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Lombardo M, Serrao S, Lombardo G. Challenges in Age-Related Macular Degeneration: From Risk Factors to Novel Diagnostics and Prevention Strategies. Front Med (Lausanne) 2022; 9:887104. [PMID: 35733877 PMCID: PMC9207205 DOI: 10.3389/fmed.2022.887104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Abstract
Age-related macular degeneration (AMD) is a chronic multifactorial eye disease representing the primary cause of vision loss in people aged 60 years and older. The etiopathogenesis of the disease remains uncertain, with several risk factors contributing to its onset and progression, such as genotype, aging, hypertension, smoking, overweight, and low dietary intake of carotenoids. Since the aging populations of the industrialized world are increasing rapidly, the impact of AMD in the socio-economical life-developed countries is expected to increase dramatically in the next years. In this context, the benefits of prevention and early disease detection for prompt and effective treatment can be enormous to reduce the social and economic burden of AMD. Nutritional and lifestyle changes, including dietary intake of xanthophyll pigments, such as lutein and zeaxanthin, no smoking, and regular exercise, are known to protect from risk of AMD progression from early to advanced disease stages. In this review, we present the clinical outcomes of a pilot study on trans-scleral iontophoresis delivery of lutein in patients with AMD. Topical delivery of lutein directly to the macula may provide a more efficient method for enriching the macular pigment and for achieving greater patient compliance to therapy than oral administration and thus enhancing prevention strategies. Modern diagnostic methodologies shall address the major problem of accurately detecting the risk of transition from intermediate AMD to advanced AMD stages. Adaptive optics retinal imaging and resonance Raman spectroscopy are two highly promising technologies for the objective assessment of patients with AMD. In this review, we present some of their clinical applications for collecting quantitative measurements of retinal cellular changes and macular content of xanthophyll pigments, respectively. In conclusion, there is great expectation that technological advancements in AMD management will deliver improved screening, therapeutic prevention, and diagnostic systems in the coming decade through a pro-active strategy of “treatment for prevention” that will aim to reduce the global burden of vision loss caused by AMD in the elderly.
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Affiliation(s)
- Marco Lombardo
- Studio Italiano di Oftalmologia, Rome, Italy
- Vision Engineering Italy srl, Rome, Italy
- *Correspondence: Marco Lombardo
| | - Sebastiano Serrao
- Studio Italiano di Oftalmologia, Rome, Italy
- Vision Engineering Italy srl, Rome, Italy
| | - Giuseppe Lombardo
- Vision Engineering Italy srl, Rome, Italy
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Messina, Italy
- Giuseppe Lombardo
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Baraas RC, Horjen Å, Gilson SJ, Pedersen HR. The Relationship Between Perifoveal L-Cone Isolating Visual Acuity and Cone Photoreceptor Spacing-Understanding the Transition Between Healthy Aging and Early AMD. Front Aging Neurosci 2021; 13:732287. [PMID: 34566629 PMCID: PMC8458634 DOI: 10.3389/fnagi.2021.732287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Age-related macular degeneration (AMD) is a multifactorial degenerative disorder that can lead to irreversible loss of visual function, with aging being the prime risk factor. However, knowledge about the transition between healthy aging and early AMD is limited. We aimed to examine the relationship between psychophysical measures of perifoveal L-cone acuity and cone photoreceptor structure in healthy aging and early AMD. Methods and Results: Thirty-nine healthy participants, 10 with early AMD and 29 healthy controls were included in the study. Multimodal high-resolution retinal images were obtained with adaptive-optics scanning-light ophthalmoscopy (AOSLO), optical-coherence tomography (OCT), and color fundus photographs. At 5 degrees retinal eccentricity, perifoveal L-cone isolating letter acuity was measured with psychophysics, cone inner segment and outer segment lengths were measured using OCT, while cone density, spacing, and mosaic regularity were measured using AOSLO. The Nyquist sampling limit of cone mosaic (Nc) was calculated for each participant. Both L-cone acuity and photoreceptor inner segment length declined with age, but there was no association between cone density nor outer segment length and age. A multiple regression showed that 56% of the variation in log L-cone acuity was accounted for by Nc when age was taken into account. Six AMD participants with low risk of progression were well within confidence limits, while two with medium-to-severe risk of progression were outliers. The observable difference in cone structure between healthy aging and early AMD was a significant shortening of cone outer segments. Conclusion: The results underscore the resilience of cone structure with age, with perifoveal functional changes preceding detectable changes in the cone photoreceptor mosaic. L-cone acuity is a sensitive measure for assessing age-related decline in this region. The transition between healthy aging of cone structures and changes in cone structures secondary to early AMD relates to outer segment shortening.
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Affiliation(s)
- Rigmor C Baraas
- Faculty of Health and Social Sciences, National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Åshild Horjen
- Faculty of Health and Social Sciences, National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Stuart J Gilson
- Faculty of Health and Social Sciences, National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Hilde R Pedersen
- Faculty of Health and Social Sciences, National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
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Schneck ME, Lott LA, Haegerstrom-Portnoy G, Hewlett S, Gauer BM, Zaidi A. Visual Function in Eyes with Intermediate AMD with and without Retinal Pigment Abnormalities. Optom Vis Sci 2021; 98:64-72. [PMID: 33394933 PMCID: PMC7774812 DOI: 10.1097/opx.0000000000001624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 08/22/2020] [Indexed: 11/28/2022] Open
Abstract
SIGNIFICANCE In intermediate AMD, a simple, clinically feasible vision test of sensitivity to radial deformation is significantly more impaired in eyes with hyperpigmentation than in eyes with large drusen but normal retinal pigmentation, consistent with the former's increased risk of progression to advanced AMD. This ongoing longitudinal study will determine whether this vision measure is predictive of progression to advanced AMD. PURPOSE This study aimed to determine whether simple, clinically feasible psychophysical measures distinguish between two levels of intermediate AMD that differ in their risk of progression to advanced AMD: eyes with large macular drusen and retinal pigment abnormalities versus eyes with large macular drusen without pigment abnormalities. Abnormal pigmentation in the presence of large drusen is associated with a higher risk of development of advanced AMD. METHODS Each eye of 39 individuals with the same form of intermediate AMD in both eyes was tested monocularly on a battery of vision tests. The measures (photopic optotype contrast sensitivity, discrimination of desaturated colors, and sensitivity to radial deformation [shape discrimination hyperacuity]) were compared for both dominant and nondominant eyes. ANOVA with eye (dominant or nondominant) as a within-subject factor and retinal status (pigmentary abnormalities present or absent from the macula) as a between-subject factor was used to determine statistical significance. RESULTS Sensitivity to radial deformation was significantly reduced in eyes with large drusen and pigment changes compared with eyes with large drusen and normal retinal pigmentation (-0.40 ± 0.04 vs. -0.61 ± 0.02, respectively; F = 13.31, P = .001). CONCLUSIONS In the presence of large macular drusen, performance on a shape discrimination task is related to the presence versus absence of abnormal retinal pigmentation, being poorer in the higher-risk group, supportive of the measure's potential to predict progression to advanced AMD.
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Affiliation(s)
| | - Lori A. Lott
- The Smith-Kettlewell Eye Research Institute, San Francisco, California
| | - Gunilla Haegerstrom-Portnoy
- The Smith-Kettlewell Eye Research Institute, San Francisco, California
- School of Optometry, University of California, Berkeley, Berkeley, California
| | - Susan Hewlett
- The Smith-Kettlewell Eye Research Institute, San Francisco, California
- School of Optometry, University of California, Berkeley, Berkeley, California
| | | | - Ali Zaidi
- Pacific Eye Associates, San Francisco, California
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Zhang Y, Wang X, Clark ME, Curcio CA, Owsley C. Imaging of Age-Related Macular Degeneration by Adaptive Optics Scanning Laser Ophthalmoscopy in Eyes With Aged Lenses or Intraocular Lenses. Transl Vis Sci Technol 2020; 9:41. [PMID: 32855887 PMCID: PMC7422803 DOI: 10.1167/tvst.9.8.41] [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: 01/15/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose To assess the performance of adaptive optics scanning laser ophthalmoscopy (AOSLO) in a large sample of eyes with or without age-related macular degeneration (AMD) and with cataracts or intraocular lenses (IOLs). Methods Patients with various degrees of AMD and age-similar normal subjects underwent fundus photography. Cataract severity and IOL clarity were assessed by fundus reflex photographs. In phakic eyes, lenticular opacity was graded as nuclear, cortical, or posterior subcapsular cataract. In eyes with IOLs, lens clarity was assessed by posterior capsule opacification (PCO). Quality of AOSLO images of the macular photoreceptor mosaic was classified as good, adequate or inadequate by human graders in a subjective assessment of cone visibility. Results A total of 159 eyes in 80 subjects (41 males, 39 females, aged 72.5 ± 11.5 years, 16 normals) were examined. Seventy-nine eyes had IOLs, and 80 eyes were phakic. AOSLO produced good images in 91 eyes (57%), adequate images in eight eyes (5%), and inadequate images in 27 eyes (17%). AOSLO did not acquire images in 33 eyes (21%), because of dense lenticular opacity, widespread PCO, or problems specific to individual subjects. Conclusions AOSLO images considered at least Adequate or better for visualizing cone photoreceptors were acquired from 62% of study eyes. Translational Relevance AOSLO can be used as an additional imaging modality to investigate the structure of cone photoreceptors in research on visual function in AMD and in clinical trials involving older patients.
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Affiliation(s)
- Yuhua Zhang
- Department of Ophthalmology, University of California-Los Angeles, Los Angeles, CA, USA.,Doheny Eye Institute, Los Angeles, CA, USA
| | | | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Wang Y, He Y, Wei L, Yang J, Li X, Zhou H, Shi G, Zhang Y. Bimorph deformable mirror-based adaptive optics scanning laser ophthalmoscope for the clinical design and performance. NEUROPHOTONICS 2019; 6:041111. [PMID: 31720308 PMCID: PMC6830288 DOI: 10.1117/1.nph.6.4.041111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
We developed a clinical ophthalmic prototype by combining bimorph deformable mirror (DM)-based adaptive optics (AO) with a confocal scanning laser ophthalmoscope. A low-cost bimorph DM with a large stroke of 50 μ m and an aperture of 20 mm was utilized to realize a strategy for successive AO control of aberration correction, which permitted open-loop compensation for low-order aberrations and closed-loop correction of high-order aberrations to acceptable root mean square errors of < 0.08 μ m in all subjects. Spherical mirrors were folded in a nonplanar configuration to minimize off-axis aberrations and provide a compact, cost-effective design, which achieved a diffraction-limited performance capable of imaging individual photoreceptor cells and blood vessels not only in healthy subjects but also in patients suffering from retinitis pigmentosa. The adaptive optics scanning laser ophthalmoscope (AOSLO) images of the diseased retina had much higher resolutions than those captured by the commercial AO fundus camera, and loss of the photoreceptor mosaic could be distinguished more accurately due to the improvement in resolution. The compact design and easy handling of the bimorph DM-based AO control may facilitate the translation of AOSLO into clinical settings, and this prototype development will continue with future device refinement and extensive clinical testing.
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Affiliation(s)
- Yuanyuan Wang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Wenzhou Medical University, Wenzhou, China
- Chinese Academy of Sciences, Key Laboratory on Adaptive Optics, Chengdu, China
| | - Yi He
- Chinese Academy of Sciences, Key Laboratory on Adaptive Optics, Chengdu, China
- Jiangsu Key Laboratory of Medical Optics, Suzhou, China
- Chinese Academy of Sciences, Suzhou Institute of Biomedical Engineering and Technology, Suzhou, China
| | - Ling Wei
- Chinese Academy of Sciences, Key Laboratory on Adaptive Optics, Chengdu, China
| | - Jinsheng Yang
- Chinese Academy of Sciences, Key Laboratory on Adaptive Optics, Chengdu, China
| | - Xiqi Li
- Chinese Academy of Sciences, Key Laboratory on Adaptive Optics, Chengdu, China
| | - Hong Zhou
- Chinese Academy of Sciences, Key Laboratory on Adaptive Optics, Chengdu, China
| | - Guohua Shi
- Jiangsu Key Laboratory of Medical Optics, Suzhou, China
- Chinese Academy of Sciences, Suzhou Institute of Biomedical Engineering and Technology, Suzhou, China
| | - Yudong Zhang
- Chinese Academy of Sciences, Key Laboratory on Adaptive Optics, Chengdu, China
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Burns SA, Elsner AE, Sapoznik KA, Warner RL, Gast TJ. Adaptive optics imaging of the human retina. Prog Retin Eye Res 2019; 68:1-30. [PMID: 30165239 PMCID: PMC6347528 DOI: 10.1016/j.preteyeres.2018.08.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/18/2022]
Abstract
Adaptive Optics (AO) retinal imaging has provided revolutionary tools to scientists and clinicians for studying retinal structure and function in the living eye. From animal models to clinical patients, AO imaging is changing the way scientists are approaching the study of the retina. By providing cellular and subcellular details without the need for histology, it is now possible to perform large scale studies as well as to understand how an individual retina changes over time. Because AO retinal imaging is non-invasive and when performed with near-IR wavelengths both safe and easily tolerated by patients, it holds promise for being incorporated into clinical trials providing cell specific approaches to monitoring diseases and therapeutic interventions. AO is being used to enhance the ability of OCT, fluorescence imaging, and reflectance imaging. By incorporating imaging that is sensitive to differences in the scattering properties of retinal tissue, it is especially sensitive to disease, which can drastically impact retinal tissue properties. This review examines human AO retinal imaging with a concentration on the use of the Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO). It first covers the background and the overall approaches to human AO retinal imaging, and the technology involved, and then concentrates on using AO retinal imaging to study the structure and function of the retina.
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Affiliation(s)
- Stephen A Burns
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States.
| | - Ann E Elsner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Kaitlyn A Sapoznik
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Raymond L Warner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Thomas J Gast
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
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Cooper RF, Wilk MA, Tarima S, Carroll J. Evaluating Descriptive Metrics of the Human Cone Mosaic. Invest Ophthalmol Vis Sci 2017; 57:2992-3001. [PMID: 27273598 PMCID: PMC4898203 DOI: 10.1167/iovs.16-19072] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate how metrics used to describe the cone mosaic change in response to simulated photoreceptor undersampling (i.e., cell loss or misidentification). METHODS Using an adaptive optics ophthalmoscope, we acquired images of the cone mosaic from the center of fixation to 10° along the temporal, superior, inferior, and nasal meridians in 20 healthy subjects. Regions of interest (n = 1780) were extracted at regular intervals along each meridian. Cone mosaic geometry was assessed using a variety of metrics - density, density recovery profile distance (DRPD), nearest neighbor distance (NND), intercell distance (ICD), farthest neighbor distance (FND), percentage of six-sided Voronoi cells, nearest neighbor regularity (NNR), number of neighbors regularity (NoNR), and Voronoi cell area regularity (VCAR). The "performance" of each metric was evaluated by determining the level of simulated loss necessary to obtain 80% statistical power. RESULTS Of the metrics assessed, NND and DRPD were the least sensitive to undersampling, classifying mosaics that lost 50% of their coordinates as indistinguishable from normal. The NoNR was the most sensitive, detecting a significant deviation from normal with only a 10% cell loss. CONCLUSIONS The robustness of cone spacing metrics makes them unsuitable for reliably detecting small deviations from normal or for tracking small changes in the mosaic over time. In contrast, regularity metrics are more sensitive to diffuse loss and, therefore, better suited for detecting such changes, provided the fraction of misidentified cells is minimal. Combining metrics with a variety of sensitivities may provide a more complete picture of the integrity of the photoreceptor mosaic.
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Affiliation(s)
- Robert F Cooper
- Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States
| | - Melissa A Wilk
- Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Sergey Tarima
- Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph Carroll
- Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States 2Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 4Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, U
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Litts KM, Cooper RF, Duncan JL, Carroll J. Photoreceptor-Based Biomarkers in AOSLO Retinal Imaging. Invest Ophthalmol Vis Sci 2017; 58:BIO255-BIO267. [PMID: 28873135 PMCID: PMC5584616 DOI: 10.1167/iovs.17-21868] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/28/2017] [Indexed: 01/08/2023] Open
Abstract
Improved understanding of the mechanisms underlying inherited retinal degenerations has created the possibility of developing much needed treatments for these relentless, blinding diseases. However, standard clinical indicators of retinal health (such as visual acuity and visual field sensitivity) are insensitive measures of photoreceptor survival. In many retinal degenerations, significant photoreceptor loss must occur before measurable differences in visual function are observed. Thus, there is a recognized need for more sensitive outcome measures to assess therapeutic efficacy as numerous clinical trials are getting underway. Adaptive optics (AO) retinal imaging techniques correct for the monochromatic aberrations of the eye and can be used to provide nearly diffraction-limited images of the retina. Many groups routinely are using AO imaging tools to obtain in vivo images of the rod and cone photoreceptor mosaic, and it now is possible to monitor photoreceptor structure over time with single cell resolution. Highlighting recent work using AO scanning light ophthalmoscopy (AOSLO) across a range of patient populations, we review the development of photoreceptor-based metrics (e.g., density/geometry, reflectivity, and size) as candidate biomarkers. Going forward, there is a need for further development of automated tools and normative databases, with the latter facilitating the comparison of data sets across research groups and devices. Ongoing and future clinical trials for inherited retinal diseases will benefit from the improved resolution and sensitivity that multimodal AO retinal imaging affords to evaluate safety and efficacy of emerging therapies.
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Affiliation(s)
- Katie M. Litts
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Robert F. Cooper
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jacque L. Duncan
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Mariotti L, Devaney N, Lombardo G, Lombardo M. Understanding the changes of cone reflectance in adaptive optics flood illumination retinal images over three years. BIOMEDICAL OPTICS EXPRESS 2016; 7:2807-22. [PMID: 27446708 PMCID: PMC4948632 DOI: 10.1364/boe.7.002807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 05/18/2023]
Abstract
Although there is increasing interest in the investigation of cone reflectance variability, little is understood about its characteristics over long time scales. Cone detection and its automation is now becoming a fundamental step in the assessment and monitoring of the health of the retina and in the understanding of the photoreceptor physiology. In this work we provide an insight into the cone reflectance variability over time scales ranging from minutes to three years on the same eye, and for large areas of the retina (≥ 2.0 × 2.0 degrees) at two different retinal eccentricities using a commercial adaptive optics (AO) flood illumination retinal camera. We observed that the difference in reflectance observed in the cones increases with the time separation between the data acquisitions and this may have a negative impact on algorithms attempting to track cones over time. In addition, we determined that displacements of the light source within 0.35 mm of the pupil center, which is the farthest location from the pupil center used by operators of the AO camera to acquire high-quality images of the cone mosaic in clinical studies, does not significantly affect the cone detection and density estimation.
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Affiliation(s)
- Letizia Mariotti
- Applied Optics Group, School of Physics, National University of Ireland, Galway,
Ireland
| | - Nicholas Devaney
- Applied Optics Group, School of Physics, National University of Ireland, Galway,
Ireland
| | - Giuseppe Lombardo
- Istituto per i Processi Chimico-Fisici, Consiglio Nazionale delle Ricerche, Viale F. Stagno D’Alcontres 37, 98158, Messina,
Italy
- Vision Engineering Italy srl, Via Adda 7, 00198 Rome,
Italy
| | - Marco Lombardo
- Fondazione G.B. Bietti IRCCS, Via Livenza 3, 00198 Rome,
Italy
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Morgan JIW. The fundus photo has met its match: optical coherence tomography and adaptive optics ophthalmoscopy are here to stay. Ophthalmic Physiol Opt 2016; 36:218-39. [PMID: 27112222 PMCID: PMC4963017 DOI: 10.1111/opo.12289] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/20/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Over the past 25 years, optical coherence tomography (OCT) and adaptive optics (AO) ophthalmoscopy have revolutionised our ability to non-invasively observe the living retina. The purpose of this review is to highlight the techniques and human clinical applications of recent advances in OCT and adaptive optics scanning laser/light ophthalmoscopy (AOSLO) ophthalmic imaging. RECENT FINDINGS Optical coherence tomography retinal and optic nerve head (ONH) imaging technology allows high resolution in the axial direction resulting in cross-sectional visualisation of retinal and ONH lamination. Complementary AO ophthalmoscopy gives high resolution in the transverse direction resulting in en face visualisation of retinal cell mosaics. Innovative detection schemes applied to OCT and AOSLO technologies (such as spectral domain OCT, OCT angiography, confocal and non-confocal AOSLO, fluorescence, and AO-OCT) have enabled high contrast between retinal and ONH structures in three dimensions and have allowed in vivo retinal imaging to approach that of histological quality. In addition, both OCT and AOSLO have shown the capability to detect retinal reflectance changes in response to visual stimuli, paving the way for future studies to investigate objective biomarkers of visual function at the cellular level. Increasingly, these imaging techniques are being applied to clinical studies of the normal and diseased visual system. SUMMARY Optical coherence tomography and AOSLO technologies are capable of elucidating the structure and function of the retina and ONH noninvasively with unprecedented resolution and contrast. The techniques have proven their worth in both basic science and clinical applications and each will continue to be utilised in future studies for many years to come.
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Affiliation(s)
- Jessica I W Morgan
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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