Progress on Developing Adaptive Optics-Optical Coherence Tomography for In Vivo Retinal Imaging: Monitoring and Correction of Eye Motion Artifacts

Relationship of retinal capillary plexus and ganglion cell complex with mild cognitive impairment and dementia

OBJECTIVE

To investigate relationship of the retinal capillary plexus (RCP) and ganglion cell complex (GCC) with mild cognitive impairment (MCI) and dementia in a community-based study1.

METHODS

This cross-sectional study incorporated the participants of the Jidong Eye Cohort Study. Optical coherence tomography angiography was performed to obtain RCP vessel density and GCC thickness with detailed segments. The Mini-mental State Examination and Montreal Cognitive Assessment were used to assess cognitive status by professional neuropsychologists. Participants were thus divided into three groups: normal, mild cognitive impairment, and dementia. Multivariable analysis was used to measure relationship of ocular parameters with cognitive impairment.

RESULTS

Of the 2678 participants, the mean age was 44.1 ± 11.7 years. MCI and dementia occurred in 197 (7.4%) and 80 (3%) participants, respectively. Compared to the normal group, the adjusted odds ratio (OR) with the 95% confidence interval was 0.76 (0.65-0.90) for the correlation of lower deep RCP with MCI. We found the following items significantly associated with dementia compared with the normal group: a superficial (OR, 0.68 [0.54-0.86]) and deep (OR, 0.75 [0.57-0.99]) RCP, as well as the GCC (OR, 0.68 [0.54-0.85]). Compared to the MCI group, those with dementia had decreased GCC (OR, 0.75 [0.58-0.97]).

CONCLUSIONS

Decreased deep RCP density was associated with MCI. Decreased superficial and deep RCP and the thin GCC were correlated with dementia. These implied that the retinal microvasculature may develop into a promising non-invasive imaging marker to predict severity of cognitive impairment.

Retinal imaging using adaptive optics optical coherence tomography with fast and accurate real-time tracking

One of the main obstacles in high-resolution 3-D retinal imaging is eye motion, which causes blur and distortion artifacts that require extensive post-processing to be corrected. Here, an adaptive optics optical coherence tomography (AOOCT) system with real-time active eye motion correction is presented. Correction of ocular aberrations and of retinal motion is provided by an adaptive optics scanning laser ophthalmoscope (AOSLO) that is optically and electronically combined with the AOOCT system. We describe the system design and quantify its performance. The AOOCT system features an independent focus adjustment that allows focusing on different retinal layers while maintaining the AOSLO focus on the photoreceptor mosaic for high fidelity active motion correction. The use of a high-quality reference frame for eye tracking increases revisitation accuracy between successive imaging sessions, allowing to collect several volumes from the same area. This system enables spatially targeted retinal imaging as well as volume averaging over multiple imaging sessions with minimal correction of motion in post processing.

Retinal cross-section motion correction in three-dimensional retinal optical coherence tomography

Motion correction is an important issue in ophthalmic optical coherence tomography (OCT), and can improve the ability of data sets to reflect the physiological structures of tissues and make visualization and subsequent analysis easier. In this study, we present a novel method to correct the cross-sectional motion artifacts in retinal OCT volumes. Motion along the x-direction (fast-scan direction) is corrected through the normalized cross-correlation algorithm, while axial motion compensation is performed using the polynomial fitting method on the inner segment/outer segment (IS/OS) layer segmented by the shortest path faster algorithm (SPFA). The results of volunteers with central serous chorioretinopathy demonstrate that the proposed method effectively corrects motion artifacts in OCT volumes and may have potential application value in the evaluation of ophthalmic diseases such as diabetic retinopathy, glaucoma and age-related macular degeneration.

Eighty-Five Percent of Improved Optical Power Delivery to Epiretinal Prostheses Using Rigid Body Compensation Algorithm

Vision impairment caused by degenerative retinal pathologies such as age-related macular degeneration can be treated using retinal implants. Such devices receive power and data using cables passing through a permanent surgical incision in the eye wall (sclera), which increases the risk to patients and surgical costs. A recently developed retinal implant design eliminates the necessity of the implant cable using a photonic power converter (PPC), which receives optical power and data through the pupil and is directed by an ellipsoidal reflector and micro-electromechanical mirror. We present a misalignment compensation algorithm model that accounts for rigid-body motions of the reflector relative to the eye and applies the correction to the mirror coordinates in the presence of angular misalignment of the reflector. We demonstrate that up to 85% of the nominal optical power can be delivered to the implant with axial reflector misalignments up to 30 deg using the compensation algorithm.

Accurately motion-corrected Lissajous OCT with multi-type image registration

Passive motion correction methods for optical coherence tomography (OCT) use image registration to estimate eye movements. To improve motion correction, a multi-image cross-correlation that employs spatial features in different image types is introduced. Lateral motion correction using en face OCT and OCT-A projections on Lissajous-scanned OCT data is applied. Motion correction using OCT-A projection of whole depth and OCT amplitude, OCT logarithmic intensity, and OCT maximum intensity projections were evaluated in retinal imaging with 76 patients. The proposed method was compared with motion correction using OCT-A projection of whole depth. The comparison shows improvements in the image quality of motion-corrected superficial OCT-A images and image registration.

Spatio-temporal filtering in laser Doppler holography for retinal blood flow imaging

Laser Doppler holography (LDH) is a full-field interferometric imaging technique recently applied in ophthalmology to measure blood flow, a parameter of high clinical interest. From the temporal fluctuations of digital holograms acquired at ultrafast frame rates, LDH reveals retinal and choroidal blood flow with a few milliseconds of temporal resolution. However, LDH experiences difficulties to detect slower blood flow as it requires to work with low Doppler frequency shifts which are corrupted by eye motion. We here demonstrate the use of a spatio-temporal decomposition adapted from Doppler ultrasound that provides a basis appropriate to the discrimination of blood flow from eye motion. A singular value decomposition (SVD) can be used as a simple, robust, and efficient way to separate the Doppler fluctuations of blood flow from those of strong spatial coherence such as eye motion. We show that the SVD outperforms the conventional Fourier based filter to reveal slower blood flow, and dramatically improves the ability of LDH to reveal vessels of smaller size or with a pathologically reduced blood flow.

Adaptive optics imaging of the human retina

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.

Impact of CMOS Pixel and Electronic Circuitry in the Performance of a Hartmann-Shack Wavefront Sensor

This work presents a numerical simulation of a Hartmann-Shack wavefront sensor (WFS) that assesses the impact of integrated electronic circuitry on the sensor performance, by evaluating a full detection chain encompassing wavefront sampling, photodetection, electronic circuitry and wavefront reconstruction. This platform links dedicated C algorithms for WFS to a SPICE circuit simulator for integrated electronics. The complete codes can be easily replaced in order to represent different detection or reconstruction methods, while the circuit simulator employs reliable models of either off-the-shelf circuit components or custom integrated circuit modules. The most relevant role of this platform is to enable the evaluation of the applicability and constraints of the focal plane of a given wavefront sensor prior to the actual fabrication of the detector chip. In this paper, we will present the simulation results for a Hartmann-Shack wavefront sensor with an orthogonal array of quad-cells (QC) integrated along with active-pixel (active-pixel sensor (APS)) circuitry and analog-to-digital converters (ADC) on a “complementary metal oxide semiconductor” (CMOS) process and deploying a modal wavefront reconstructor. This extended simulation capability for wavefront sensors enables the test and verification of different photosensitive and circuitry topologies for position-sensitive detectors combined with the simulation of sampling microlenses and reconstruction algorithms, with the goal of enhancing the accuracy in the prediction of the wavefront-sensor performance before a detector CMOS chip is actually fabricated.

Volumetric imaging of rod and cone photoreceptor structure with a combined adaptive optics-optical coherence tomography-scanning laser ophthalmoscope

We have designed and implemented a dual-mode adaptive optics (AO) imaging system that combines spectral domain optical coherence tomography (OCT) and scanning laser ophthalmoscopy (SLO) for in vivo imaging of the human retina. The system simultaneously acquires SLO frames and OCT B-scans at 60 Hz with an OCT volume acquisition time of 4.2 s. Transverse eye motion measured from the SLO is used to register the OCT B-scans to generate three-dimensional (3-D) volumes. Key optical design considerations include: minimizing system aberrations through the use of off-axis relay telescopes, conjugate pupil plane requirements, and the use of dichroic beam splitters to separate and recombine the OCT and SLO beams around the nonshared horizontal scanning mirrors. To demonstrate system performance, AO-OCT-SLO images and measurements are taken from three normal human subjects ranging in retinal eccentricity from the fovea out to 15-deg temporal and 20-deg superior. Also presented are en face OCT projections generated from the registered 3-D volumes. The ability to acquire high-resolution 3-D images of the human retina in the midperiphery and beyond has clinical importance in diseases, such as retinitis pigmentosa and cone-rod dystrophy.

In-vivo digital wavefront sensing using swept source OCT

Sub-aperture based digital adaptive optics is demonstrated in a fiber based point scanning optical coherence tomography system using a 1060 nm swept source laser. To detect optical aberrations in-vivo, a small lateral field of view of ~[Formula: see text] is scanned on the sample at a high volume rate of 17 Hz (~1.3 kHz B-scan rate) to avoid any significant lateral and axial motion of the sample, and is used as a "guide star" for the sub-aperture based DAO. The proof of principle is demonstrated using a micro-beads phantom sample, wherein a significant root mean square wavefront error (RMS WFE) of 1.48 waves (> 1[Formula: see text]) is detected. In-vivo aberration measurement with a RMS WFE of 0.33 waves, which is ~5 times higher than the Marechal's criterion of [Formula: see text] waves for the diffraction limited performance, is shown for a human retinal OCT. Attempt has been made to validate the experimental results with the conventional Shack-Hartmann wavefront sensor within reasonable limitations.

Adaptive optics optical coherence tomography in glaucoma

Since the introduction of commercial optical coherence tomography (OCT) systems, the ophthalmic imaging modality has rapidly expanded and it has since changed the paradigm of visualization of the retina and revolutionized the management and diagnosis of neuro-retinal diseases, including glaucoma. OCT remains a dynamic and evolving imaging modality, growing from time-domain OCT to the improved spectral-domain OCT, adapting novel image analysis and processing methods, and onto the newer swept-source OCT and the implementation of adaptive optics (AO) into OCT. The incorporation of AO into ophthalmic imaging modalities has enhanced OCT by improving image resolution and quality, particularly in the posterior segment of the eye. Although OCT previously captured in-vivo cross-sectional images with unparalleled high resolution in the axial direction, monochromatic aberrations of the eye limit transverse or lateral resolution to about 15-20 μm and reduce overall image quality. In pairing AO technology with OCT, it is now possible to obtain diffraction-limited resolution images of the optic nerve head and retina in three-dimensions, increasing resolution down to a theoretical 3 μm3. It is now possible to visualize discrete structures within the posterior eye, such as photoreceptors, retinal nerve fiber layer bundles, the lamina cribrosa, and other structures relevant to glaucoma. Despite its limitations and barriers to widespread commercialization, the expanding role of AO in OCT is propelling this technology into clinical trials and onto becoming an invaluable modality in the clinician's arsenal.

Involuntary eye motion correction in retinal optical coherence tomography: Hardware or software solution?

In this paper, we review state-of-the-art techniques to correct eye motion artifacts in Optical Coherence Tomography (OCT) imaging. The methods for eye motion artifact reduction can be categorized into two major classes: (1) hardware-based techniques and (2) software-based techniques. In the first class, additional hardware is mounted onto the OCT scanner to gather information about the eye motion patterns during OCT data acquisition. This information is later processed and applied to the OCT data for creating an anatomically correct representation of the retina, either in an offline or online manner. In software based techniques, the motion patterns are approximated either by comparing the acquired data to a reference image, or by considering some prior assumptions about the nature of the eye motion. Careful investigations done on the most common methods in the field provides invaluable insight regarding future directions of the research in this area. The challenge in hardware-based techniques lies in the implementation aspects of particular devices. However, the results of these techniques are superior to those obtained from software-based techniques because they are capable of capturing secondary data related to eye motion during OCT acquisition. Software-based techniques on the other hand, achieve moderate success and their performance is highly dependent on the quality of the OCT data in terms of the amount of motion artifacts contained in them. However, they are still relevant to the field since they are the sole class of techniques with the ability to be applied to legacy data acquired using systems that do not have extra hardware to track eye motion.

A Review of Adaptive Optics Optical Coherence Tomography: Technical Advances, Scientific Applications, and the Future

PURPOSE

Optical coherence tomography (OCT) has enabled "virtual biopsy" of the living human retina, revolutionizing both basic retina research and clinical practice over the past 25 years. For most of those years, in parallel, adaptive optics (AO) has been used to improve the transverse resolution of ophthalmoscopes to foster in vivo study of the retina at the microscopic level. Here, we review work done over the last 15 years to combine the microscopic transverse resolution of AO with the microscopic axial resolution of OCT, building AO-OCT systems with the highest three-dimensional resolution of any existing retinal imaging modality.

METHODS

We surveyed the literature to identify the most influential antecedent work, important milestones in the development of AO-OCT technology, its applications that have yielded new knowledge, research areas into which it may productively expand, and nascent applications that have the potential to grow.

RESULTS

Initial efforts focused on demonstrating three-dimensional resolution. Since then, many improvements have been made in resolution and speed, as well as other enhancements of acquisition and postprocessing techniques. Progress on these fronts has produced numerous discoveries about the anatomy, function, and optical properties of the retina.

CONCLUSIONS

Adaptive optics OCT continues to evolve technically and to contribute to our basic and clinical knowledge of the retina. Due to its capacity to reveal cellular and microscopic detail invisible to clinical OCT systems, it is an ideal companion to those instruments and has the demonstrable potential to produce images that can guide the interpretation of clinical findings.

Multi-modal adaptive optics system including fundus photography and optical coherence tomography for the clinical setting

We present a new compact multi-modal imaging prototype that combines an adaptive optics (AO) fundus camera with AO-optical coherence tomography (OCT) in a single instrument. The prototype allows acquiring AO fundus images with a field of view of 4°x4° and with a frame rate of 10fps. The exposure time of a single image is 10 ms. The short exposure time results in nearly motion artifact-free high resolution images of the retina. The AO-OCT mode allows acquiring volumetric data of the retina at 200kHz A-scan rate with a transverse resolution of ~4 µm and an axial resolution of ~5 µm. OCT imaging is acquired within a field of view of 2°x2° located at the central part of the AO fundus image. Recording of OCT volume data takes 0.8 seconds. The performance of the new system is tested in healthy volunteers and patients with retinal diseases.

Adaptive optics ophthalmoscopy

This review starts with a brief history and description of adaptive optics (AO) technology, followed by a showcase of the latest capabilities of AO systems for imaging the human retina and an extensive review of the literature on where AO is being used clinically. The review concludes with a discussion on future directions and guidance on usage and interpretation of images from AO systems for the eye.