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Kreminger J, Iby J, Rokitansky S, Stino H, Niederleithner M, Schlegl T, Drexler W, Schmoll T, Leitgeb R, Pollreisz A, Schmidt-Erfurth U, Sacu S. Association of microaneurysms with retinal vascular alterations in patients with retinal vein occlusion. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00253-9. [PMID: 39216511 DOI: 10.1016/j.jcjo.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/04/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To investigate the localization, distribution, and type of central microaneurysms (MAs) and their relationship with retinal vascular alterations in patients with retinal vein occlusion (RVO). METHODS In this cross-sectional study, ultra-widefield color fundus photography (UWF-CF), standard and single-capture 65° widefield (WF) optical coherence tomography angiography (OCTA) were performed in consecutive patients with RVO treated at the Department of Ophthalmology and Optometry, Medical University of Vienna. UWF-CF, en face and B-Scans in 6 mm × 6 mm OCTA were examined for detection of MAs. Nonperfusion areas (NPA) and collateral vessels (CV) were evaluated on WF-OCTA, ghost vessels (GV), and tortuous vessels (TV) on UWF-CF. RESULTS One-hundred-and-twelve patients were included in the study, and data from 59 eyes of 59 patients with disease duration longer than 3 months, good image quality, and without relevant ocular comorbidities were eligible for statistical analysis. Fifty-six of 59 (94.9%) patients were previously treated with anti-vascular endothelial growth factor agents for macular edema, 31 of 59 (52.5%) patients presented with MAs in the central 6 mm and 60 MAs were found in total using multimodal imaging. There was no statistically significant difference in the greatest diameter of fluid-associated versus non-fluid-associated MAs (p = 0.53). Eyes with MAs were associated with CV, TV, and GV (χ2-test; p < 0.001, p = 0.0498, and p = 0.001). Median NPA was 27.3 mm2 (quartiles 1.3-62.8 mm2) in eyes with MAs and 0 mm2 (quartiles 0-36.2 mm2) in eyes without MAs (Mann-Whitney-U-test; p = 0.018). CONCLUSION MAs were associated with extensive NPA, the presence of CV, GV, and TV. There was no correlation between the diameter of the MA and the adjacent intraretinal fluid in our predominantly pretreated RVO study patients.
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Affiliation(s)
- Judith Kreminger
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Johannes Iby
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stephanie Rokitansky
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Heiko Stino
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Michael Niederleithner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlegl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Tilman Schmoll
- Carl Zeiss Meditec, Dublin, California, United States; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Rainer Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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2
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Ke M, Kumar A, Ansbæk TE, Leitgeb RA. Wide Dynamic Range Digital Aberration Measurement and Fast Anterior-Segment OCT Imaging †. SENSORS (BASEL, SWITZERLAND) 2024; 24:5161. [PMID: 39204856 PMCID: PMC11359324 DOI: 10.3390/s24165161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/26/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
Ocular aberrometry with a wide dynamic range for assessing vision performance and anterior segment imaging that provides anatomical details of the eye are both essential for vision research and clinical applications. Defocus error is a major limitation of digital wavefront aberrometry (DWA), as the blurring of the detected point spread function (PSF) significantly reduces the signal-to-noise ratio (SNR) beyond the ±3 D range. With the aid of Badal-like precompensation of defocus, the dynamic defocus range of the captured aberrated PSFs can be effectively extended. We demonstrate a dual-modality MHz VCSEL-based swept-source OCT (SS-OCT) system with easy switching between DWA and OCT imaging modes. The system is capable of measuring aberrations with defocus dynamic range of 20 D as well as providing fast anatomical imaging of the anterior segment at an A-scan rate of 1.6 MHz.
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Affiliation(s)
- Mengyuan Ke
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Wien, Austria;
| | | | | | - Rainer A. Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Wien, Austria;
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3
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Han B, Chang Y, Tan RR, Han C. Evaluating deep learning techniques for identifying tongue features in subthreshold depression: a prospective observational study. Front Psychiatry 2024; 15:1361177. [PMID: 39176227 PMCID: PMC11338782 DOI: 10.3389/fpsyt.2024.1361177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
Objective This study aims to evaluate the potential of using tongue image features as non-invasive biomarkers for diagnosing subthreshold depression and to assess the correlation between these features and acupuncture treatment outcomes using advanced deep learning models. Methods We employed five advanced deep learning models-DenseNet169, MobileNetV3Small, SEResNet101, SqueezeNet, and VGG19_bn-to analyze tongue image features in individuals with subthreshold depression. These models were assessed based on accuracy, precision, recall, and F1 score. Additionally, we investigated the relationship between the best-performing model's predictions and the success of acupuncture treatment using Pearson's correlation coefficient. Results Among the models, SEResNet101 emerged as the most effective, achieving an impressive 98.5% accuracy and an F1 score of 0.97. A significant positive correlation was found between its predictions and the alleviation of depressive symptoms following acupuncture (Pearson's correlation coefficient = 0.72, p<0.001). Conclusion The findings suggest that the SEResNet101 model is highly accurate and reliable for identifying tongue image features in subthreshold depression. It also appears promising for assessing the impact of acupuncture treatment. This study contributes novel insights and approaches to the auxiliary diagnosis and treatment evaluation of subthreshold depression.
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Affiliation(s)
- Bo Han
- Department of Rehabilitation, Daqing Longnan Hospital, Daqing, China
| | - Yue Chang
- Department of Pharmacy, Baoan Central Hospital of Shenzhen, Shenzhen, China
| | - Rui-rui Tan
- Changchun University of Chinese Medicine, Changchun, China
| | - Chao Han
- Department of Acupuncture, Shenzhen Bao’an Authentic Traditional Chinese Medicine (TCM) Therapy Hospital, Shenzhen, China
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Huber KL, Stino H, Schlegl T, Steiner I, Nagy G, Niederleithner M, Baumann B, Drexler W, Leitgeb RA, Schmidt-Erfurth U, Schmoll T, Pollreisz A. Microaneurysm detection using high-speed megahertz optical coherence tomography angiography in advanced diabetic retinopathy. Acta Ophthalmol 2024; 102:e687-e695. [PMID: 38126128 DOI: 10.1111/aos.16619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare detection rates of microaneurysms (MAs) on high-speed megahertz optical coherence tomography angiography (MHz-OCTA), fluorescein angiography (FA) and colour fundus photography (CF) in patients with diabetic retinopathy (DR). METHODS For this exploratory cross-sectional study, MHz-OCTA data were acquired with a swept-source OCT prototype (A-scan rate: 1.7 MHz), and FA and CF imaging was performed using Optos® California. MA count was manually evaluated on en face MHz-OCTA/FA/CF images within an extended ETDRS grid. Detectability of MAs visible on FA images was evaluated on corresponding MHz-OCTA and CF images. MA distribution and leakage were correlated with detectability on OCTA and CF imaging. RESULTS 47 eyes with severe DR (n = 12) and proliferative DR (n = 35) were included. MHz-OCTA and CF imaging detected on average 56% and 36% of MAs, respectively. MHz-OCTA detection rate was significantly higher than CF (p < 0.01). The combination of MHz-OCTA and CF leads to an increased detection rate of 70%. There was no statistically significant association between leakage and MA detectability on OCTA (p = 0.13). For CF, the odds of detecting leaking MAs were significantly lower than non-leaking MAs (p = 0.012). Using MHz-OCTA, detection of MAs outside the ETDRS grid was less likely than MAs located within the ETDRS grid (outer ring, p < 0.01; inner ring, p = 0.028). No statistically significant difference between rings was observed for CF measurements. CONCLUSIONS More MAs were detected on MHz-OCTA than on CF imaging. Detection rate was lower for MAs located outside the macular region with MHz-OCTA and for leaking MAs with CF imaging. Combining both non-invasive modalities can improve MA detection.
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Affiliation(s)
- Kim Lien Huber
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Heiko Stino
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlegl
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Irene Steiner
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Gergely Nagy
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Michael Niederleithner
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Rainer A Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Tilman Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Carl Zeiss Meditec, Inc., Dublin, California, USA
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Zhang Z, Deng C, Paulus YM. Advances in Structural and Functional Retinal Imaging and Biomarkers for Early Detection of Diabetic Retinopathy. Biomedicines 2024; 12:1405. [PMID: 39061979 PMCID: PMC11274328 DOI: 10.3390/biomedicines12071405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/27/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetic retinopathy (DR), a vision-threatening microvascular complication of diabetes mellitus (DM), is a leading cause of blindness worldwide that requires early detection and intervention. However, diagnosing DR early remains challenging due to the subtle nature of initial pathological changes. This review explores developments in multimodal imaging and functional tests for early DR detection. Where conventional color fundus photography is limited in the field of view and resolution, advanced quantitative analysis of retinal vessel traits such as retinal microvascular caliber, tortuosity, and fractal dimension (FD) can provide additional prognostic value. Optical coherence tomography (OCT) has also emerged as a reliable structural imaging tool for assessing retinal and choroidal neurodegenerative changes, which show potential as early DR biomarkers. Optical coherence tomography angiography (OCTA) enables the evaluation of vascular perfusion and the contours of the foveal avascular zone (FAZ), providing valuable insights into early retinal and choroidal vascular changes. Functional tests, including multifocal electroretinography (mfERG), visual evoked potential (VEP), multifocal pupillographic objective perimetry (mfPOP), microperimetry, and contrast sensitivity (CS), offer complementary data on early functional deficits in DR. More importantly, combining structural and functional imaging data may facilitate earlier detection of DR and targeted management strategies based on disease progression. Artificial intelligence (AI) techniques show promise for automated lesion detection, risk stratification, and biomarker discovery from various imaging data. Additionally, hematological parameters, such as neutrophil-lymphocyte ratio (NLR) and neutrophil extracellular traps (NETs), may be useful in predicting DR risk and progression. Although current methods can detect early DR, there is still a need for further research and development of reliable, cost-effective methods for large-scale screening and monitoring of individuals with DM.
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Affiliation(s)
- Zhengwei Zhang
- Department of Ophthalmology, Jiangnan University Medical Center, Wuxi 214002, China;
- Department of Ophthalmology, Wuxi No.2 People’s Hospital, Wuxi Clinical College, Nantong University, Wuxi 214002, China
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Callie Deng
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA;
- Department of Biomedical Engineering, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, USA
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6
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Lin W, Wang P, Qi Y, Zhao Y, Wei X. Progress and challenges of in vivo flow cytometry and its applications in circulating cells of eyes. Cytometry A 2024; 105:437-445. [PMID: 38549391 DOI: 10.1002/cyto.a.24837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/05/2024] [Accepted: 03/15/2024] [Indexed: 06/15/2024]
Abstract
Circulating inflammatory cells in eyes have emerged as early indicators of numerous major diseases, yet the monitoring of these cells remains an underdeveloped field. In vivo flow cytometry (IVFC), a noninvasive technique, offers the promise of real-time, dynamic quantification of circulating cells. However, IVFC has not seen extensive applications in the detection of circulating cells in eyes, possibly due to the eye's unique physiological structure and fundus imaging limitations. This study reviews the current research progress in retinal flow cytometry and other fundus examination techniques, such as adaptive optics, ultra-widefield retinal imaging, multispectral imaging, and optical coherence tomography, to propose novel ideas for circulating cell monitoring.
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Affiliation(s)
- Wei Lin
- Department of Public Scientific Research Platform, School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Institute of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Peng Wang
- Department of Public Scientific Research Platform, School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Institute of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yingxin Qi
- Department of Public Scientific Research Platform, School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Institute of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Yanlong Zhao
- Department of Public Scientific Research Platform, School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Institute of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xunbin Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
- Biomedical Engineering Department, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- International Cancer Institute, Peking University, Beijing, China
- Department of Critical-care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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7
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Hu Y, Feng Y, Long X, Zheng D, Liu G, Lu Y, Ren Q, Huang Z. Megahertz multi-parametric ophthalmic OCT system for whole eye imaging. BIOMEDICAL OPTICS EXPRESS 2024; 15:3000-3017. [PMID: 38855668 PMCID: PMC11161356 DOI: 10.1364/boe.517757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 06/11/2024]
Abstract
An ultrahigh-speed, wide-field OCT system for the imaging of anterior, posterior, and ocular biometers is crucial for obtaining comprehensive ocular parameters and quantifying ocular pathology size. Here, we demonstrate a multi-parametric ophthalmic OCT system with a speed of up to 1 MHz for wide-field imaging of the retina and 50 kHz for anterior chamber and ocular biometric measurement. A spectrum correction algorithm is proposed to ensure the accurate pairing of adjacent A-lines and elevate the A-scan speed from 500 kHz to 1 MHz for retinal imaging. A registration method employing position feedback signals was introduced, reducing pixel offsets between forward and reverse galvanometer scanning by 2.3 times. Experimental validation on glass sheets and the human eye confirms feasibility and efficacy. Meanwhile, we propose a revised formula to determine the "true" fundus size using all-axial length parameters from different fields of view. The efficient algorithms and compact design enhance system compatibility with clinical requirements, showing promise for widespread commercialization.
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Affiliation(s)
- Yicheng Hu
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing 100871, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen 518055, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518071, China
| | - Yutao Feng
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing 100871, China
- The College of Biochemical Engineering, Beijing Union University, Beijing 100021, China
| | - Xing Long
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing 100871, China
| | - Dongye Zheng
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing 100871, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen 518055, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518071, China
| | - Gangjun Liu
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518071, China
| | - Yanye Lu
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen 518055, China
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Qiushi Ren
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing 100871, China
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen 518055, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518071, China
| | - Zhiyu Huang
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen 518055, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen 518071, China
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8
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Hormel TT, Liang GB, Wei X, Guo Y, Gao M, Wang J, Huang D, Bailey ST, Hwang TS, Jia Y. Visualizing features with wide-field volumetric OCT angiography. OPTICS EXPRESS 2024; 32:10329-10347. [PMID: 38571248 PMCID: PMC11018334 DOI: 10.1364/oe.510640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 04/05/2024]
Abstract
Optical coherence tomography (OCT) and its extension OCT angiography (OCTA) have become essential clinical imaging modalities due to their ability to provide depth-resolved angiographic and tissue structural information non-invasively and at high resolution. Within a field of view, the anatomic detail available is sufficient to identify several structural and vascular pathologies that are clinically relevant for multiple prevalent blinding diseases, including age-related macular degeneration (AMD), diabetic retinopathy (DR), and vein occlusions. The main limitation in contemporary OCT devices is that this field of view is limited due to a fundamental trade-off between system resolution/sensitivity, sampling density, and imaging window dimensions. Here, we describe a swept-source OCT device that can capture up to a 12 × 23-mm field of view in a single shot and show that it can identify conventional pathologic features such as non-perfusion areas outside of conventional fields of view. We also show that our approach maintains sensitivity sufficient to visualize novel features, including choriocapillaris morphology beneath the macula and macrophage-like cells at the inner limiting membrane, both of which may have implications for disease.
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Affiliation(s)
- Tristan T. Hormel
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
| | - Guangru B. Liang
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
| | - Xiang Wei
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA
| | - Yukun Guo
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA
| | - Min Gao
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jie Wang
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
| | - David Huang
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
| | - Steven T. Bailey
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
| | - Thomas S. Hwang
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
| | - Yali Jia
- Casey Eye Institutue, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA
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9
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El Habib Daho M, Li Y, Zeghlache R, Boité HL, Deman P, Borderie L, Ren H, Mannivanan N, Lepicard C, Cochener B, Couturier A, Tadayoni R, Conze PH, Lamard M, Quellec G. DISCOVER: 2-D multiview summarization of Optical Coherence Tomography Angiography for automatic diabetic retinopathy diagnosis. Artif Intell Med 2024; 149:102803. [PMID: 38462293 DOI: 10.1016/j.artmed.2024.102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 03/12/2024]
Abstract
Diabetic Retinopathy (DR), an ocular complication of diabetes, is a leading cause of blindness worldwide. Traditionally, DR is monitored using Color Fundus Photography (CFP), a widespread 2-D imaging modality. However, DR classifications based on CFP have poor predictive power, resulting in suboptimal DR management. Optical Coherence Tomography Angiography (OCTA) is a recent 3-D imaging modality offering enhanced structural and functional information (blood flow) with a wider field of view. This paper investigates automatic DR severity assessment using 3-D OCTA. A straightforward solution to this task is a 3-D neural network classifier. However, 3-D architectures have numerous parameters and typically require many training samples. A lighter solution consists in using 2-D neural network classifiers processing 2-D en-face (or frontal) projections and/or 2-D cross-sectional slices. Such an approach mimics the way ophthalmologists analyze OCTA acquisitions: (1) en-face flow maps are often used to detect avascular zones and neovascularization, and (2) cross-sectional slices are commonly analyzed to detect macular edemas, for instance. However, arbitrary data reduction or selection might result in information loss. Two complementary strategies are thus proposed to optimally summarize OCTA volumes with 2-D images: (1) a parametric en-face projection optimized through deep learning and (2) a cross-sectional slice selection process controlled through gradient-based attribution. The full summarization and DR classification pipeline is trained from end to end. The automatic 2-D summary can be displayed in a viewer or printed in a report to support the decision. We show that the proposed 2-D summarization and classification pipeline outperforms direct 3-D classification with the advantage of improved interpretability.
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Affiliation(s)
- Mostafa El Habib Daho
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Yihao Li
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Rachid Zeghlache
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Hugo Le Boité
- Sorbonne University, Paris, F-75006, France; Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Pierre Deman
- ADCIS, Saint-Contest, F-14280, France; Evolucare Technologies, Le Pecq, F-78230, France
| | | | - Hugang Ren
- Carl Zeiss Meditec, Dublin, CA 94568, USA
| | | | - Capucine Lepicard
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Béatrice Cochener
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France; Service d'Ophtalmologie, CHRU Brest, Brest, F-29200, France
| | - Aude Couturier
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Ramin Tadayoni
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France; Paris Cité University, Paris, F-75006, France
| | - Pierre-Henri Conze
- Inserm, UMR 1101, Brest, F-29200, France; IMT Atlantique, Brest, F-29200, France
| | - Mathieu Lamard
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
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10
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Liang GB, Hormel TT, Wei X, Guo Y, Wang J, Hwang T, Jia Y. Single-shot OCT and OCT angiography for slab-specific detection of diabetic retinopathy. BIOMEDICAL OPTICS EXPRESS 2023; 14:5682-5695. [PMID: 38021127 PMCID: PMC10659794 DOI: 10.1364/boe.503476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
In this study, we present an optical coherence tomographic angiography (OCTA) prototype using a 500 kHz high-speed swept-source laser. This system can generate a 75-degree field of view with a 10.4 µm lateral resolution with a single acquisition. With this prototype we acquired detailed, wide-field, and plexus-specific images throughout the retina and choroid in eyes with diabetic retinopathy, detecting early retinal neovascularization and locating pathology within specific retinal slabs. Our device could also visualize choroidal flow and identify signs of key biomarkers in diabetic retinopathy.
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Affiliation(s)
- Guangru B. Liang
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Xiang Wei
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Yukun Guo
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Jie Wang
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Thomas Hwang
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Yali Jia
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
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11
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Hormel TT, Jia Y. OCT angiography and its retinal biomarkers [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:4542-4566. [PMID: 37791289 PMCID: PMC10545210 DOI: 10.1364/boe.495627] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 10/05/2023]
Abstract
Optical coherence tomography angiography (OCTA) is a high-resolution, depth-resolved imaging modality with important applications in ophthalmic practice. An extension of structural OCT, OCTA enables non-invasive, high-contrast imaging of retinal and choroidal vasculature that are amenable to quantification. As such, OCTA offers the capability to identify and characterize biomarkers important for clinical practice and therapeutic research. Here, we review new methods for analyzing biomarkers and discuss new insights provided by OCTA.
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Affiliation(s)
- Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
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12
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Matten P, Scherer J, Schlegl T, Nienhaus J, Stino H, Niederleithner M, Schmidt-Erfurth UM, Leitgeb RA, Drexler W, Pollreisz A, Schmoll T. Multiple instance learning based classification of diabetic retinopathy in weakly-labeled widefield OCTA en face images. Sci Rep 2023; 13:8713. [PMID: 37248309 DOI: 10.1038/s41598-023-35713-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023] Open
Abstract
Diabetic retinopathy (DR), a pathologic change of the human retinal vasculature, is the leading cause of blindness in working-age adults with diabetes mellitus. Optical coherence tomography angiography (OCTA), a functional extension of optical coherence tomography, has shown potential as a tool for early diagnosis of DR through its ability to visualize the retinal vasculature in all spatial dimensions. Previously introduced deep learning-based classifiers were able to support the detection of DR in OCTA images, but require expert labeling at the pixel level, a labor-intensive and expensive process. We present a multiple instance learning-based network, MIL-ResNet,14 that is capable of detecting biomarkers in an OCTA dataset with high accuracy, without the need for annotations other than the information whether a scan is from a diabetic patient or not. The dataset we used for this study was acquired with a diagnostic ultra-widefield swept-source OCT device with a MHz A-scan rate. We were able to show that our proposed method outperforms previous state-of-the-art networks for this classification task, ResNet14 and VGG16. In addition, our network pays special attention to clinically relevant biomarkers and is robust against adversarial attacks. Therefore, we believe that it could serve as a powerful diagnostic decision support tool for clinical ophthalmic screening.
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Affiliation(s)
- Philipp Matten
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria.
| | - Julius Scherer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria
| | - Thomas Schlegl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria
| | - Jonas Nienhaus
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria
| | - Heiko Stino
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Niederleithner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria
| | - Ursula M Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Rainer A Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tilman Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20 (4L), 1090, Vienna, Austria
- Carl Zeiss Meditec Inc, 5300 Central Pkwy, Dublin, CA, 94568, USA
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13
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Britten A, Matten P, Weiss J, Niederleithner M, Roodaki H, Sorg B, Hecker-Denschlag N, Drexler W, Leitgeb RA, Schmoll T. Surgical microscope integrated MHz SS-OCT with live volumetric visualization. BIOMEDICAL OPTICS EXPRESS 2023; 14:846-865. [PMID: 36874504 PMCID: PMC9979659 DOI: 10.1364/boe.477386] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 06/18/2023]
Abstract
Intraoperative optical coherence tomography is still not overly pervasive in routine ophthalmic surgery, despite evident clinical benefits. That is because today's spectral-domain optical coherence tomography systems lack flexibility, acquisition speed, and imaging depth. We present to the best of our knowledge the most flexible swept-source optical coherence tomography (SS-OCT) engine coupled to an ophthalmic surgical microscope that operates at MHz A-scan rates. We use a MEMS tunable VCSEL to implement application-specific imaging modes, enabling diagnostic and documentary capture scans, live B-scan visualizations, and real-time 4D-OCT renderings. The technical design and implementation of the SS-OCT engine, as well as the reconstruction and rendering platform, are presented. All imaging modes are evaluated in surgical mock maneuvers using ex vivo bovine and porcine eye models. The applicability and limitations of MHz SS-OCT as a visualization tool for ophthalmic surgery are discussed.
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Affiliation(s)
- Anja Britten
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4 L, 1090 Vienna, Austria
- These authors contributed equally to this manuscript
| | - Philipp Matten
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4 L, 1090 Vienna, Austria
- These authors contributed equally to this manuscript
| | - Jakob Weiss
- Chair for Computer Aided Medical Procedures, Technical University of Munich, Boltzmannstrasse 385748 Munich, Germany
| | - Michael Niederleithner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4 L, 1090 Vienna, Austria
| | - Hessam Roodaki
- Carl Zeiss Meditec AG, Kistlerhofstrasse 75, 81379 Munich, Germany
| | - Benjamin Sorg
- Carl Zeiss Meditec AG, Rudolf-Eber-Strasse 11, 73447 Oberkochen, Germany
| | | | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4 L, 1090 Vienna, Austria
| | - Rainer A. Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4 L, 1090 Vienna, Austria
| | - Tilman Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4 L, 1090 Vienna, Austria
- Carl Zeiss Meditec, Inc., 5300 Central Pkwy, Dublin, CA 94568, USA
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14
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Guo X, Zhou Y, Gu C, Wu Y, Liu H, Chang Q, Lei B, Wang M. Characteristics and Classification of Choroidal Caverns in Patients with Various Retinal and Chorioretinal Diseases. J Clin Med 2022; 11:jcm11236994. [PMID: 36498569 PMCID: PMC9740557 DOI: 10.3390/jcm11236994] [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] [Received: 11/01/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To investigate the features of choroidal caverns in diverse retinal diseases with swept-source optical coherence tomography (SS-OCT). METHODS Subjects with normal eyes, retinitis pigmentosa (RP), wet age-related macular degeneration (wAMD), acute central serous chorioretinopathy (CSC), or chronic CSC were enrolled. The characteristics of choroidal caverns were evaluated with SS-OCT. The prevalence of choroidal caverns in retinal diseases and the correlations between the number, width and depth of choroidal caverns with the thickness of choroid were analyzed. RESULTS Among 315 eyes of 220 subjects, choroidal caverns were found in 110 eyes (34.9%). Choroidal caverns were divided into two categories based on their location and size. Type I was small and usually lobulated, presented in the choroidal capillary and Sattler's layers. Type II was larger, usually isolated, and presented in the Sattler's and Haller's layers. The prevalence of type I in subjects with normal eyes, RP, wAMD, acute CSC, or chronic CSC was 17.4%, 19.6%, 1.6%, 32.8%, and 85.2%, respectively, while that of type II was 0%, 0%, 21.3%, 13.8%, and 53.7%, respectively. The number, width, and thickness of type II choroidal caverns correlated positively with macular choroidal thickness. CONCLUSIONS Choroidal caverns could be divided into two categories. Type II choroidal caverns appeared associated with the pachychoroid spectrum and RPE atrophic diseases.
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Affiliation(s)
- Xiaohong Guo
- Henan Eye Hospital, Henan Eye Institute, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Yao Zhou
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai 200031, China
| | - Chenyang Gu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai 200031, China
| | - Yingjie Wu
- Henan Eye Hospital, Henan Eye Institute, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Hui Liu
- Henan Eye Hospital, Henan Eye Institute, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, China
| | - Qing Chang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai 200031, China
| | - Bo Lei
- Henan Eye Hospital, Henan Eye Institute, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou 450003, China
- Correspondence: (B.L.); (M.W.)
| | - Min Wang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai 200031, China
- Correspondence: (B.L.); (M.W.)
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