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Loveless BA, Moin KA, Hoopes PC, Moshirfar M. The Utilization of Brillouin Microscopy in Corneal Diagnostics: A Systematic Review. Cureus 2024; 16:e65769. [PMID: 39211657 PMCID: PMC11361473 DOI: 10.7759/cureus.65769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Corneal biomechanical data has been used since 2005 to screen for keratoconus and corneal ectasia by corneal specialists. Older technology uses force applanation techniques over a 3 mm area in the central cornea, making it highly dependent on extraneous variables and unable to calculate the elasticity of the tissue. Brillouin microscopy is a newer method that uses a natural shift in the frequency of light as it passes through a material. This frequency shift can be used to estimate the viscoelasticity of the tissue. The advantage of Brillouin microscopy is that it can create a full three-dimensional (3D) map of the entire cornea without direct contact. A literature search was conducted using the databases PubMed, Google Scholar, and Ovid regarding the applications of Brillouin microscopy in corneal diagnostics. A final total of 16 articles was included describing the various ex vivo and in vivo studies conducted using Brillouin microscopy. Applications of this technology spanned from keratoconus diagnosis to post-corneal refractive surgery evaluation. All studies evaluated corneal biomechanics and other corneal properties through the quantification of Brillouin frequency shifts. Many of the studies found that this diagnostic device is capable of detecting subtle changes in corneal thickness and biomechanics in keratoconic corneas at a high level of specificity and sensitivity. However, limitations of Brillouin microscopy may include the duration of time required for use and fluctuations in accuracy depending on the corneal hydration state. Future technology seems to be geared toward a combination of optical coherence tomography (OCT) and Brillouin microscopy, using OCT as a three-dimensional pupil-tracking modality. Further research and understanding of the technology involved will lead to better care of patients in the field of ophthalmology.
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Affiliation(s)
- Bosten A Loveless
- Ophthalmology, Hoopes Vision Research Center, Draper, USA
- Ophthalmology, Rocky Vista University College of Osteopathic Medicine, Ivins, USA
| | - Kayvon A Moin
- Ophthalmology, Hoopes Vision Research Center, Draper, USA
- Ophthalmology, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | | | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, USA
- Ophthalmology, Hoopes Vision Research Center, Draper, USA
- Eye Banking and Corneal Transplantation, Utah Lions Eye Bank, Murray, USA
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Zhang H, Asroui L, Tarib I, Dupps WJ, Scarcelli G, Randleman JB. Motion-Tracking Brillouin Microscopy Evaluation of Normal, Keratoconic, and Post-Laser Vision Correction Corneas. Am J Ophthalmol 2023; 254:128-140. [PMID: 36963605 PMCID: PMC11108093 DOI: 10.1016/j.ajo.2023.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE To characterize focal biomechanical differences between normal, keratoconic, and post-laser vision correction (LVC) corneas using motion-tracking Brillouin microscopy. DESIGN Prospective cross-sectional study. METHODS Thirty eyes from 30 patients (10 normal controls [Controls], 10 post-LVC, and 10 stage I or II keratoconus [KC]) had Scheimpflug and motion-tracking Brillouin microscopy imaging using a custom-built device. Mean, maximum (max) and minimum (min) Brillouin shift, spatial standard deviation, and max-min values were compared. Min values were correlated with local Brillouin values at multiple Scheimpflug imaging locations. RESULTS Mean (P < .0003), min (P < .00001), spatial standard deviation (P < .01), and max-min (P < .001) were significantly different between the groups. In post hoc pairwise comparisons, the best differentiators for group comparisons were mean (P = .0004) and min (P = .000002) for Controls vs KC, min (P = .0022) and max-min (P = .002) for Controls vs LVC, and mean (P = .0037) and min (P = .0043) for LVC vs KC. Min (area under the receiver operating characteristic = 1.0) and mean (area under the receiver operating characteristic = 0.96) performed well in differentiating Control and KC eyes. Min values correlated best with Brillouin shift values at the thinnest corneal point (r2 = 0.871, P = .001) and maximum keratometry value identified in the tangential curvature map (r2 = 0.840, P = .002). CONCLUSIONS Motion-tracking Brillouin microscopy effectively characterized focal corneal biomechanical alterations in LVC and KC and clearly differentiated these groups from Controls. Primary motion-tracking Brillouin metrics performed well in differentiating groups as compared with basic Scheimpflug metrics, in contrast to previous Brillouin studies, and identified focal changes after LVC where prior Brillouin studies did not.
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Affiliation(s)
- Hongyuan Zhang
- From The Cole Eye Institute, Cleveland Clinic (H.Z., L.A., I.T., W.J.D., J.B.R.)
| | - Lara Asroui
- From The Cole Eye Institute, Cleveland Clinic (H.Z., L.A., I.T., W.J.D., J.B.R.)
| | - Imane Tarib
- From The Cole Eye Institute, Cleveland Clinic (H.Z., L.A., I.T., W.J.D., J.B.R.)
| | - William J Dupps
- From The Cole Eye Institute, Cleveland Clinic (H.Z., L.A., I.T., W.J.D., J.B.R.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (W.J.D., J.B.R.); Department of Biomedical Engineering, Case Western Reserve University (W.J.D.), Cleveland, Ohio
| | - Giuliano Scarcelli
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland (GS), USA
| | - J Bradley Randleman
- From The Cole Eye Institute, Cleveland Clinic (H.Z., L.A., I.T., W.J.D., J.B.R.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (W.J.D., J.B.R.).
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Lan G, Twa MD, Song C, Feng J, Huang Y, Xu J, Qin J, An L, Wei X. In vivo corneal elastography: A topical review of challenges and opportunities. Comput Struct Biotechnol J 2023; 21:2664-2687. [PMID: 37181662 PMCID: PMC10173410 DOI: 10.1016/j.csbj.2023.04.009] [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: 02/14/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Clinical measurement of corneal biomechanics can aid in the early diagnosis, progression tracking, and treatment evaluation of ocular diseases. Over the past two decades, interdisciplinary collaborations between investigators in optical engineering, analytical biomechanical modeling, and clinical research has expanded our knowledge of corneal biomechanics. These advances have led to innovations in testing methods (ex vivo, and recently, in vivo) across multiple spatial and strain scales. However, in vivo measurement of corneal biomechanics remains a long-standing challenge and is currently an active area of research. Here, we review the existing and emerging approaches for in vivo corneal biomechanics evaluation, which include corneal applanation methods, such as ocular response analyzer (ORA) and corneal visualization Scheimpflug technology (Corvis ST), Brillouin microscopy, and elastography methods, and the emerging field of optical coherence elastography (OCE). We describe the fundamental concepts, analytical methods, and current clinical status for each of these methods. Finally, we discuss open questions for the current state of in vivo biomechanics assessment techniques and requirements for wider use that will further broaden our understanding of corneal biomechanics for the detection and management of ocular diseases, and improve the safety and efficacy of future clinical practice.
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Affiliation(s)
- Gongpu Lan
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Michael D. Twa
- College of Optometry, University of Houston, Houston, TX 77204, United States
| | - Chengjin Song
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
| | - JinPing Feng
- Institute of Engineering and Technology, Hubei University of Science and Technology, Xianning, Hubei 437100, China
| | - Yanping Huang
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Jingjiang Xu
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Jia Qin
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Lin An
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Xunbin Wei
- Biomedical Engineering Department, Peking University, Beijing 100081, China
- International Cancer Institute, Peking University, Beijing 100191, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
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Wallerstein A, Gauvin M, Rocha G, Sison R, Korban S, Cohen M. Three-Year Outcomes of Under-flap Stromal Bed CXL for Early Post-LASIK Ectasia. J Refract Surg 2022; 38:511-519. [PMID: 35946998 DOI: 10.3928/1081597x-20220713-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the 36-month clinical outcomes of under-flap stromal bed CXL (ufCXL) and report on its ability to stabilize post-laser in situ keratomileusis (LASIK) ectasia. METHODS This case series included 20 eyes with diagnosed early post-LASIK ectasia treated with ufCXL. Inclusion criteria were early, mild post-LASIK ectasia, defined as new-onset postoperative manifest refraction cylinder of 1.50 diopters (D) or less, with new topographic inferior steepening consistent with ectasia, uncorrected distance visual acuity of 20/40 or better, and corrected distance visual acuity of 20/25 or better. The existing LASIK flap was lifted, 0.25% isotonic riboflavin was applied directly to the stromal bed, the flap was repositioned, and 18 mW/cm2 ultraviolet light was applied for 5 minutes to the corneal flap surface. Post-ufCXL ophthalmic data were compared to pre-ufCXL baseline measurements. RESULTS Visual outcomes were maintained pre-ufCXL to 36 months post-ufCXL, with preserved safety index (P = .6545), efficacy index (P = .4980), spherical equivalent accuracy (P = .1536), defocus equivalent accuracy (P = .1032), central corneal thickness (P = .5196), and corneal irregularity indices at 3 mm (P = .8548) and 5 mm (P = .3399). Refractive astigmatism significantly decreased from 0.83 to 0.55 D pre-ufCXL to post-ufCXL (P = .0439), as did maximum keratometry from 42.40 to 42.00 D pre-ufCXL to post-ufCXL (P = .0420). The ufCXL demarcation line depth was 336 ± 21 µm post-ufCXL, with normal endothelial cell density (2,574 ± 203 cells/mm2). Only 1 of 20 eyes showed evidence of progression of 1.00 D in maximum keratometry. CONCLUSIONS The ufCXL procedure shows promise in stabilizing early post-LASIK ectasia. Visual function, refractive astigmatism, maximum keratometry, and corneal irregularity indices were statistically maintained at 36 months postoperatively. [J Refract Surg. 2022;38(8):511-519.].
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Li J, Zhang H, Lu M, Wei H, Li Y. Sensitive impulsive stimulated Brillouin spectroscopy by an adaptive noise-suppression Matrix Pencil. OPTICS EXPRESS 2022; 30:29598-29610. [PMID: 36299131 DOI: 10.1364/oe.465106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/17/2022] [Indexed: 06/16/2023]
Abstract
Impulsive stimulated Brillouin spectroscopy (ISBS) plays a critical role in investigating mechanical properties thanks to its fast measurement rate. However, traditional Fourier transform-based data processing cannot decipher measured data sensitively because of its incompetence in dealing with low signal-to-noise ratio (SNR) signals caused by a short exposure time and weak signals in a multi-peak spectrum. Here, we propose an adaptive noise-suppression Matrix Pencil method for heterodyne ISBS as an alternative spectral analysis technique, speeding up the measurement regardless of the low SNR and enhancing the sensitivity of multi-component viscoelastic identification. The algorithm maintains accuracy of 0.005% for methanol sound speed even when the SNR drops 33 dB and the exposure time is reduced to 0.4 ms. Moreover, it proves to extract a weak component that accounts for 6% from a polymer mixture, which is inaccessible for the traditional method. With its outstanding ability to sensitively decipher weak signals without spectral a priori information and regardless of low SNRs or concentrations, this method offers a fresh perspective for ISBS on fast viscoelasticity measurements and multi-component identifications.
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Nasef MH, El Emam SY, Haleem TI, Shalaby WS, Allam WA. Visual and Topographic Outcomes of Corneal Collagen Cross Linking for Post LASIK Ectasia. Clin Ophthalmol 2022; 16:2025-2032. [PMID: 35757019 PMCID: PMC9231688 DOI: 10.2147/opth.s370033] [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] [Received: 04/12/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the topographic and visual outcomes of corneal cross-linking (CXL) for post-LASIK ectasia. Methods A retrospective case series of patients who had progressive post-LASIK ectasia, with at least 2 years of follow-up. They had epithelium-off CXL. Topographical and visual changes were recorded. Results The study included 21 eyes of 11 patients. At month 24, the final logMAR corrected distance visual acuity (CDVA) and spherical equivalent (SE) were stable compared to baseline (0.16, and −2.0 diopter (D), respectively). The final Kmean and Kmax were 42.5 and 47.4 D, respectively. Stability or improvement in CDVA, SE, and Kmax was seen in 17 eyes (81%). Significant corneal thinning was seen (438 vs 457 microns, p = 0.003). Thinning by 2% or more was seen in 12 eyes (57.1%). Failure of CXL was seen in 4 eyes (19%). No other ocular complications were seen. Conclusion CXL for post LASIK ectasia is a safe and effective modality. Despite corneal thinning, there was stability or improvement in topographic parameters and CDVA over the 2-year follow-up period.
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Affiliation(s)
- Mohamed H Nasef
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
- Correspondence: Mohamed H Nasef, Tanta University Ophthalmology Hospital, Tanta University Medical Campus, Al-Geish St, Tanta, Gharbia, 31527, Egypt, Tel +20 10 02826555, Email
| | - Sharif Y El Emam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Tamer I Haleem
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Wesam S Shalaby
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Waleed A Allam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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Ferguson TJ, Singuri S, Jalaj S, Ford MR, De Stefano VS, Seven I, Dupps WJ. Depth-resolved Corneal Biomechanical Changes Measured Via Optical Coherence Elastography Following Corneal Crosslinking. Transl Vis Sci Technol 2021; 10:7. [PMID: 34313710 PMCID: PMC8322708 DOI: 10.1167/tvst.10.5.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate depth-resolved changes of corneal biomechanical properties in eyes with corneal ectasia after corneal crosslinking (CXL) using optical coherence elastography. Methods In a prospective pilot series of eyes with corneal ectasia, a custom high-speed swept source optical coherence tomography system was used to image the cornea before and 3 months after CXL during a low-speed applanating deformation while monitoring applanation force. Cross-correlation was applied to track frame-by-frame two-dimensional optical coherence tomography speckle displacements, and the slope of force versus local axial displacement behavior during the deformation was used to produce a two-dimensional array of axial stiffness (k). These values were averaged for anterior (ka) and posterior (kp) stromal regions and expressed as a ratio (ka/kp) to assess depth-dependent differences in stiffness. CXL was performed according to the Dresden protocol with a system approved by the U.S. Food and Drug Administration. Results Four eyes from four patients with keratoconus (n = 3) or post-LASIK ectasia (n = 1) underwent optical coherence elastography before and 3 months after CXL. The mean ka/kp was 1.03 ± 0.07 before CXL compared with 1.34 ± 0.17 after the CXL procedure. All four eyes demonstrated at least a 20% increase in the ka/kp. Conclusions Preferential stiffening of the anterior stroma with the standard CXL protocol was demonstrated with optical coherence elastography in live human subjects. Translational Relevance Although ex vivo studies have demonstrated anterior stiffening effects after CXL using various destructive and nondestructive methods, this report presents the first evidence of such changes in serial live human measurements.
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Affiliation(s)
| | - Srinidhi Singuri
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, Ohio, USA
| | - Sanjai Jalaj
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew R Ford
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ibrahim Seven
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William J Dupps
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, Ohio, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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