Adaptive optics for studying visual function: a comprehensive review

Semi-supervised generative adversarial learning for denoising adaptive optics retinal images

This study presents denoiseGAN, a novel semi-supervised generative adversarial network, for denoising adaptive optics (AO) retinal images. By leveraging both synthetic and real-world data, denoiseGAN effectively addresses various noise sources, including blur, motion artifacts, and electronic noise, commonly found in AO retinal imaging. Experimental results demonstrate that denoiseGAN outperforms traditional image denoising methods and the state-of-the-art conditional GAN model, preserving retinal cell structures and enhancing image contrast. Moreover, denoiseGAN aids downstream analysis, improving cell segmentation accuracy. Its 30% faster computational efficiency makes it a potential choice for real-time AO image processing in ophthalmology research and clinical practice.

Ocular aberration measurement with and without an aperture stop using a Shack-Hartmann wavefront sensor

Pupil size is an important parameter since it governs the magnitude of ocular aberrations. The pupil size of a human eye has significant individual differences and varies with light level and accommodation. In order to accurately measure ocular aberrations under different pupil sizes using a Shack-Hartmann wavefront sensor (SHWFS), two types of relationship matrices R (1) and R (2) were proposed, which corresponded to wavefront reconstruction with and without an aperture stop, respectively. The numerical and experimental results indicated that matrix R (2) can significantly improve the accuracy of wavefront restoration when the incident beam size is inconsistent with the wavefront reconstruction aperture. Meanwhile, the impact of the aperture stop on the reconstruction accuracy will become smaller and smaller as the ratio ρ of the outer area to the detection aperture decreases. This study not only can be used for accurately measuring ocular aberrations under different pupil sizes, but also for other variable aperture aberrations measurement in other applications.

Laser pulse train parameters determine the brightness of a two-photon stimulus

This report presents the results of measurements of the two-photon vision threshold for various pulse trains. We employed three pulsed near-infrared lasers and pulse stretchers to obtain variations of the pulse duty cycle parameter over three orders of magnitude. We proposed and extensively described a mathematical model that combines the laser parameters with the visual threshold value. The presented methodology enables one to predict the visual threshold value for a two-photon stimulus for a healthy subject while using a laser source of known parameters. Our findings would be of value to laser engineers and the community interested in nonlinear visual perception.

Advanced Optical Wavefront Technologies to Improve Patient Quality of Vision and Meet Clinical Requests

Adaptive optics (AO) is employed for the continuous measurement and correction of ocular aberrations. Human eye refractive errors (lower-order aberrations such as myopia and astigmatism) are corrected with contact lenses and excimer laser surgery. Under twilight vision conditions, when the pupil of the human eye dilates to 5-7 mm in diameter, higher-order aberrations affect the visual acuity. The combined use of wavefront (WF) technology and AO systems allows the pre-operative evaluation of refractive surgical procedures to compensate for the higher-order optical aberrations of the human eye, guiding the surgeon in choosing the procedure parameters. Here, we report a brief history of AO, starting from the description of the Shack-Hartmann method, which allowed the first in vivo measurement of the eye's wave aberration, the wavefront sensing technologies (WSTs), and their principles. Then, the limitations of the ocular wavefront ascribed to the IOL polymeric materials and design, as well as future perspectives on improving patient vision quality and meeting clinical requests, are described.

Evaluating the effect of ocular aberrations on the simulated performance of a new refractive IOL design using adaptive optics

Adaptive optics (AO) visual simulators are excellent platforms for non-invasive simulation visual performance with new intraocular lens (IOL) designs, in combination with a subject own ocular aberrations and brain. We measured the through focus visual acuity in subjects through a new refractive IOL physically inserted in a cuvette and projected onto the eye's pupil, while aberrations were manipulated (corrected, or positive/negative spherical aberration added) using a deformable mirror (DM) in a custom-developed AO simulator. The IOL increased depth-of-focus (DOF) to 1.53 ± 0.21D, while maintaining high Visual Acuity (VA, -0.07 ± 0.05), averaged across subjects and conditions. Modifying the aberrations did not alter IOL performance on average.

Adaptive optics visual simulators: a review of recent optical designs and applications [Invited]

In their pioneering work demonstrating measurement and full correction of the eye's optical aberrations, Liang, Williams and Miller, [JOSA A14, 2884 (1997)10.1364/JOSAA.14.002884] showed improvement in visual performance using adaptive optics (AO). Since then, AO visual simulators have been developed to explore the spatial limits to human vision and as platforms to test non-invasively optical corrections for presbyopia, myopia, or corneal irregularities. These applications have allowed new psychophysics bypassing the optics of the eye, ranging from studying the impact of the interactions of monochromatic and chromatic aberrations on vision to neural adaptation. Other applications address new paradigms of lens designs and corrections of ocular errors. The current paper describes a series of AO visual simulators developed in laboratories around the world, key applications, and current trends and challenges. As the field moves into its second quarter century, new available technologies and a solid reception by the clinical community promise a vigorous and expanding use of AO simulation in years to come.

Application of Adaptive Optics in Ophthalmology

The eye, the photoreceptive organ used to perceive the external environment, is of great importance to humans. It has been proven that some diseases in humans are accompanied by fundus changes; therefore, the health status of people may be interpreted from retinal images. However, the human eye is not a perfect refractive system for the existence of ocular aberrations. These aberrations not only affect the ability of human visual discrimination and recognition, but restrict the observation of the fine structures of human eye and reduce the possibility of exploring the mechanisms of eye disease. Adaptive optics (AO) is a technique that corrects optical wavefront aberrations. Once integrated into ophthalmoscopes, AO enables retinal imaging at the cellular level. This paper illustrates the principle of AO in correcting wavefront aberrations in human eyes, and then reviews the applications and advances of AO in ophthalmology, including the adaptive optics fundus camera (AO-FC), the adaptive optics scanning laser ophthalmoscope (AO-SLO), the adaptive optics optical coherence tomography (AO-OCT), and their combined multimodal imaging technologies. The future development trend of AO in ophthalmology is also prospected.

Emulated retinal image capture (ERICA) to test, train and validate processing of retinal images

High resolution retinal imaging systems, such as adaptive optics scanning laser ophthalmoscopes (AOSLO), are increasingly being used for clinical research and fundamental studies in neuroscience. These systems offer unprecedented spatial and temporal resolution of retinal structures in vivo. However, a major challenge is the development of robust and automated methods for processing and analysing these images. We present ERICA (Emulated Retinal Image CApture), a simulation tool that generates realistic synthetic images of the human cone mosaic, mimicking images that would be captured by an AOSLO, with specified image quality and with corresponding ground-truth data. The simulation includes a self-organising mosaic of photoreceptors, the eye movements an observer might make during image capture, and data capture through a real system incorporating diffraction, residual optical aberrations and noise. The retinal photoreceptor mosaics generated by ERICA have a similar packing geometry to human retina, as determined by expert labelling of AOSLO images of real eyes. In the current implementation ERICA outputs convincingly realistic en face images of the cone photoreceptor mosaic but extensions to other imaging modalities and structures are also discussed. These images and associated ground-truth data can be used to develop, test and validate image processing and analysis algorithms or to train and validate machine learning approaches. The use of synthetic images has the advantage that neither access to an imaging system, nor to human participants is necessary for development.

Feature issue introduction: applications of adaptive optics

This feature issue of Optics Express follows the 2020 Imaging and Applied Optics Congress and comprises of articles on the development and use of adaptive optics across the broad range of domains in which the technique has been applied - including atmospheric correction, ophthalmology, vision science, microscopy, optical communications and beam control. This review provides a basic introduction to adaptive optics and a summary of the multidisciplinary articles included in this issue.

Functional reallocation of sensory processing resources caused by long-term neural adaptation to altered optics

The eye’s optics are a major determinant of visual perception. Elucidating how long-term exposure to optical defects affects visual processing is key to understanding the capacity for, and limits of, sensory plasticity. Here, we show evidence of functional reallocation of sensory processing resources following long-term exposure to poor optical quality. Using adaptive optics to bypass all optical defects, we assessed visual processing in neurotypically-developed adults with healthy eyes and with keratoconus – a corneal disease causing severe optical aberrations. Under fully-corrected optical conditions, keratoconus patients showed altered contrast sensitivity, with impaired sensitivity for fine spatial details and better-than-typical sensitivity for coarse spatial details. Both gains and losses in sensitivity were more pronounced in patients experiencing poorer optical quality in their daily life and mediated by changes in signal enhancement mechanisms. These findings show that adult neural processing adapts to better match the changes in sensory inputs caused by long-term exposure to altered optics.

The effect of refractive error on optokinetic nystagmus

Subjective refraction is the gold-standard for prescribing refractive correction, but its accuracy is limited by patient’s subjective judgment about their clarity of vision. We asked if an involuntary eye movement, optokinetic nystagmus (OKN), could serve as an objective measure of visual-clarity, specifically measuring the dependence of OKN—elicited by drifting spatial-frequency filtered noise—on mean spherical equivalent (MSE) refractive error. In Experiment 1 we quantified OKN score—a measure of consistency with stimulus-direction—for participants with different MSEs. Estimates of MSE based on OKN scores correlate well with estimates of MSE made using autorefraction (r = 0.878, p < 0.001, Bland–Altman analysis: mean difference of 0.00D (95% limits of agreement: − 0.85 to + 0.85D). In Experiment 2, we quantified the relationship between OKN gain (ratio of tracking eye-movement velocity to stimulus velocity) and MSEs (− 2.00, − 1.00, − 0.50, 0.00 and + 1.00D) induced with contact lenses for each participant. The mean difference between measures of MSE based on autorefraction or on OKN gain was + 0.05D (− 0.90 to + 1.01D), and the correlation of these measures across participants was r = 0.976, p < 0.001. Results indicate that MSE attenuates OKN gain so that OKN can be used as an objective proxy for patient response to select the best corrective lens.

Structural imaging of the retina in psychosis spectrum disorders: current status and perspectives

PURPOSE OF REVIEW

Structural changes of the retina in schizophrenia and other psychotic disorders seem plausible as these conditions are accompanied by widespread morphological abnormalities of the brain. Advances in structural retinal imaging have led to the possibility of precise quantification of individual retinal layers, using optical coherence tomography (OCT) scanners.

RECENT FINDINGS

The aggregation of information related to OCT findings in schizophrenia has resulted in three metaanalyses, which are currently described. Areas where retinal changes were reported include retinal nerve fiber layer (RNFL), ganglion cell layer complex (GCC), macular volume, and macular thickness, but findings on affected retinal segments vary to some extent across studies. Discrepancies in individual studies could be because of small samples, heterogeneity within schizophrenia (phase of the illness, illness duration, predominant symptomatology), inconsistent reporting of antipsychotic therapy, insufficient control of confounding variables (somatic comorbidities, smoking, and so on), and use of the different types of OCT scanners.

SUMMARY

Exploration of potential disturbances in retinal architecture could provide new insights into neuronal changes associated with psychosis spectrum disorders, with potential to elucidate the nature and timing of developmental, progressive, inflammatory, and degenerative aspects of neuropathology and pathophysiology, and to assist with characterizing heterogeneity and facilitating personalized treatment approaches.

Average gradient of Zernike polynomials over polygons

Wavefront estimation from slope sensor data is often achieved by fitting measured slopes with Zernike polynomial derivatives averaged over the sampling subapertures. Here we discuss how the calculation of these average derivatives can be reduced to one-dimensional integrals of the Zernike polynomials, rather than their derivatives, along the perimeter of each subaperture. We then use this result to derive closed-form expressions for the average Zernike polynomial derivatives over polygonal areas, only requiring evaluation of polynomials at the polygon vertices. Finally, these expressions are applied to simulated Shack-Hartmann wavefront sensors with 7 and 23 fully illuminated lenslets across a circular pupil, with their accuracy and calculation time compared against commonly used integration methods.

Color, Pattern, and the Retinal Cone Mosaic

Textbook trichromacy accounts for human color vision in terms of spectral sampling by three classes of cone photoreceptors. This account neglects entangling of color and pattern information created by wavelength-dependent optical blur (chromatic aberrations) and interleaved spatial sampling of the retinal image by the three classes of cones. Recent experimental, computational, and neurophysiological work is now considering color and pattern vision at the elementary scale of daylight vison, that is at the scale of individual cones. The results provide insight about rich interactions between color and pattern vision as well as the role of the statistical structure of natural scenes in shaping visual processing.

Aberrations and accommodation

Modern methods of measuring the refractive state of the eye include wavefront sensors which make it possible to monitor both static and dynamic changes of the ocular wavefront while the eye observes a target positioned at different distances away from the eye. In addition to monitoring the ocular aberrations, wavefront refraction methods allow measurement of the accommodative response while viewing with the eye's habitual chromatic and monochromatic aberrations present, with these aberrations removed, and with specific aberrations added or removed. A large number of experiments describing the effects of accommodation on aberrations and vice versa are reviewed, pointing out the implications for fundamental questions related to the mechanism of accommodation.

Sensorless adaptive optics multimodal en-face small animal retinal imaging

Vision researchers often use small animals due to the availability of many transgenic strains that model human diseases or express biomarkers. Adaptive optics (AO) enables non-invasive single-cell imaging in a living animal but often results in high system complexity. Sensorless AO (SAO) can provide depth-resolved aberration correction with low system complexity. We present a multi-modal sensorless AO en face retina imaging system that includes optical coherence tomography (OCT), OCT-angiography, confocal scanning laser ophthalmoscopy (SLO), and fluorescence detection. We present a compact lens-based imaging system design that allows for a 50-degree maximum field of view (FOV), which can be reduced to the region of interest to perform SAO with the modality of choice. The system performance was demonstrated on wild type mice (C57BL/6J), and transgenic mice with GFP labeled cells. SAO SLO was used for imaging microglia (Cx3cr1-GFP) over ~1 hour, where dynamics of the microglia branches were clearly observed. Our results also include volumetric cellular imaging of microglia throughout the inner retina.

Optofluidic adaptive optics

We introduce a transmissive refractive adaptive optics system featuring a deformable transparent optofluidic wavefront modulator and a sensorless wavefront error estimation algorithm. The wavefront modulator consists of a cavity filled with an optical liquid which is sealed by a deformable elastic polymer membrane. Deformation of the membrane is achieved through electrostatic actuation using 25 transparent indium tin oxide electrodes buried in the cavity. Modulation of the two-dimensional phase distribution generated by the system is performed using open loop control both with and without active wavefront sensing. For the latter, a progressive modal decomposition algorithm is used to estimate and correct distortion in the point-spread function (PSF) of the wavefront arising due to the optical system and other sources of wavefront distortion. Using this control method, we experimentally demonstrate high-fidelity recreation of Zernike modes up to the fourth order, and blind (sensorless) PSF correction in a wide-field microscope.

Generation of high-quality tunable Airy beams with an adaptive deformable mirror

Self-accelerating Airy beams have emerged to hold great promise in wide applications due to their non-diffraction and self-healing characteristics. The generation of Airy beams with high quality and high efficiency still remains challenging for conventional diffractive or refractive optical elements. In this Letter, tunable Airy beams with high quality are realized using a reflective adaptive deformable mirror (DM). Both the controllable cubic phase and the compensatory phase for aberrations of the optical system are generated simultaneously to ensure high quality of the resultant Airy beam. Continuous cubic phases with different amplitudes and rotation angles can be readily generated, demonstrating exceptional tunability of the generated Airy beams using a DM device. The intensity profiles and propagation trajectories of the experimentally generated Airy beams are in good agreement with the theoretical results. Benefiting from the intrinsic superiority of a DM with high reflectivity and a high damage threshold, our proposed method for dynamic generation of Airy beams opens up an avenue to plenty of applications such as ultrahigh-power laser shaping, laser fabrication, and optical manipulation.

Foveal Crowding Resolved

Crowding is the substantial interference of neighboring items on target identification. Crowding with letter stimuli has been studied primarily in the visual periphery, with conflicting results for foveal stimuli. While a cortical locus for peripheral crowding is well established (with a large spatial extent up to half of the target eccentricity), disentangling the contributing factors in the fovea is more challenging due to optical limitations. Here, we used adaptive optics (AO) to overcome ocular aberrations and employed high-resolution stimuli to precisely characterize foveal lateral interactions with high-contrast letters flanked by letters. Crowding was present, with a maximal edge-to-edge interference zone of 0.75-1.3 minutes at typical unflanked performance levels. In agreement with earlier foveal contour interaction studies, performance was non-monotonic, revealing a recovery effect with proximal flankers. Modeling revealed that the deleterious effects of flankers can be described by a single function across stimulus sizes when the degradation is expressed as a reduction in sensitivity (expressed in Z-score units). The recovery, however, did not follow this pattern, likely reflecting a separate mechanism. Additional analysis reconciles multiple results from the literature, including the observed scale invariance of center-to-center spacing, as well as the size independence of edge-to-edge spacing.

Repeatability of a Commercially Available Adaptive Optics Visual Simulator and Aberrometer in Normal and Keratoconic Eyes

PURPOSE

To evaluate the repeatability of aberration measurement obtained by a Hartmann-Shack aberrometer combined with a visual adaptive optics simulator in normal and keratoconic eyes.

METHODS

One hundred fifteen normal eyes and 92 eyes with grade I and II keratoconus, as per the Amsler-Krumeich classification, were included in the study. To evaluate the repeatability, three consecutive measurements of ocular aberrations were obtained by a single operator. Zernike analyses up to the 5th order for a pupil size of 4.5 mm were performed. Statistical analyses included the intraclass correlation coefficient (ICC) and within-subject standard deviation (SD).

RESULTS

For intrasession repeatability, the ICC value for sphere and cylinder was 0.94 and 0.93 in normal eyes and 0.98 and 0.97 in keratoconic eyes, respectively. The ICC for root mean square of higher order aberrations (HOA_RMS) was 0.82 in normal and 0.98 in keratoconic eyes. For 3rd order aberrations (trefoil and coma), the ICC values were greater than 0.87 for normal eyes and greater than 0.92 for keratoconic eyes. The ICC for spherical aberration was 0.92 and 0.90 in normal and keratoconic eyes, respectively.

CONCLUSIONS

Visual adaptive optics provided repeatable aberrometry data in both normal and keratoconic eyes. For most of the parameters, the repeatability in eyes with early keratoconus was somewhat better than that for normal eyes. The repeatability of the Zernike terms was acceptable for 3rd order (trefoil and coma) and spherical aberrations. Therefore, visual adaptive optics was a suitable tool to perform repeatable aberrometric measurements. [J Refract Surg. 2017;33(11):769-772.].

Aberration laser beams with autofocusing properties

We investigate theoretically, numerically, and experimentally a novel type of laser beam-an aberration laser beam (ALB). To generate the ALB, a diffractive optical element with a phase transmission function having an arbitrary radial dependence of power q and a periodic angular dependence of sin(mϕ) or cos(mϕ) form can be used. Such a light distribution is more general than classic aberrations including Zernike polynomials. We demonstrate that such radial nonuniformity results in autofocusing properties of ALBs. The autofocusing feature of ALBs is analogous to that of circular Airy beams, but the ALBs' autofocusing feature has more flexibility. The presence of the periodic angular dependence in the phase results in a diffraction pattern with mth-order symmetry. Transformation of ALBs during propagation in free space is analogous to transformation of the three-Airy beams; however, the generated light distributions have an arbitrary integer order of symmetry. The presence of an additional focusing lens leads to formation of an optical field in its focal plane with symmetry that depends on the parity of m: for even m, the generated light distribution has 2mth-order symmetry, and, for odd m, it has mth-order symmetry.

Intraocular light scatter, reflections, fluorescence and absorption: what we see in the slit lamp

PURPOSE

Much knowledge has been collected over the past 20 years about light scattering in the eye- in particular in the eye lens- and its visual effect, called straylight. It is the purpose of this review to discuss how these insights can be applied to understanding the slit lamp image.

RESULTS

The slit lamp image mainly results from back scattering, whereas the effects on vision result mainly from forward scatter. Forward scatter originates from particles of about wavelength size distributed throughout the lens. Most of the slit lamp image originates from small particle scatter (Rayleigh scatter). For a population of middle aged lenses it will be shown that both these scatter components remove around 10% of the light from the direct beam. For slit lamp observation close to the reflection angles, zones of discontinuity (Wasserspalten) at anterior and posterior parts of the lens show up as rough surface reflections. All these light scatter effects increase with age, but the correlations with age, and also between the different components, are weak. For retro-illumination imaging it will be argued that the density or opacity seen in areas of cortical or posterior subcapsular cataract show up because of light scattering, not because of light loss. NOTES: (1) Light scatter must not be confused with aberrations. Light penetrating the eye is divided into two parts: a relatively small part is scattered, and removed from the direct beam. Most of the light is not scattered, but continues as the direct beam. This non-scattered part is the basis for functional imaging, but its quality is under the control of aberrations. Aberrations deflect light mainly over small angles (<1°), whereas light scatter is important because of the straylight effects over large angles (>1°), causing problems like glare and hazy vision. (2) The slit lamp image in older lenses and nuclear cataract is strongly influenced by absorption. However, this effect is greatly exaggerated by the light path lengths concerned. This obviates proper judgement of the functional importance of absorption, and hinders the appreciation of the Rayleigh nature of what is seen in the slit lamp image.

Ultra-high contrast retinal display system for single photoreceptor psychophysics

Due to the enormous dynamic range of human photoreceptors in response to light, studying their visual function in the intact retina challenges the stimulation hardware, specifically with regard to the displayable luminance contrast. The adaptive optics scanning laser ophthalmoscope (AOSLO) is an optical platform that focuses light to extremely small retinal extents, approaching the size of single photoreceptor cells. However, the current light modulation techniques produce spurious visible backgrounds which fundamentally limit experimental options. To remove unwanted background light and to improve contrast for high dynamic range visual stimulation in an AOSLO, we cascaded two commercial fiber-coupled acousto-optic modulators (AOMs) and measured their combined optical contrast. By compensating for zero-point differences in the individual AOMs, we demonstrate a multiplicative extinction ratio in the cascade that was in accordance with the extinction ratios of both single AOMs. When latency differences in the AOM response functions were individually corrected, single switch events as short as 50 ns with radiant power contrasts up to 1:10¹⁰ were achieved. This is the highest visual contrast reported for any display system so far. We show psychophysically that this contrast ratio is sufficient to stimulate single foveal photoreceptor cells with small and bright enough visible targets that do not contain a detectable background. Background-free stimulation will enable photoreceptor testing with custom adaptation lights. Furthermore, a larger dynamic range in displayable light levels can drive photoreceptor responses in cones as well as in rods.

Drifts in real-time partial wavefront correction and how to avoid them

In visual experiments that require real-time partial correction of wavefront aberrations, small errors occur that accumulate over time and lead to drifts in Zernike coefficients of the uncorrected aberrations. A simple algorithm that does not require the inclusion of an additional optical path to obtain independent measurements of the eye's aberrations is described here, and its effectiveness in preventing these drifts is demonstrated.

Glaucoma: the retina and beyond

Over 60 million people worldwide are diagnosed with glaucomatous optic neuropathy, which is estimated to be responsible for 8.4 million cases of irreversible blindness globally. Glaucoma is associated with characteristic damage to the optic nerve and patterns of visual field loss which principally involves the loss of retinal ganglion cells (RGCs). At present, intraocular pressure (IOP) presents the only modifiable risk factor for glaucoma, although RGC and vision loss can continue in patients despite well-controlled IOP. This, coupled with the present inability to diagnose glaucoma until relatively late in the disease process, has led to intense investigations towards the development of novel techniques for the early diagnosis of disease. This review outlines our current understanding of the potential mechanisms underlying RGC and axonal loss in glaucoma. Similarities between glaucoma and other neurodegenerative diseases of the central nervous system are drawn before an overview of recent developments in techniques for monitoring RGC health is provided, including recent progress towards the development of RGC specific contrast agents. The review concludes by discussing techniques to assess glaucomatous changes in the brain using MRI and the clinical relevance of glaucomatous-associated changes in the visual centres of the brain.

Temporal multiplexing with adaptive optics for simultaneous vision

We present and test a methodology for generating simultaneous vision with a deformable mirror that changed shape at 50 Hz between two vergences: 0 D (far vision) and -2.5 D (near vision). Different bifocal designs, including toric and combinations of spherical aberration, were simulated and assessed objectively. We found that typical corneal aberrations of a 60-year-old subject changes the shape of objective through-focus curves of a perfect bifocal lens. This methodology can be used to investigate subjective visual performance for different multifocal contact or intraocular lens designs.

Zinc selenide-based large aperture photo-controlled deformable mirror

Realization of large aperture deformable mirrors with a large density of actuators is important in many applications, and photo-controlled deformable mirrors (PCDMs) represent an innovation. Herein we show that PCDMs are scalable realizing a 2-inch aperture device based on a polycrystalline zinc selenide (ZnSe) as the photoconductive substrate and a thin polymeric reflective membrane. ZnSe is electrically characterized and analyzed through a model that we previously introduced. The PCDM is then optically tested, demonstrating its capabilities in adaptive optics.

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.

The fundus photo has met its match: optical coherence tomography and adaptive optics ophthalmoscopy are here to stay

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.

Where are you looking? Pseudogaze in afterimages

How do we know where we are looking? A frequent assumption is that the subjective experience of our direction of gaze is assigned to the location in the world that falls on our fovea. However, we find that observers can shift their subjective direction of gaze among different nonfoveal points in an afterimage. Observers were asked to look directly at different corners of a diamond-shaped afterimage. When the requested corner was 3.5° in the periphery, the observer often reported that the image moved away in the direction of the attempted gaze shift. However, when the corner was at 1.75° eccentricity, most reported successfully fixating at the point. Eye-tracking data revealed systematic drift during the subjective fixations on peripheral locations. For example, when observers reported looking directly at a point above the fovea, their eyes were often drifting steadily upwards. We then asked observers to make a saccade from a subjectively fixated, nonfoveal point to another point in the afterimage, 7° directly below their fovea. The observers consistently reported making appropriately diagonal saccades, but the eye movement traces only occasionally followed the perceived oblique direction. These results suggest that the perceived direction of gaze can be assigned flexibly to an attended point near the fovea. This may be how the visual world acquires its stability during fixation of an object, despite the drifts and microsaccades that are normal characteristics of visual fixation.

Wavefront sensorless adaptive optics fluorescence biomicroscope for in vivo retinal imaging in mice

Cellular-resolution in vivo fluorescence imaging is a valuable tool for longitudinal studies of retinal function in vision research. Wavefront sensorless adaptive optics (WSAO) is a developing technology that enables high-resolution imaging of the mouse retina. In place of the conventional method of using a Shack-Hartmann wavefront sensor to measure the aberrations directly, WSAO uses an image quality metric and a search algorithm to drive the shape of the adaptive element (i.e. deformable mirror). WSAO is a robust approach to AO and it is compatible with a compact, low-cost lens-based system. In this report, we demonstrated a hill-climbing algorithm for WSAO with a variable focus lens and deformable mirror for non-invasive in vivo imaging of EGFP (enhanced green fluorescent protein) labelled ganglion cells and microglia cells in the mouse retina.

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.

Wavefront correction and high-resolution in vivo OCT imaging with an objective integrated multi-actuator adaptive lens

Adaptive optics is rapidly transforming microscopy and high-resolution ophthalmic imaging. The adaptive elements commonly used to control optical wavefronts are liquid crystal spatial light modulators and deformable mirrors. We introduce a novel Multi-actuator Adaptive Lens that can correct aberrations to high order, and which has the potential to increase the spread of adaptive optics to many new applications by simplifying its integration with existing systems. Our method combines an adaptive lens with an imaged-based optimization control that allows the correction of images to the diffraction limit, and provides a reduction of hardware complexity with respect to existing state-of-the-art adaptive optics systems. The Multi-actuator Adaptive Lens design that we present can correct wavefront aberrations up to the 4th order of the Zernike polynomial characterization. The performance of the Multi-actuator Adaptive Lens is demonstrated in a wide field microscope, using a Shack-Hartmann wavefront sensor for closed loop control. The Multi-actuator Adaptive Lens and image-based wavefront-sensorless control were also integrated into the objective of a Fourier Domain Optical Coherence Tomography system for in vivo imaging of mouse retinal structures. The experimental results demonstrate that the insertion of the Multi-actuator Objective Lens can generate arbitrary wavefronts to correct aberrations down to the diffraction limit, and can be easily integrated into optical systems to improve the quality of aberrated images.

Adaptive-optics SLO imaging combined with widefield OCT and SLO enables precise 3D localization of fluorescent cells in the mouse retina

Adaptive optics scanning laser ophthalmoscopy (AO-SLO) has recently been used to achieve exquisite subcellular resolution imaging of the mouse retina. Wavefront sensing-based AO typically restricts the field of view to a few degrees of visual angle. As a consequence the relationship between AO-SLO data and larger scale retinal structures and cellular patterns can be difficult to assess. The retinal vasculature affords a large-scale 3D map on which cells and structures can be located during in vivo imaging. Phase-variance OCT (pv-OCT) can efficiently image the vasculature with near-infrared light in a label-free manner, allowing 3D vascular reconstruction with high precision. We combined widefield pv-OCT and SLO imaging with AO-SLO reflection and fluorescence imaging to localize two types of fluorescent cells within the retinal layers: GFP-expressing microglia, the resident macrophages of the retina, and GFP-expressing cone photoreceptor cells. We describe in detail a reflective afocal AO-SLO retinal imaging system designed for high resolution retinal imaging in mice. The optical performance of this instrument is compared to other state-of-the-art AO-based mouse retinal imaging systems. The spatial and temporal resolution of the new AO instrumentation was characterized with angiography of retinal capillaries, including blood-flow velocity analysis. Depth-resolved AO-SLO fluorescent images of microglia and cone photoreceptors are visualized in parallel with 469 nm and 663 nm reflectance images of the microvasculature and other structures. Additional applications of the new instrumentation are discussed.

Clinical applications of wavefront refraction

Purpose

To determine normative reference ranges for higher-order wavefront error (HO-WFE), compare these values with those in common ocular pathologies, and evaluate treatments.

Methods

A review of 17 major studies on HO-WFE was made, involving data for a total of 31,605 subjects. The upper limit of the 95% confidence interval (CI) for HO-WFE was calculated from the most comprehensive of these studies using normal healthy patients aged 20 to 80 years. There were no studies identified using the natural pupil size for subjects, and for this reason, the HO-WFE was tabulated for pupil diameters of 3 to 7 mm. Effects of keratoconus, pterygium, cataract, and dry eye on HO-WFE were reviewed and treatment efficacy was considered.

Results

The calculated upper limit of the 95% CI for HO-WFE in a healthy normal 35-year-old patient with a mesopic pupil diameter of 6 mm would be 0.471 μm (471 nm) root-mean-square or less. Although the normal HO-WFE increases with age for a given pupil size, it is not yet completely clear how the concurrent influence of age-related pupillary miosis affects these findings. Abnormal ocular conditions such as keratoconus can induce a large HO-WFE, often in excess of 3.0 μm, particularly attributed to coma. For pterygium or cortical cataract, a combination of coma and trefoil was more commonly induced. Nuclear cataract can induce a negative spherical HO-WFE, usually in excess of 1.0 μm.

Conclusions

The upper limit of the 95% CI for HO-WFE root-mean-square is about 0.5 μm with normal physiological pupil sizes. With ocular pathologies, HO-WFE can be in excess of 1.0 μm, although many devices and therapeutic and surgical treatments are reported to be highly effective at minimizing HO-WFE. More accurate normative reference ranges for HO-WFE will require future studies using the subjects’ natural pupil size.

Imaging of retinal vasculature using adaptive optics SLO/OCT

We use our previously developed adaptive optics (AO) scanning laser ophthalmoscope (SLO)/ optical coherence tomography (OCT) instrument to investigate its capability for imaging retinal vasculature. The system records SLO and OCT images simultaneously with a pixel to pixel correspondence which allows a direct comparison between those imaging modalities. Different field of views ranging from 0.8°x0.8° up to 4°x4° are supported by the instrument. In addition a dynamic focus scheme was developed for the AO-SLO/OCT system in order to maintain the high transverse resolution throughout imaging depth. The active axial eye tracking that is implemented in the OCT channel allows time resolved measurements of the retinal vasculature in the en-face imaging plane. Vessel walls and structures that we believe correspond to individual erythrocytes could be visualized with the system.

Effects of optical blur reduction on equivalent intrinsic blur

PURPOSE

To determine the effect of optical blur reduction on equivalent intrinsic blur, an estimate of the blur within the visual system, by comparing optical and equivalent intrinsic blur before and after adaptive optics (AO) correction of wavefront error.

METHODS

Twelve visually normal subjects (mean [±SD] age, 31 [±12] years) participated in this study. Equivalent intrinsic blur (σint) was derived using a previously described model. Optical blur (σopt) caused by high-order aberrations was quantified by Shack-Hartmann aberrometry and minimized using AO correction of wavefront error.

RESULTS

σopt and σint were significantly reduced and visual acuity was significantly improved after AO correction (p ≤ 0.004). Reductions in σopt and σint were linearly dependent on the values before AO correction (r ≥ 0.94, p ≤ 0.002). The reduction in σint was greater than the reduction in σopt, although it was marginally significant (p = 0.05). σint after AO correlated significantly with σint before AO (r = 0.92, p < 0.001), and the two parameters were related linearly with a slope of 0.46.

CONCLUSIONS

Reduction in equivalent intrinsic blur was greater than the reduction in optical blur after AO correction of wavefront error. This finding implies that visual acuity in subjects with high equivalent intrinsic blur can be improved beyond that expected from the reduction in optical blur alone.

Adaptive optics vision simulation and perceptual learning system based on a 35-element bimorph deformable mirror

An adaptive optics visual simulation combined with a perceptual learning (PL) system based on a 35-element bimorph deformable mirror (DM) was established. The larger stroke and smaller size of the bimorph DM made the system have larger aberration correction or superposition ability and be more compact. By simply modifying the control matrix or the reference matrix, select correction or superposition of aberrations was realized in real time similar to a conventional adaptive optics closed-loop correction. PL function was first integrated in addition to conventional adaptive optics visual simulation. PL training undertaken with high-order aberrations correction obviously improved the visual function of adult anisometropic amblyopia. The preliminary application of high-order aberrations correction with PL training on amblyopia treatment was being validated with a large scale population, which might have great potential in amblyopia treatment and visual performance maintenance.

Mapping the perceptual grain of the human retina

In humans, experimental access to single sensory receptors is difficult to achieve, yet it is crucial for learning how the signals arising from each receptor are transformed into perception. By combining adaptive optics microstimulation with high-speed eye tracking, we show that retinal function can be probed at the level of the individual cone photoreceptor in living eyes. Classical psychometric functions were obtained from cone-sized microstimuli targeted to single photoreceptors. Revealed psychophysically, the cone mosaic also manifests a variable sensitivity to light across its surface that accords with a simple model of cone light capture. Because this microscopic grain of vision could be detected on the perceptual level, it suggests that photoreceptors can act individually to shape perception, if the normally suboptimal relay of light by the eye's optics is corrected. Thus the precise arrangement of cones and the exact placement of stimuli onto those cones create the initial retinal limits on signals mediating spatial vision.

Immature visual neural system in children reflected by contrast sensitivity with adaptive optics correction

This study aimed to explore the neural development status of the visual system of children (around 8 years old) using contrast sensitivity. We achieved this by eliminating the influence of higher order aberrations (HOAs) with adaptive optics correction. We measured HOAs, modulation transfer functions (MTFs) and contrast sensitivity functions (CSFs) of six children and five adults with both corrected and uncorrected HOAs. We found that when HOAs were corrected, children and adults both showed improvements in MTF and CSF. However, the CSF of children was still lower than the adult level, indicating the difference in contrast sensitivity between groups cannot be explained by differences in optical factors. Further study showed that the difference between the groups also could not be explained by differences in non-visual factors. With these results we concluded that the neural systems underlying vision in children of around 8 years old are still immature in contrast sensitivity.

Mapping the primate lateral geniculate nucleus: a review of experiments and methods

Mapping neuronal responses in the lateral geniculate nucleus (LGN) is key to understanding how visual information is processed in the brain. This paper focuses on our current knowledge of the dynamics the receptive field (RF) as broken down into the classical receptive field (CRF) and the extra-classical receptive field (ECRF) in primate LGN. CRFs in the LGN are known to be similar to those in the retinal ganglion cell layer in terms of both spatial and temporal characteristics, leading to the standard interpretation of the LGN as a relay center from retina to primary visual cortex. ECRFs have generally been found to be large and inhibitory, with some differences in magnitude between the magno-, parvo-, and koniocellular pathways. The specific contributions of the retina, thalamus, and visual cortex to LGN ECRF properties are presently unknown. Some reports suggest a retinal origin for extra-classical suppression based on latency arguments and other reports have suggested a thalamic origin for extra-classical suppression. This issue is complicated by the use of anesthetized animals, where cortical activity is likely to be altered. Thus further study of LGN ECRFs is warranted to reconcile these discrepancies. Producing descriptions of RF properties of LGN neurons could be enhanced by employing preferred naturalistic stimuli. Although there has been significant work in cats with natural scene stimuli and noise that statistically imitates natural scenes, we highlight a need for similar data from primates. Obtaining these data may be aided by recent advancements in experimental and analytical techniques that permit the efficient study of nonlinear RF characteristics in addition to traditional linear factors. In light of the reviewed topics, we conclude by suggesting experiments to more clearly elucidate the spatial and temporal structure of ECRFs of primate LGN neurons.

Processing blur of conflicting stimuli during the latency and onset of accommodation

The accommodative response (AR) to changes in dioptric accommodative stimulus (AS) during the latency period and onset of accommodation was investigated. Participants monocularly observed one period of a square wave in AS, with a 2-D baseline and mean, and amplitude 1 D or 2 D; the period of the square wave ranged from 0.10 s to 1.00 s; both increases and decreases were used for the first step in AS. At periods of 0.30s and longer, accommodation was found to respond to both levels of the stimulus. Rapid retinal monitoring appeared to be taking place for such stimuli. The amplitudes of peaks in AR did not usually depend on whether a particular level of AS occurred first or second, but for 8/40 conditions, a significant difference was found, with a stronger response when the level of AS occurred second. Null or incorrect responses were also observed in many trials, possibly linked with the natural microfluctuations of accommodation. Minimum response times to the changes in AS were observed, which increased with decreasing period of the AS. The time interval between peaks in the AR decreased with decreasing period of the AS. The findings were consistent with a parallel processing model previously proposed for saccades, where input from a later change in stimulus may enter an element of the control system when that element has finished processing an earlier change. More than one change in stimulus may therefore be passing through the multi-element control system at a time.

Lowered threshold energy for femtosecond laser induced optical breakdown in a water based eye model by aberration correction with adaptive optics

In femtosecond laser ophthalmic surgery tissue dissection is achieved by photodisruption based on laser induced optical breakdown. In order to minimize collateral damage to the eye laser surgery systems should be optimized towards the lowest possible energy threshold for photodisruption. However, optical aberrations of the eye and the laser system distort the irradiance distribution from an ideal profile which causes a rise in breakdown threshold energy even if great care is taken to minimize the aberrations of the system during design and alignment. In this study we used a water chamber with an achromatic focusing lens and a scattering sample as eye model and determined breakdown threshold in single pulse plasma transmission loss measurements. Due to aberrations, the precise lower limit for breakdown threshold irradiance in water is still unknown. Here we show that the threshold energy can be substantially reduced when using adaptive optics to improve the irradiance distribution by spatial beam shaping. We found that for initial aberrations with a root-mean-square wave front error of only one third of the wavelength the threshold energy can still be reduced by a factor of three if the aberrations are corrected to the diffraction limit by adaptive optics. The transmitted pulse energy is reduced by 17% at twice the threshold. Furthermore, the gas bubble motions after breakdown for pulse trains at 5 kilohertz repetition rate show a more transverse direction in the corrected case compared to the more spherical distribution without correction. Our results demonstrate how both applied and transmitted pulse energy could be reduced during ophthalmic surgery when correcting for aberrations. As a consequence, the risk of retinal damage by transmitted energy and the extent of collateral damage to the focal volume could be minimized accordingly when using adaptive optics in fs-laser surgery.

Pre-processing, registration and selection of adaptive optics corrected retinal images

PURPOSE

In this paper, the aim is to demonstrate enhanced processing of sequences of fundus images obtained using a commercial AO flood illumination system. The purpose of the work is to (1) correct for uneven illumination at the retina (2) automatically select the best quality images and (3) precisely register the best images.

METHODS

Adaptive optics corrected retinal images are pre-processed to correct uneven illumination using different methods; subtracting or dividing by the average filtered image, homomorphic filtering and a wavelet based approach. These images are evaluated to measure the image quality using various parameters, including sharpness, variance, power spectrum kurtosis and contrast. We have carried out the registration in two stages; a coarse stage using cross-correlation followed by fine registration using two approaches; parabolic interpolation on the peak of the cross-correlation and maximum-likelihood estimation. The angle of rotation of the images is measured using a combination of peak tracking and Procrustes transformation.

RESULTS

We have found that a wavelet approach (Daubechies 4 wavelet at 6th level decomposition) provides good illumination correction with clear improvement in image sharpness and contrast. The assessment of image quality using a 'Designer metric' works well when compared to visual evaluation, although it is highly correlated with other metrics. In image registration, sub-pixel translation measured using parabolic interpolation on the peak of the cross-correlation function and maximum-likelihood estimation are found to give very similar results (RMS difference 0.047 pixels). We have confirmed that correcting rotation of the images provides a significant improvement, especially at the edges of the image. We observed that selecting the better quality frames (e.g. best 75% images) for image registration gives improved resolution, at the expense of poorer signal-to-noise. The sharpness map of the registered and de-rotated images shows increased sharpness over most of the field of view.

CONCLUSION

Adaptive optics assisted images of the cone photoreceptors can be better pre-processed using a wavelet approach. These images can be assessed for image quality using a 'Designer Metric'. Two-stage image registration including correcting for rotation significantly improves the final image contrast and sharpness.

Eccentricity dependent changes of density, spacing and packing arrangement of parafoveal cones

PURPOSE

To investigate the distribution of cone density and spacing as well as the preferred packing arrangement of the cone mosaic as a function of retinal eccentricity.

METHODS

An adaptive optics retinal camera (rtx1, www.imagine-eyes.com) was used to obtain images of the parafoveal cone mosaic in nineteen healthy volunteers. Cone density and spacing were estimated for each subject (both eyes) using a sampling window of 80 × 80 pixels, at 250-, 450-, 650- and 1100-μm eccentricities from the fovea along the nasal and temporal retina of both eyes. The inter-subject and intra-subject variation of cone density and spacing were calculated via Coefficient of Variation (CoV). Cone packing arrangement was assessed using Voronoi analysis; calculations were done over 1024 × 128 pixels image sections of the cone mosaic across the horizontal meridian from 200- to 1050-μm eccentricities.

RESULTS

The inter-subject variation of parafoveal cone density ranged between 10% and 15% (p < 0.001) and the intra-subject variation of cone density was lower than 8% in all subjects, except for two. The cone spacing values showed a moderate inter-subject (CoV<7%; p < 0.001) and a low intra-subject variation (CoV<4% in all subjects, except for two cases). In the parafoveal region, 40-50% of cones were hexagonally arranged; the percentage of non-hexagonal Voronoi tiles increased at greater eccentricities.

CONCLUSION

The use of multiple and complementary metric descriptors allows for a more detailed description of packing distribution and preferred arrangement of cone photoreceptors across the parafoveal retina.

Optical properties of retinal tissue and the potential of adaptive optics to visualize retinal ganglion cells in vivo

Many efforts have been made to improve the diagnostic tools used to identify and to estimate the progress of ganglion cell and nerve fibre degeneration in glaucoma. Imaging by optical coherence tomography and measurements of the dimensions of the optic nerve head and the nerve fibre layer in central retinal areas is currently used to estimate the grade of pathological changes. The visualization and quantification of ganglion cells and nerve fibres directly in patients would dramatically improve glaucoma diagnostics. We have investigated the optical properties of cellular structures of retinal tissue in order to establish a means of visualizing and quantifying ganglion cells in the living retina without staining. We have characterized the optical properties of retinal tissue in several species including humans. Nerve fibres, blood vessels, ganglion cells and their cell processes have been visualized at high image resolution by means of the reflection mode of a confocal laser scanning microscope. The potential of adaptive optics in current imaging systems and the possibilities of imaging single ganglion cells non-invasively in patients are discussed.

Comparison of spherical aberration and small-pupil profiles in improving depth of focus for presbyopic corrections

PURPOSE

To compare the validity and effectiveness of 2 methods for expanding depth of focus to correct for presbyopia; that is, induction of spherical aberration and small-pupil apertures.

SETTING

University of California, Berkeley, California, USA.

DESIGN

Comparative case series.

METHODS

A random 4-alternative forced-choice acuity task was performed on 13 subjects. Visual performance and depth of focus were compared using adaptive optics-corrected distance visual acuity (CDVA) values and mean visual acuity over a 3.0 diopter (D) range of defocus using the following 3 adaptive optics-corrected profiles: 2.0 mm pupil, 5.0 mm pupil, and 5.0 mm pupil with -0.274 μm of spherical aberration.

RESULTS

The 5.0 mm pupil profile had a CDVA of -0.218 logMAR and a mean visual acuity through focus of 0.156 logMAR. The 2.0 mm pupil profile had a worse CDVA (0.012 logMAR) but an improved mean visual acuity (0.061 logMAR). The 5.0 mm pupil profile with -0.274 μm of spherical aberration measured a CDVA of -0.082 logMAR and a mean visual acuity of 0.103 logMAR.

CONCLUSIONS

The spherical aberration and small-pupil profiles improved the mean visual acuity across a 3.0 D range of defocus but resulted in decreased CDVA at the plane of best focus in comparison to an adaptive optics-corrected 5.0 mm pupil. Small-pupil profiles are a better choice than spherical aberration profiles for presbyopic corrections due to expected accuracy, predictability, and patient satisfaction.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Subjective evaluation of intraocular lenses by visual acuity measurement using adaptive optics

We present a new method for subjectively evaluating intraocular lenses (IOLs) without implantation surgery. To illustrate the method, three types of single-piece IOL (equispherical monofocal, rotational symmetric aspheric monofocal, and diffractive bifocal) were assembled into a model eye and evaluated using an ocular adaptive optics system by a single subject. To separate the spherical aberration of the crystalline lens, the subject's corneal topography and wavefront aberrations were measured and modeled. Three levels of Zernike spherical aberration were generated and superposed on the IOLs and the subject's eye. The corrected distance visual acuity was measured by psychophysical visual procedure.