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Wang CY, Nguyen HT, Fan WS, Lue JH, Saenprasarn P, Chen MM, Huang SY, Lin FC, Wang HC. Glaucoma Detection through a Novel Hyperspectral Imaging Band Selection and Vision Transformer Integration. Diagnostics (Basel) 2024; 14:1285. [PMID: 38928700 PMCID: PMC11202918 DOI: 10.3390/diagnostics14121285] [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: 05/20/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Conventional diagnostic methods for glaucoma primarily rely on non-dynamic fundus images and often analyze features such as the optic cup-to-disc ratio and abnormalities in specific retinal locations like the macula and fovea. However, hyperspectral imaging techniques focus on detecting alterations in oxygen saturation within retinal vessels, offering a potentially more comprehensive approach to diagnosis. This study explores the diagnostic potential of hyperspectral imaging for glaucoma by introducing a novel hyperspectral imaging conversion technique. Digital fundus images are transformed into hyperspectral representations, allowing for a detailed analysis of spectral variations. Spectral regions exhibiting differences are identified through spectral analysis, and images are reconstructed from these specific regions. The Vision Transformer (ViT) algorithm is then employed for classification and comparison across selected spectral bands. Fundus images are used to identify differences in lesions, utilizing a dataset of 1291 images. This study evaluates the classification performance of models using various spectral bands, revealing that the 610-780 nm band outperforms others with an accuracy, precision, recall, F1-score, and AUC-ROC all approximately at 0.9007, indicating its superior effectiveness for the task. The RGB model also shows strong performance, while other bands exhibit lower recall and overall metrics. This research highlights the disparities between machine learning algorithms and traditional clinical approaches in fundus image analysis. The findings suggest that hyperspectral imaging, coupled with advanced computational techniques such as the ViT algorithm, could significantly enhance glaucoma diagnosis. This understanding offers insights into the potential transformation of glaucoma diagnostics through the integration of hyperspectral imaging and innovative computational methodologies.
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Affiliation(s)
- Ching-Yu Wang
- Department of Ophthalmology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan; (C.-Y.W.); (W.-S.F.)
| | - Hong-Thai Nguyen
- Department of Mechanical Engineering, National Chung Cheng University, Chiayi 62102, Taiwan;
| | - Wen-Shuang Fan
- Department of Ophthalmology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan; (C.-Y.W.); (W.-S.F.)
| | - Jiann-Hwa Lue
- Department of Optometry, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Taichung City 406053, Taiwan; (J.-H.L.); (S.-Y.H.)
| | - Penchun Saenprasarn
- School of Nursing, Shinawatra University, 99 Moo 10, Bangtoey, Samkhok, Pathum Thani 12160, Thailand;
| | - Meei-Maan Chen
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, 168, University Rd., Min Hsiung, Chiayi 62102, Taiwan;
| | - Shuan-Yu Huang
- Department of Optometry, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Taichung City 406053, Taiwan; (J.-H.L.); (S.-Y.H.)
| | - Fen-Chi Lin
- Department of Ophthalmology, Kaohsiung Armed Forces General Hospital, 2, Zhongzheng 1st. Rd., Kaohsiung City 80284, Taiwan
| | - Hsiang-Chen Wang
- Department of Optometry, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Taichung City 406053, Taiwan; (J.-H.L.); (S.-Y.H.)
- Hitspectra Intelligent Technology Co., Ltd., Kaohsiung City 80661, Taiwan
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Xuan M, Wang W, Bulloch G, Zhang J, Ha J, Wang Q, Wang J, Lin X, He M. Impact of Acute Ocular Hypertension on Retinal Ganglion Cell Loss in Mice. Transl Vis Sci Technol 2024; 13:17. [PMID: 38506800 PMCID: PMC10959197 DOI: 10.1167/tvst.13.3.17] [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: 05/02/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose To assess the correlation between intraocular pressure (IOP) levels and retinal ganglion cell (RGC) loss across different fixed-duration episodes of acute ocular hypertension (AOH). Methods AOH was induced in Thy1-YFP-H transgenic mice by inserting a needle connected to a saline solution container into the anterior chamber. Thirty-one groups were tested, each comprising three to five mice exposed to IOP levels ranging from 50 to 110 mm Hg in 5/10 mm Hg increments for 60/90/120 minutes and a sham control group. The YFP-expressing RGCs were quantified by confocal scanning laser ophthalmoscopy, whereas peripapillary ganglion cell complex thickness was measured using spectral-domain optical coherence tomography. Changes in RGC count and GCCT were determined from values measured 30 days after AOH relative to baseline (before AOH). Results In the 60-minute AOH groups, RGC loss varied even when IOP was increased up to 110 mm Hg (36.8%-68.2%). However, for longer durations (90 and 120 minutes), a narrow range of IOP levels (60-70 mm Hg for 90-minute duration; 55-65 mm Hg for 120-minute duration) produced a significant difference in RGC loss, ranging from <25% to >90%. Additionally, loss of YFP-expressing RGCs was comparable to that of total RGCs in the same retinas. Conclusions Reproducible RGC loss during AOH depends on precise durations and IOP thresholds. In the current study, the optimal choice is an AOH protocol set at 70 mm Hg for a duration of 90 minutes. Translational Relevance This study can assist in determining the optimal duration and intensity of IOP for the effective utilization of AOH models.
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Affiliation(s)
- Meng Xuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Jason Ha
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Qilin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Juanjuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Xingyan Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, Guangdong, China
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Centre for Eye and Vision Research (CEVR), Hong Kong, China
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Kurokawa K, Nemeth M. Multifunctional adaptive optics optical coherence tomography allows cellular scale reflectometry, polarimetry, and angiography in the living human eye. BIOMEDICAL OPTICS EXPRESS 2024; 15:1331-1354. [PMID: 38404344 PMCID: PMC10890865 DOI: 10.1364/boe.505395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/27/2024]
Abstract
Clinicians are unable to detect glaucoma until substantial loss or dysfunction of retinal ganglion cells occurs. To this end, novel measures are needed. We have developed an optical imaging solution based on adaptive optics optical coherence tomography (AO-OCT) to discern key clinical features of glaucoma and other neurodegenerative diseases at the cellular scale in the living eye. Here, we test the feasibility of measuring AO-OCT-based reflectance, retardance, optic axis orientation, and angiogram at specifically targeted locations in the living human retina and optic nerve head. Multifunctional imaging, combined with focus stacking and global image registration algorithms, allows us to visualize cellular details of retinal nerve fiber bundles, ganglion cell layer somas, glial septa, superior vascular complex capillaries, and connective tissues. These are key histologic features of neurodegenerative diseases, including glaucoma, that are now measurable in vivo with excellent repeatability and reproducibility. Incorporating this noninvasive cellular-scale imaging with objective measurements will significantly enhance existing clinical assessments, which is pivotal in facilitating the early detection of eye disease and understanding the mechanisms of neurodegeneration.
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Affiliation(s)
- Kazuhiro Kurokawa
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Legacy Health, Portland, OR 97232, USA
| | - Morgan Nemeth
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Legacy Health, Portland, OR 97232, USA
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Szewczuk A, Wawrzyniak ZM, Szaflik JP, Zaleska-Żmijewska A. Is Primary Open-Angle Glaucoma a Vascular Disease? Assessment of the Relationship between Retinal Arteriolar Morphology and Glaucoma Severity Using Adaptive Optics. J Clin Med 2024; 13:478. [PMID: 38256612 PMCID: PMC10817033 DOI: 10.3390/jcm13020478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/02/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables the analysis of retinal vasculature at the cellular level in vivo. The purpose of this study was to evaluate retinal arteriolar parameters using the rtx1 adaptive optics fundus camera (AO-FC) in patients with primary open-angle glaucoma (POAG) at different stages and to investigate the relationship between these parameters and changes in spectral-domain optical coherence tomography (SD-OCT) and perimetry. METHODS Parameters of the retinal supratemporal and infratemporal arterioles (wall thickness (WT), lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall (WCSA)) were analysed with the rtx1 in 111 POAG eyes, which were divided into three groups according to the severity of the disease, and 70 healthy eyes. The associations between RTX1 values and the cup-to-disk ratio, SD-OCT parameters, and visual field parameters were assessed. RESULTS Compared with the control group, the POAG groups showed significantly smaller TD and LD values (p < 0.05) and significantly higher WLR and WT values (p < 0.05) for the supratemporal and infratemporal arterioles. TD was significantly positively correlated with the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) (p < 0.05). LD was significantly positively correlated with the RNFL, GCC, and rim area (p < 0.05). The WLR was significantly negatively correlated with the RNFL, GCC, rim area, and MD (p < 0.05), while it was significantly positively correlated with the cup-to-disc ratio and PSD (p < 0.05). CONCLUSIONS The results suggest that vascular dysfunction is present in POAG, even at a very early stage of glaucoma, and increases with the severity of the disease.
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Affiliation(s)
- Alina Szewczuk
- Department of Ophthalmology, Public Ophthalmic Clinical Hospital (SPKSO), 00-576 Warsaw, Poland
| | - Zbigniew M. Wawrzyniak
- Faculty of Electronics and Information Technology, Warsaw University of Technology, 00-665 Warsaw, Poland;
| | - Jacek P. Szaflik
- Department of Ophthalmology, Public Ophthalmic Clinical Hospital (SPKSO), Medical University of Warsaw, 02-091 Warsaw, Poland; (J.P.S.); (A.Z.-Ż.)
| | - Anna Zaleska-Żmijewska
- Department of Ophthalmology, Public Ophthalmic Clinical Hospital (SPKSO), Medical University of Warsaw, 02-091 Warsaw, Poland; (J.P.S.); (A.Z.-Ż.)
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Hammer DX, Kovalick K, Liu Z, Chen C, Saeedi OJ, Harrison DM. Cellular-Level Visualization of Retinal Pathology in Multiple Sclerosis With Adaptive Optics. Invest Ophthalmol Vis Sci 2023; 64:21. [PMID: 37971733 PMCID: PMC10664728 DOI: 10.1167/iovs.64.14.21] [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: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Purpose To apply adaptive optics-optical coherence tomography (AO-OCT) to quantify multiple sclerosis (MS)-induced changes in axonal bundles in the macular nerve fiber layer, ganglion cell somas, and macrophage-like cells at the vitreomacular interface. Methods We used AO-OCT imaging in a pilot study of MS participants (n = 10), including those without and with a history of optic neuritis (ON, n = 4), and healthy volunteers (HV, n = 9) to reveal pathologic changes to inner retinal cells and structures affected by MS. Results We found that nerve fiber layer axonal bundles had 38% lower volume in MS participants (1.5 × 10-3 mm3) compared to HVs (2.4 × 10-3 mm3; P < 0.001). Retinal ganglion cell (RGC) density was 51% lower in MS participants (12.3 cells/mm2 × 1000) compared to HVs (25.0 cells/mm2 × 1000; P < 0.001). Spatial differences across the macula were observed in RGC density. RGC diameter was 15% higher in MS participants (11.7 µm) compared to HVs (10.1 µm; P < 0.001). A nonsignificant trend of higher density of macrophage-like cells in MS eyes was also observed. For all AO-OCT measures, outcomes were worse for MS participants with a history of ON compared to MS participants without a history of ON. AO-OCT measures were associated with key visual and physical disabilities in the MS cohort. Conclusions Our findings demonstrate the utility of AO-OCT for highly sensitive and specific detection of neurodegenerative changes in MS. Moreover, the results shed light on the mechanisms that underpin specific neuronal pathology that occurs when MS attacks the retina. The new findings support the further development of AO-based biomarkers for MS.
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Affiliation(s)
- Daniel X. Hammer
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Katherine Kovalick
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Zhuolin Liu
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Chixiang Chen
- Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Osamah J. Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Daniel M. Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Department of Neurology, Baltimore VA Medical Center, Baltimore, Maryland, United States
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Montesano G, Redmond T, Mulholland PJ, Garway-Heath DF, Ometto G, Romano D, Antonacci F, Tanga L, Carnevale C, Rossetti LM, Crabb DP, Oddone F. Spatial Summation in the Glaucomatous Macula: A Link With Retinal Ganglion Cell Damage. Invest Ophthalmol Vis Sci 2023; 64:36. [PMID: 38010697 PMCID: PMC10683773 DOI: 10.1167/iovs.64.14.36] [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: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose The purpose of this study was to test whether functional loss in the glaucomatous macula is characterized by an enlargement of Ricco's area (RA) through the application of a computational model linking retinal ganglion cell (RGC) damage to perimetric sensitivity. Methods One eye from each of 29 visually healthy subjects <40 years old, 30 patients with glaucoma, and 20 age-similar controls was tested with a 10-2 grid with stimuli of 5 different area sizes. Structural estimates of point-wise RGC density were obtained from optical coherence tomography (OCT) scans. Structural and functional data from the young healthy cohort were used to estimate the parameters of a computational spatial summation model to generate a template. The template was fitted with a Bayesian hierarchical model to estimate the latent RGC density in patients with glaucoma and age-matched controls. We tested two alternative hypotheses: fitting the data by translating the template horizontally (H1: change in RA) or vertically (H2: loss of sensitivity without a change in RA). Root mean squared error (RMSE) of the model fits to perimetric sensitivity were compared. Ninety-five percent confidence intervals were bootstrapped. The dynamic range of the functional and structural RGC density estimates was denoted by their 1st and 99th percentiles. Results The RMSE was 2.09 (95% CI = 1.92-2.26) under H1 and 2.49 (95% CI = 2.24-2.72) under H2 (P < 0.001). The average dynamic range for the structural RGC density estimates was only 11% that of the functional estimates. Conclusions Macular sensitivity loss in glaucoma is better described by a model in which RA changes with RGC loss. Structural measurements have limited dynamic range.
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Affiliation(s)
- Giovanni Montesano
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Tony Redmond
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Pádraig J. Mulholland
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom
| | - David F. Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Giovanni Ometto
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - Dario Romano
- ASST Santi Paolo e Carlo, Eye Clinic – University of Milan, Milan, Italy
| | - Federica Antonacci
- ASST Santi Paolo e Carlo, Eye Clinic – University of Milan, Milan, Italy
| | | | | | - Luca M. Rossetti
- ASST Santi Paolo e Carlo, Eye Clinic – University of Milan, Milan, Italy
| | - David P. Crabb
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
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Tong J, Khou V, Trinh M, Alonso‐Caneiro D, Zangerl B, Kalloniatis M. Derivation of human retinal cell densities using high-density, spatially localized optical coherence tomography data from the human retina. J Comp Neurol 2023; 531:1108-1125. [PMID: 37073514 PMCID: PMC10953454 DOI: 10.1002/cne.25483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/20/2023]
Abstract
This study sought to identify demographic variations in retinal thickness measurements from optical coherence tomography (OCT), to enable the calculation of cell density parameters across the neural layers of the healthy human macula. From macular OCTs (n = 247), ganglion cell (GCL), inner nuclear (INL), and inner segment-outer segment (ISOS) layer measurements were extracted using a customized high-density grid. Variations with age, sex, ethnicity, and refractive error were assessed with multiple linear regression analyses, with age-related distributions further assessed using hierarchical cluster analysis and regression models. Models were tested on a naïve healthy cohort (n = 40) with Mann-Whitney tests to determine generalizability. Quantitative cell density data were calculated from histological data from previous human studies. Eccentricity-dependent variations in OCT retinal thickness closely resemble topographic cell density maps from human histological studies. Age was consistently identified as significantly impacting retinal thickness (p = .0006, .0007, and .003 for GCL, INL and ISOS), with gender affecting ISOS only (p < .0001). Regression models demonstrated that age-related changes in the GCL and INL begin in the 30th decade and were linear for the ISOS. Model testing revealed significant differences in INL and ISOS thickness (p = .0008 and .0001; however, differences fell within the OCT's axial resolution. Qualitative comparisons show close alignment between OCT and histological cell densities when using unique, high-resolution OCT data, and correction for demographics-related variability. Overall, this study describes a process to calculate in vivo cell density from OCT for all neural layers of the human retina, providing a framework for basic science and clinical investigations.
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Affiliation(s)
- Janelle Tong
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - Vincent Khou
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - Matt Trinh
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - David Alonso‐Caneiro
- School of Optometry and Vision ScienceCentre for Vision and Eye ResearchContact Lens and Visual Optics LaboratoryQueensland University of TechnologyQueenslandBrisbaneAustralia
- School of Science, Technology and EngineeringUniversity of Sunshine CoastQueenslandSippy DownsAustralia
| | - Barbara Zangerl
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- Coronary Care UnitRoyal Prince Alfred HospitalNew South WalesSydneyAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- Department of OptometrySchool of MedicineDeakin UniversityVictoriaWaurn PondsAustralia
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Shiga Y, Nishida T, Jeoung JW, Di Polo A, Fortune B. Optical Coherence Tomography and Optical Coherence Tomography Angiography: Essential Tools for Detecting Glaucoma and Disease Progression. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1217125. [PMID: 37982032 PMCID: PMC10655832 DOI: 10.3389/fopht.2023.1217125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/03/2023] [Indexed: 11/21/2023]
Abstract
Early diagnosis and detection of disease progression are critical to successful therapeutic intervention in glaucoma, the leading cause of irreversible blindness worldwide. Optical coherence tomography (OCT) is a non-invasive imaging technique that allows objective quantification in vivo of key glaucomatous structural changes in the retina and the optic nerve head (ONH). Advances in OCT technology have increased the scan speed and enhanced image quality, contributing to early glaucoma diagnosis and monitoring, as well as the visualization of critically important structures deep within the ONH, such as the lamina cribrosa. OCT angiography (OCTA) is a dye-free technique for noninvasively assessing ocular microvasculature, including capillaries within each plexus serving the macula, peripapillary retina and ONH regions, as well as the deeper vessels of the choroid. This layer-specific assessment of the microvasculature has provided evidence that retinal and choroidal vascular impairments can occur during early stages of glaucoma, suggesting that OCTA-derived measurements could be used as biomarkers for enhancing detection of glaucoma and its progression, as well as to reveal novel insights about pathophysiology. Moreover, these innovations have demonstrated that damage to the macula, a critical region for the vision-related quality of life, can be observed in the early stages of glaucomatous eyes, leading to a paradigm shift in glaucoma monitoring. Other advances in software and hardware, such as artificial intelligence-based algorithms, adaptive optics, and visible-light OCT, may further benefit clinical management of glaucoma in the future. This article reviews the utility of OCT and OCTA for glaucoma diagnosis and disease progression detection, emphasizes the importance of detecting macula damage in glaucoma, and highlights the future perspective of OCT and OCTA. We conclude that the OCT and OCTA are essential glaucoma detection and monitoring tools, leading to clinical and economic benefits for patients and society.
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Affiliation(s)
- Yukihiro Shiga
- Neuroscience Division, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec H2X 0A9, Canada
- Department of Neuroscience, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California 92093, USA
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Adriana Di Polo
- Neuroscience Division, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec H2X 0A9, Canada
- Department of Neuroscience, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, 1225 NE Second Avenue, Portland, Oregon 97232, USA
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Morgan JIW, Chui TYP, Grieve K. Twenty-five years of clinical applications using adaptive optics ophthalmoscopy [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:387-428. [PMID: 36698659 PMCID: PMC9841996 DOI: 10.1364/boe.472274] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 05/02/2023]
Abstract
Twenty-five years ago, adaptive optics (AO) was combined with fundus photography, thereby initiating a new era in the field of ophthalmic imaging. Since that time, clinical applications of AO ophthalmoscopy to investigate visual system structure and function in both health and disease abound. To date, AO ophthalmoscopy has enabled visualization of most cell types in the retina, offered insight into retinal and systemic disease pathogenesis, and been integrated into clinical trials. This article reviews clinical applications of AO ophthalmoscopy and addresses remaining challenges for AO ophthalmoscopy to become fully integrated into standard ophthalmic care.
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Affiliation(s)
- Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Contributed equally
| | - Toco Y. P. Chui
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
- Contributed equally
| | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
- Contributed equally
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10
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Liu Z, Zhang F, Zucca K, Agrawal A, Hammer DX. Ultrahigh-speed multimodal adaptive optics system for microscopic structural and functional imaging of the human retina. BIOMEDICAL OPTICS EXPRESS 2022; 13:5860-5878. [PMID: 36733751 PMCID: PMC9872887 DOI: 10.1364/boe.462594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 05/02/2023]
Abstract
We describe the design and performance of a multimodal and multifunctional adaptive optics (AO) system that combines scanning laser ophthalmoscopy (SLO) and optical coherence tomography (OCT) for simultaneous retinal imaging at 13.4 Hz. The high-speed AO-OCT channel uses a 3.4 MHz Fourier-domain mode-locked (FDML) swept source. The system achieves exquisite resolution and sensitivity for pan-macular and transretinal visualization of retinal cells and structures while providing a functional assessment of the cone photoreceptors. The ultra-high speed also enables wide-field scans for clinical usability and angiography for vascular visualization. The FDA FDML-AO system is a powerful platform for studying various retinal and neurological diseases for vision science research, retina physiology investigation, and biomarker development.
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Affiliation(s)
- Zhuolin Liu
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Furu Zhang
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
- Co-first author
| | - Kelvy Zucca
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Anant Agrawal
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Daniel X. Hammer
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
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11
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Huang X, Anderson T, Dubra A. Retinal magnification factors at the fixation locus derived from schematic eyes with four individualized surfaces. BIOMEDICAL OPTICS EXPRESS 2022; 13:3786-3808. [PMID: 35991930 PMCID: PMC9352277 DOI: 10.1364/boe.460553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 05/02/2023]
Abstract
Retinal magnification factors (RMFs) allow the conversion of angles to lengths in retinal images. In this work, we propose paraxial and non-paraxial RMF calculation methods that incorporate the individual topography and separation of the anterior and posterior surfaces of the cornea and crystalline lens, assuming homogeneous ocular media. Across 34 eyes, the two RMF methods differ by 0.1% on average, due to surface tilt, decenter, and lack of rotational symmetry in the non-paraxial modeling, which results in up to 2.2% RMF variation with retinal meridian. Differences with widely used individualized RMF calculation methods are smallest for eyes with ∼24 mm axial length, and as large as 7.5% in a 29.7 mm long eye (15D myope). To better model the capture of retinal images, we propose the tracing of chief rays, instead of the scaling of posterior nodal or principal distances often used in RMF definitions. We also report that RMF scale change is approximately proportional to both refractive error and axial separation between the ophthalmoscope's exit pupil and the eye's entrance pupil, resulting in RMF changes as large as 13% for a 1cm displacement in a 15D myopic eye. Our biometry data shows weak correlation and statistical significance between surface radii and refractive error, as well as axial length, whether considering all eyes in the study, or just the high myopes, defined as those with refractive error sphere equivalent ≤ -4D. In contrast, vitreous thicknesses show a strong correlation (r ≤ -0.92) and significance (p ≤ 10-13) with refractive error when considering all eyes or just high myopes (r ≤ -0.95; p ≤ 10-5). We also found that potential RMF change with depth of cycloplegia and/or residual accommodation is smaller than 0.2%. Finally, we propose the reporting of individual ocular biometry data and a detailed RMF calculation method description in scientific publications to facilitate the comparison of retinal imaging biomarker data across studies.
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Affiliation(s)
- Xiaojing Huang
- Institute of Optics, University of Rochester, Rochester, NY 14620, USA
- Byers Eye Institute, Stanford University, Palo Alto, CA 94303, USA
| | | | - Alfredo Dubra
- Byers Eye Institute, Stanford University, Palo Alto, CA 94303, USA
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12
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Van Gelder RN, Chiang MF, Dyer MA, Greenwell TN, Levin LA, Wong RO, Svendsen CN. Regenerative and restorative medicine for eye disease. Nat Med 2022; 28:1149-1156. [PMID: 35715505 PMCID: PMC10718186 DOI: 10.1038/s41591-022-01862-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/06/2022] [Indexed: 12/11/2022]
Abstract
Causes of blindness differ across the globe; in higher-income countries, most blindness results from the degeneration of specific classes of cells in the retina, including retinal pigment epithelium (RPE), photoreceptors, and retinal ganglion cells. Advances over the past decade in retinal regenerative medicine have allowed each of these cell types to be produced ex vivo from progenitor stem cells. Here, we review progress in applying these technologies to cell replacement - with the goal of vision restoration in degenerative disease. We discuss the landscape of human clinical trials for RPE transplantation and advanced preclinical studies for other cell types. We also review progress toward in situ repair of retinal degeneration using endogenous progenitor cells. Finally, we provide a high-level overview of progress toward prosthetic ocular vision restoration, including advanced photovoltaic devices, opsin-based gene therapy, and small-molecule photoswitches. Progress in each of these domains is at or near the human clinical-trial stage, bringing the audacious goal of vision restoration within sight.
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Affiliation(s)
- Russell N Van Gelder
- Karalis-Johnson Retina Center, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Biological Structure, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Pathology and Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, USA.
- Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine, Seattle, WA, USA.
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Dyer
- Department of Developmental Neurobiology, St. Jude's Research Hospital, Memphis, TN, USA
| | - Thomas N Greenwell
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leonard A Levin
- Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Rachel O Wong
- Karalis-Johnson Retina Center, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Biological Structure, University of Washington School of Medicine, Seattle, WA, USA
| | - Clive N Svendsen
- Board of Governors Regenerative Medicine Institute, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars Sinai Medical Center, Los Angeles, CA, USA
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13
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Levin LA, Sengupta M, Balcer LJ, Kupersmith MJ, Miller NR. Report From the National Eye Institute Workshop on Neuro-Ophthalmic Disease Clinical Trial Endpoints: Optic Neuropathies. Invest Ophthalmol Vis Sci 2021; 62:30. [PMID: 34846515 PMCID: PMC8648055 DOI: 10.1167/iovs.62.14.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Leonard A Levin
- Departments of Ophthalmology and Visual Sciences, Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Mohor Sengupta
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Laura J Balcer
- Departments of Neurology, Ophthalmology, and Population Health, New York University Grossman School of Medicine, New York, New York, United States
| | - Mark J Kupersmith
- Departments of Neurology, Ophthalmology, and Neurosurgery, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, New York, United States
| | - Neil R Miller
- Neuro-Ophthalmology Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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14
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Villanueva R, Le C, Liu Z, Zhang F, Magder L, Hammer DX, Saeedi O. Cell - Vessel Mismatch in Glaucoma: Correlation of Ganglion Cell Layer Soma and Capillary Densities. Invest Ophthalmol Vis Sci 2021; 62:2. [PMID: 34605879 PMCID: PMC8496408 DOI: 10.1167/iovs.62.13.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to characterize the relationship between retinal ganglion cell layer (GCL) soma density and capillary density in glaucomatous eyes. Methods Six glaucoma subjects with known hemifield defects and 6 age-matched controls were imaged with adaptive optics - optical coherence tomography (AO-OCT) at 6 locations: 3 degrees, 6 degrees, and 12 degrees temporal to the fovea above and below the midline. GCL soma density and capillary density were measured at each location. Coefficients of determination (pseudo R2) and slopes between GCL soma and capillary density were determined from mixed-effects regressions and were compared between glaucoma and control subjects, between more and less affected hemifield in subjects with glaucoma, and between subjects with early and moderate glaucoma, both in a local, bivariate model and then a global, multivariable model controlling for eccentricity and soma size. Results The global correlation between GCL soma and capillary density was stronger in control versus subjects with glaucoma (R2 = 0.59 vs. 0.22), less versus more affected hemifields (R2 = 0.55 vs. 0.01), and subjects with early versus moderate glaucoma subjects (R2 = 0.44 vs. 0.18). When controlling for eccentricity and soma size, we noted an inverse soma-capillary density local relationship in subjects with glaucoma (-388 ± 190 cells/mm2 per 1% change in capillary density, P = 0.046) and more affected hemifields (-602 ± 257 cells/mm2 per 1% change in capillary density, P = 0.03). Conclusions An inverted soma-capillary density local relationship in areas affected by glaucoma potentially explains weaker global correlations observed between GCL soma and capillary density, suggesting cell-vessel mismatch is associated with the disease.
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Affiliation(s)
- Ricardo Villanueva
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, United States
| | - Christopher Le
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Zhuolin Liu
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, United States
| | - Furu Zhang
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, United States
| | - Laurence Magder
- Department of Epidemiology and Biostatistics, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Daniel X Hammer
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, United States
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
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15
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Pandiyan VP, Jiang X, Kuchenbecker JA, Sabesan R. Reflective mirror-based line-scan adaptive optics OCT for imaging retinal structure and function. BIOMEDICAL OPTICS EXPRESS 2021; 12:5865-5880. [PMID: 34692221 PMCID: PMC8515964 DOI: 10.1364/boe.436337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 05/06/2023]
Abstract
Line-scan OCT incorporated with adaptive optics (AO) offers high resolution, speed, and sensitivity for imaging retinal structure and function in vivo. Here, we introduce its implementation with reflective mirror-based afocal telescopes, optimized for imaging light-induced retinal activity (optoretinography) and weak retinal reflections at the cellular scale. A non-planar optical design was followed based on previous recommendations with key differences specific to a line-scan geometry. The three beam paths fundamental to an OCT system -illumination/sample, detection, and reference- were modeled in Zemax optical design software to yield theoretically diffraction-limited performance over a 2.2 deg. field-of-view and 1.5 D vergence range at the eye's pupil. The performance for imaging retinal structure was exemplified by cellular-scale visualization of retinal ganglion cells, macrophages, foveal cones, and rods in human observers. The performance for functional imaging was exemplified by resolving the light-evoked optical changes in foveal cone photoreceptors where the spatial resolution was sufficient for cone spectral classification at an eccentricity 0.3 deg. from the foveal center. This enabled the first in vivo demonstration of reduced S-cone (short-wavelength cone) density in the human foveola, thus far observed only in ex vivo histological preparations. Together, the feasibility for high resolution imaging of retinal structure and function demonstrated here holds significant potential for basic science and translational applications.
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Affiliation(s)
- Vimal Prabhu Pandiyan
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98109, USA
- Co-first authors with equal contribution
| | - Xiaoyun Jiang
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98109, USA
- Co-first authors with equal contribution
| | - James A Kuchenbecker
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98109, USA
| | - Ramkumar Sabesan
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98109, USA
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16
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Soltanian-Zadeh S, Kurokawa K, Liu Z, Zhang F, Saeedi O, Hammer DX, Miller DT, Farsiu S. Weakly supervised individual ganglion cell segmentation from adaptive optics OCT images for glaucomatous damage assessment. OPTICA 2021; 8:642-651. [PMID: 35174258 PMCID: PMC8846574 DOI: 10.1364/optica.418274] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Cell-level quantitative features of retinal ganglion cells (GCs) are potentially important biomarkers for improved diagnosis and treatment monitoring of neurodegenerative diseases such as glaucoma, Parkinson's disease, and Alzheimer's disease. Yet, due to limited resolution, individual GCs cannot be visualized by commonly used ophthalmic imaging systems, including optical coherence tomography (OCT), and assessment is limited to gross layer thickness analysis. Adaptive optics OCT (AO-OCT) enables in vivo imaging of individual retinal GCs. We present an automated segmentation of GC layer (GCL) somas from AO-OCT volumes based on weakly supervised deep learning (named WeakGCSeg), which effectively utilizes weak annotations in the training process. Experimental results show that WeakGCSeg is on par with or superior to human experts and is superior to other state-of-the-art networks. The automated quantitative features of individual GCLs show an increase in structure-function correlation in glaucoma subjects compared to using thickness measures from OCT images. Our results suggest that by automatic quantification of GC morphology, WeakGCSeg can potentially alleviate a major bottleneck in using AO-OCT for vision research.
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Affiliation(s)
| | - Kazuhiro Kurokawa
- School of Optometry, Indiana University, Bloomington, Indiana 47405, USA
| | - Zhuolin Liu
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland 20993, USA
| | - Furu Zhang
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland 20993, USA
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
| | - Daniel X. Hammer
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland 20993, USA
| | - Donald T. Miller
- School of Optometry, Indiana University, Bloomington, Indiana 47405, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710, USA
- Corresponding author:
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