Quantitative confocal optical coherence elastography for evaluating biomechanics of optic nerve head using Lamb wave model

Quantitative assessment of corneal biomechanical changes in vivo after photorefractive intrastromal corneal cross-linking using optical coherence elastography

Background

Photorefractive intrastromal corneal cross-linking (PiXL) treatment corrects myopia by enhancing localized central corneal biomechanics. However, the dose-effect relationship between the changes in corneal biomechanics and alterations in corneal curvature resulting from this treatment remain unclear. We therefore developed an acoustic radiation force optical coherence elastography (ARF-OCE) technique to investigate the dose-effect relationship in PiXL.

Methods

ARF-OCE measurements and corneal topography were performed 3 days before and 1 week after PiXL treatment. Depth-resolved Young's modulus images of the in vivo corneas were obtained based on the phase velocity of the Lamb wave. PiXL treatments with five ultraviolet-A (UVA) energy doses (5.4, 15, 25, 35, and 45 J/cm2) were administered to rabbit corneas in vivo (n=15).

Results

The percentage change in Young's modulus (ΔE%) of the cornea increased from 0.26 to 1.71 as the UVA energy dose increased from group I (5.4 J/cm2) to group V (45 J/cm2). Meanwhile, the change in the mean keratometry (ΔKm ) of the cornea increased from 0.40 to 2.10 diopters (D) as the UVA energy dose increased from group I to group IV (35 J/cm2). Furthermore, a statistically significant positive correlation was observed between ΔE% and ΔKm in groups I to IV.

Conclusions

With increasing UVA energy dose, the corneal Young's modulus significantly increased. Given the observed correlation, ΔE% holds promise as a new quantitative biomechanical parameter for determining the dose-effect relationship in PiXL treatment. It should be emphasized that there may be an inflection point of ΔE%, at which corneal keratometry ceases to flatten and begins to increase. The ARF-OCE system has demonstrated its efficacy in quantitatively assessing changes in corneal biomechanics in vivo following PiXL treatment. This technique has great potential in facilitating the quantitative determination of the dose-effect relationship in PiXL treatment.

Quantitative Optical Coherence Elastography of the Optic Nerve Head In Vivo

OBJECTIVE

Optical coherence elastography (OCE) was used to demonstrate the relationship between the elasticity of the optic nerve head (ONH) and different intraocular pressure (IOP) levels in an in-vivo rabbit model for the first time.

METHOD

Both ex-vivo and in-vivo rabbit ONH were imaged using OCE system. A mechanical shaker initiated the propagation of elastic waves, and the elasticity of the ONH was determined by tracking the wave propagation speed. The elasticity of the ONH under varying IOP levels was reconstructed based on the wave speed. Notably, the ONH exhibited increased stiffness with elevated IOP.

RESULTS

In the in-vivo rabbit models, the Young's modulus of ONH increased from 14 kPa to 81 kPa with the IOP increased from 15 mmHg to 35 mmHg. This revealed a positive correlation between the Young's modulus of the ONH and intraocular pressure.

CONCLUSION

The OCE system proved effective in measuring the mechanical properties of ONH at different IOP levels, with validation in an in-vivo rabbit model.

SIGNIFICANCE

Considering ONH plays a critical role in vision and eye diseases, the capability to image and quantify in vivo ONH biomechanical properties has great potential to advance vision science research and improve the clinical management of glaucoma patients.

Supershear Rayleigh wave imaging for quantitative assessment of biomechanical properties of brain using air-coupled optical coherence elastography

Recently, supershear Rayleigh waves (SRWs) have been proposed to characterize the biomechanical properties of soft tissues. The SRWs propagate along the surface of the medium, unlike surface Rayleigh waves, SRWs propagate faster than bulk shear waves. However, their behavior and application in biological tissues is still elusive. In brain tissue elastography, shear waves combined with magnetic resonance elastography or ultrasound elastography are generally used to quantify the shear modulus, but high spatial resolution elasticity assessment in 10 μm scale is still improving. Here, we develop an air-coupled ultrasonic transducer for noncontact excitation of SRWs and Rayleigh waves in brain tissue, use optical coherent elastography (OCE) to detect, and reconstruct the SRW propagation process; in combing with a derived theoretical model of SRWs on a free boundary surface, we quantify the shear modulus of brain tissue with high spatial resolution. We first complete validation experiments using a homogeneous isotropic agar phantom, and the experimental results clearly show the SRW is 1.9649 times faster than the bulk shear waves. Furthermore, the propagation velocity of SRWs in both the frontal and parietal lobe regions of the brain is all 1.87 times faster than the bulk shear wave velocity. Finally, we evaluated the anisotropy in different brain regions, and the medulla oblongata region had the highest anisotropy index. Our study shows that the OCE system using the SRW model is a new potential approach for high-resolution assessment of the biomechanical properties of brain tissue.

Simultaneous Assessment of the Whole Eye Biomechanics Using Ultrasonic Elastography

OBJECTIVE

Current elastography techniques in the field of ophthalmology usually target one specific tissue, such as the cornea or the sclera. However, the eye is an inter-related organ, and some ocular diseases can alter the biomechanical properties of multiple anatomical structures. Hence, there is a need to develop an imaging tool that can non-invasively, quantitatively, and accurately characterize dynamic changes among these biomechanical properties.

METHODS

A high resolution ultrasound elastography system was developed to achieve this goal. The efficacy and accuracy of the system was first validated on tissue-mimicking phantoms while mechanical testing measurements served as the gold standard. Next, an in vivo elevated intraocular pressure (IOP) model was established in rabbits to further test our system. In particular, elastography measurements were obtained at 5 IOP levels, ranging from 10 mmHg to 30 mmHg in 5 mmHg increments. Spatial-temporal maps of the multiple ocular tissues (cornea, lens, iris, optic nerve head, and peripapillary sclera) were obtained.

RESULTS

The spatial-temporal maps were acquired simultaneously for the ocular tissues at the 5 different IOP levels. The statistical analysis of the elastic wave speed was presented for ocular tissues. Finally, the mapping for the elastic wave speed of each ocular component was acquired at each IOP level.

CONCLUSION

Our elastography system can concurrently assess the biomechanical properties of multiple ocular structures and detect changes in biomechanical properties associated with changes in IOP.

SIGNIFICANCE

This system provides a novel tool to measure and quantify the biomechanical properties of the whole eye.

The Strain Response to Intraocular Pressure Decrease in the Lamina Cribrosa of Patients with Glaucoma

OBJECTIVE

To measure biomechanical strains in the lamina cribrosa (LC) of living human eyes with intraocular pressure (IOP) lowering.

DESIGN

Cohort study.

PARTICIPANTS

Patients with glaucoma underwent imaging before and after laser suturelysis after trabeculectomy surgery (29 image pairs; 26 persons).

INTERVENTION

Noninvasive imaging of the eye.

MAIN OUTCOME MEASURES

Strains in optic nerve head tissue and changes in depths of the anterior border of the LC.

RESULTS

Intraocular pressure decreases caused the LC to expand in thickness in the anterior-posterior strain (Ezz = 0.94 ± 1.2%; P = 0.00020) and contract in radius in the radial strain (Err = - 0.19 ± 0.33%; P = 0.0043). The mean LC depth did not significantly change with IOP lowering (1.33 ± 6.26 μm; P = 0.26). A larger IOP decrease produced a larger, more tensile Ezz (P < 0.0001), greater maximum principal strain (Emax; P < 0.0001), and greater maximum shear strain (Γmax; P < 0.0001). The average LC depth change was associated with the Γmax and radial-circumferential shear strain (Erθ; P < 0.02) but was not significantly related to tensile or compressive strains. An analysis by clock hour showed that in temporal clock hours 3 to 6, a more anterior LC movement was associated with a more positive Emax, and in clock hours 3, 5, and 6, it was associated with a more positive Γmax. At 10 o'clock, a more posterior LC movement was related to a more positive Emax (P < 0.004). Greater compliance (strain/ΔIOP) of Emax (P = 0.044), Γmax (P = 0.052), and Erθ (P = 0.018) was associated with a thinner retinal nerve fiber layer. Greater compliance of Emax (P = 0.041), Γmax (P = 0.021), Erθ (P = 0.024), and in-plane shear strain (Erz; P = 0.0069) was associated with more negative mean deviations. Greater compliance of Γmax (P = 0.055), Erθ (P = 0.040), and Erz (P = 0.015) was associated with lower visual field indices.

CONCLUSIONS

With IOP lowering, the LC moves either into or out of the eye but, on average, expands in thickness and contracts in radius. Shear strains are nearly as substantial as in-plane strains. Biomechanical strains are more compliant in eyes with greater glaucoma damage. This work was registered at ClinicalTrials.gov as NCT03267849.

Quantitative Evaluation of In Vivo Corneal Biomechanical Properties after SMILE and FLEx Surgery by Acoustic Radiation Force Optical Coherence Elastography

The purpose of this study is to quantitatively evaluate the differences in corneal biomechanics after SMILE and FLEx surgery using an acoustic radiation force optical coherence elastography system (ARF-OCE) and to analyze the effect of the corneal cap on the integrity of corneal biomechanical properties. A custom ring array ultrasound transducer is used to excite corneal tissue to produce Lamb waves. Depth-resolved elastic modulus images of the in vivo cornea after refractive surgery were obtained based on the phase velocity of the Lamb wave. After refractive surgery, the average elastic modulus of the corneal flap decreased (71.7 ± 24.6 kPa), while the elastic modulus of the corneal cap increased (219.5 ± 54.9 kPa). The average elastic modulus of residual stromal bed (RSB) was increased after surgery, and the value after FLEx (305.8 ± 48.5 kPa) was significantly higher than that of SMILE (221.3 ± 43.2 kPa). Compared with FLEx, SMILE preserved most of the anterior stroma with less change in corneal biomechanics, which indicated that SMILE has an advantage in preserving the integrity of the corneal biomechanical properties. Therefore, the biomechanical properties of the cornea obtained by the ARF-OCE system may be one of the essential indicators for evaluating the safety of refractive surgery.

In Vivo Evaluation of the Effects of SMILE with Different Amounts of Stromal Ablation on Corneal Biomechanics by Optical Coherence Elastography

This work aims to depth-resolved quantitatively analyze the effect of different stromal ablation amounts on the corneal biomechanical properties during small incision lenticule extraction (SMILE) using optical coherence elastography (OCE). A 4.5-MHz ultrasonic transducer was used to excite elastic waves in the corneal tissue. The OCE system combined with the antisymmetric Lamb wave model was employed to achieve a high-resolution, high-sensitivity, and depth-resolved quantitative detection of the corneal Young's modulus. Eighteen rabbits were randomly divided into three groups; each group had six rabbits. The first and second groups underwent -3D and -6D SMILE surgeries, and the third group was the control group, respectively. Young's modulus of the corneal cap and residual stromal bed (RSB) were both increased after SMILE, which shared the stress under intraocular pressure (IOP). Furthermore, the Young's modulus of both the corneal cap and RSB after 3D SMILE group were significantly lower than that in the -6D group, which indicated that the increases in the post-operative corneal Young's modulus were positively correlated with the amount of stromal ablation. The OCE system for quantitative spatial characterization of corneal biomechanical properties can provide useful information on the extent of safe ablation for SMILE procedures.

Quantitative Microstructural Analysis of Cellular and Tissue Remodeling in Human Glaucoma Optic Nerve Head

Purpose

To measure quantitatively changes in lamina cribrosa (LC) cell and connective tissue structure in human glaucoma eyes.

Methods

We studied 27 glaucoma and 19 age-matched non-glaucoma postmortem eyes. In 25 eyes, LC cross-sections were examined by confocal and multiphoton microscopy to quantify structures identified by anti-glial fibrillary acidic protein (GFAP), phalloidin-labeled F-actin, nuclear 4',6-diamidino-2-phenylindole (DAPI), and by second harmonic generation imaging of LC beams. Additional light and transmission electron microscopy were performed in 21 eyes to confirm features of LC remodeling, including immunolabeling by anti-SOX9 and anti-collagen IV. All glaucoma eyes had detailed clinical histories of open-angle glaucoma status, and degree of axon loss was quantified in retrolaminar optic nerve cross-sections.

Results

Within LC pores, the proportionate area of both GFAP and F-actin processes was significantly lower in glaucoma eyes than in controls (P = 0.01). Nuclei were rounder (lower median aspect ratio) in glaucoma specimens (P = 0.02). In models assessing degree of glaucoma damage, F-actin process width was significantly wider in glaucoma eyes with more damage (P = 0.024), average LC beam width decreased with worse glaucoma damage (P = 0.042), and nuclear count per square millimeter rose with worse damage (P = 0.019). The greater cell count in LC pores represented 92.3% astrocytes by SOX9 labeling. The results are consistent with replacement of axons in LC pores by basement membrane labeled by anti-collagen IV and in-migrating astrocytes.

Conclusions

Alteration in LC structure in glaucoma involves migration of astrocytes into axonal bundles, change in astrocyte orientation and processes, production of basement membrane material, and thinning of connective tissue beams.

Glaucoma and biomechanics

PURPOSE OF REVIEW

Biomechanics is an important aspect of the complex family of diseases known as the glaucomas. Here, we review recent studies of biomechanics in glaucoma.

RECENT FINDINGS

Several tissues have direct and/or indirect biomechanical roles in various forms of glaucoma, including the trabecular meshwork, cornea, peripapillary sclera, optic nerve head/sheath, and iris. Multiple mechanosensory mechanisms and signaling pathways continue to be identified in both the trabecular meshwork and optic nerve head. Further, the recent literature describes a variety of approaches for investigating the role of tissue biomechanics as a risk factor for glaucoma, including pathological stiffening of the trabecular meshwork, peripapillary scleral structural changes, and remodeling of the optic nerve head. Finally, there have been advances in incorporating biomechanical information in glaucoma prognoses, including corneal biomechanical parameters and iridial mechanical properties in angle-closure glaucoma.

SUMMARY

Biomechanics remains an active aspect of glaucoma research, with activity in both basic science and clinical translation. However, the role of biomechanics in glaucoma remains incompletely understood. Therefore, further studies are indicated to identify novel therapeutic approaches that leverage biomechanics. Importantly, clinical translation of appropriate assays of tissue biomechanical properties in glaucoma is also needed.

Broadband-excitation-based mechanical spectroscopy of highly viscous tissue-mimicking phantoms

Standard rheometers assess mechanical properties of viscoelastic samples up to 100 Hz, which often hinders the assessment of the local-scale dynamics. We demonstrate that high-frequency analysis can be achieved by inducing broadband waves and monitoring their media-dependent propagation using optical coherence tomography. Here, we present a new broadband wave analysis based on two-dimensional Fourier transformation. We validated this method by comparing the mechanical parameters to monochromatic excitation and a standard oscillatory test data. Our method allows for high-frequency mechanical spectroscopy, which could be used to investigate the local-scale dynamics of different biological tissues and the influence of diseases on their microstructure.

2-D Ultrasonic Array-Based Optical Coherence Elastography

Acoustic radiation force optical coherence elastography (ARF-OCE) has been successfully implemented to characterize the biomechanical properties of soft tissues, such as the cornea and the retina, with high resolution using single-element ultrasonic transducers for ARF excitation. Most currently proposed OCE techniques, such as air puff and ARF, have less capability to control the spatiotemporal information of the induced region of deformation, resulting in limited accuracy and low temporal resolution of the shear wave elasticity imaging. In this study, we propose a new method called 2-D ultrasonic array-based OCE imaging, which combines the advantages of 3-D dynamic electronic steering of the 2-D ultrasonic array and high-resolution optical coherence tomography (OCT). The 3-D steering capability of the 2-D array was first validated using a hydrophone. Then, the combined 2-D ultrasonic array OCE system was calibrated using a homogenous phantom, followed by an experiment on ex vivo rabbit corneal tissue. The results demonstrate that our newly developed 2-D ultrasonic array-based OCE system has the capability to map tissue biomechanical properties accurately, and therefore, has the potential to be a vital diagnostic tool in ophthalmology.

Advances in multimodal imaging in ophthalmology

Multimodality ophthalmic imaging systems aim to enhance the contrast, resolution, and functionality of existing technologies to improve disease diagnostics and therapeutic guidance. These systems include advanced acquisition and post-processing methods using optical coherence tomography (OCT), combined scanning laser ophthalmoscopy and OCT systems, adaptive optics, surgical guidance, and photoacoustic technologies. Here, we provide an overview of these ophthalmic imaging systems and their clinical and basic science applications.

Ultrasonic elastography to assess biomechanical properties of the optic nerve head and peripapillary sclera of the eye

PURPOSE

To quantitatively investigate both optic nerve head (ONH) and peripapillary sclera (PPS) biomechanical properties of porcine eyes through an ultrasonic elastography imaging system in response to both increasing and decreasing intraocular pressure (IOP).

METHODS

The Young's modulus of the ONH and PPS were assessed using our high resolution ultrasonic imaging system which utilized a mechanical shaker to induce shear waves and an off-axis aligned 40 MHz needle transducer to track micron-level displacement along the direction of wave propagation. In this study, imaging on a total of 8 ex vivo porcine eyes preloaded with IOPs from 6 mmHg to 30 mmHg was performed. To have a better understanding of the effect of varying IOP on biomechanics, both increasing and decreasing IOPs were investigated.

RESULTS

The increase of the Young's modulus of ONH (92.4 ± 13.9 kPa at 6 mmHg to 224.7 ± 71.1 kPa at 30 mmHg) and PPS (176.8 ± 14.3 kPa at 6 mmHg to 573.5 ± 64.4 kPa at 30 mmHg) following IOP elevation could be observed in the reconstructed Young's modulus of the shear wave elasticity (SWE) imaging while the B-mode structural images remained almost unchanged. In addition, for the same IOP level, both ONH and PPS have a tendency to be stiffer with decreasing IOP as compared to increasing IOP.

CONCLUSIONS

Our results demonstrate the feasibility of using our ultrasonic elastography system to investigate the stiffness mapping of posterior eye with high resolution in both increasing and decreasing IOPs, making this technique potentially useful for glaucoma.

The role of neuroinflammation in the pathogenesis of glaucoma neurodegeneration

The chapter is a review enclosed in the volume "Glaucoma: A pancitopatia of the retina and beyond." No cure exists for glaucoma. Knowledge on the molecular and cellular alterations underlying glaucoma neurodegeneration (GL-ND) includes innovative and path-breaking research on neuroinflammation and neuroprotection. A series of events involving immune response (IR), oxidative stress and gene expression are occurring during the glaucoma course. Uveitic glaucoma (UG) is a prevalent acute/chronic complication, in the setting of chronic anterior chamber inflammation. Managing the disease requires a team approach to guarantee better results for eyes and vision. Advances in biomedicine/biotechnology are driving a tremendous revolution in ophthalmology and ophthalmic research. New diagnostic and imaging modalities, constantly refined, enable outstanding criteria for delimiting glaucomatous neurodegeneration. Moreover, biotherapies that may modulate or inhibit the IR must be considered among the first-line for glaucoma neuroprotection. This review offers the readers useful and practical information on the latest updates in this regard.

High resolution optical coherence elastography of retina under prosthetic electrode

Background

Quantitatively investigating the biomechanics of retina with a retinal prosthetic electrode, we explored the effects of the prosthetic electrode on the retina, and further supplemented data for a potential clinical trial.

Methods

Biomechanical properties were assessed with a high resolution optical coherence tomography (OCT) based elastography (OCE) system. A shaker was used to initiate elastic waves and an OCT system was used to track axial displacement along with wave propagation. Rabbits received surgery to implant the retinal prosthetic electrode, and elastic wave speed was measured before and after implantation; anatomical B-mode images were also acquired.

Results

Spatial-temporal maps of each layer in retina with and without prosthetic electrodes were acquired. Elastic wave speed of nerve fiber to inner plexiform layer, inner nuclear to outer nuclear layer, retinal pigmented epithelium layer and choroid to sclera layer without prosthetic electrode were found to be 3.66±0.36, 5.33±0.07, 6.85±0.37, and 9.69±0.24 m/s, respectively. With prosthetic electrode, the elastic wave speed was found to be 4.09±0.26, 5.14±0.11, 6.88±0.70, and 9.99±0.73 m/s, respectively in each layer.

Conclusions

Our results show that the elastic wave speed in each layer of retina is slightly faster with the retinal electrode, and further demonstrate that the retinal prosthetic electrode does not affect biomechanical properties significantly. In the future, we expect OCE technology to be used by clinicians where it could become part of routine testing and evaluation of the biomechanical properties of the retina in response to long term use of prosthetic electrodes in patients.