusion status of the retina and choriocapillaris in the area of laser scars on swept-source optical coherence tomography angiography (OCTA) images of eyes previously treated with panretinal photocoagulation (PRP). Methods Cross-sectional exploratory analysis of swept-source OCTA images, which were retrospectively reviewed for laser scars. The appearance of the capillary networks in the area of previous laser were evaluated following a three-step grading system (normal/sparse/missing capillary network). The superficial and deep capillary plexus of the retina and the choriocapillaris were graded separately. Results A total of 3140 laser scars in 54 eyes of 31 patients (13 female, mean age 57 ± 12 years) were included in this analysis. In the retina, 6.8% of the superficial and deep capillary network in the area evaluated appeared normal, 58% and 56% sparse, and 35% and 37% missing. Capillary dropout in the retina was not restricted to the area of prior laser treatment. The choriocapillaris decorrelation signal was either sparse (61%) or completely missing (38%) within the laser scar area. The perfusion of the choriocapillaris appeared normal in the area adjacent to laser scars. Conclusions Capillary non-perfusion in the choriocapillaris was found within the laser scar area. Laser treatment seems to cause sustained non-perfusion of choriocapillaris in the area treated.
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Affiliation(s)
- Sonja G Karst
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Hannes Beiglboeck
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Raffael Scharinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Elias L Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Christoph Mitsch
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Christoph Scholda
- Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
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17
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Jung H, Liu J, Liu T, George A, Smelkinson MG, Cohen S, Sharma R, Schwartz O, Maminishkis A, Bharti K, Cukras C, Huryn LA, Brooks BP, Fariss R, Tam J. Longitudinal adaptive optics fluorescence microscopy reveals cellular mosaicism in patients. JCI Insight 2019; 4:124904. [PMID: 30895942 DOI: 10.1172/jci.insight.124904] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
The heterogeneity of individual cells in a tissue has been well characterized, largely using ex vivo approaches that do not permit longitudinal assessments of the same tissue over long periods of time. We demonstrate a potentially novel application of adaptive optics fluorescence microscopy to visualize and track the in situ mosaicism of retinal pigment epithelial (RPE) cells directly in the human eye. After a short, dynamic period during which RPE cells take up i.v.-administered indocyanine green (ICG) dye, we observed a remarkably stable heterogeneity in the fluorescent pattern that gradually disappeared over a period of days. This pattern could be robustly reproduced with a new injection and follow-up imaging in the same eye out to at least 12 months, which enabled longitudinal tracking of RPE cells. Investigation of ICG uptake in primary human RPE cells and in a mouse model of ICG uptake alongside human imaging corroborated our findings that the observed mosaicism is an intrinsic property of the RPE tissue. We demonstrate a potentially novel application of fluorescence microscopy to detect subclinical changes to the RPE, a technical advance that has direct implications for improving our understanding of diseases such as oculocutaneous albinism, late-onset retinal degeneration, and Bietti crystalline dystrophy.
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Affiliation(s)
- HaeWon Jung
- National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Jianfei Liu
- National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Tao Liu
- National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Aman George
- National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Margery G Smelkinson
- National Institute of Allergy and Infectious Disease, Research Technologies Branch, NIH, Bethesda, Maryland, USA
| | - Sarah Cohen
- University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruchi Sharma
- National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Owen Schwartz
- National Institute of Allergy and Infectious Disease, Research Technologies Branch, NIH, Bethesda, Maryland, USA
| | | | - Kapil Bharti
- National Eye Institute, NIH, Bethesda, Maryland, USA
| | | | | | | | - Robert Fariss
- National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Johnny Tam
- National Eye Institute, NIH, Bethesda, Maryland, USA
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