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Sonntag SR, Hamann M, Seifert E, Grisanti S, Brinkmann R, Miura Y. Detection sensitivity of fluorescence lifetime imaging ophthalmoscopy for laser-induced selective damage of retinal pigment epithelium. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06449-2. [PMID: 38587656 DOI: 10.1007/s00417-024-06449-2] [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: 11/05/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
PURPOSE To investigate the sensitivity of fluorescence lifetime imaging ophthalmoscopy (FLIO) to detect retinal laser spots by comparative analysis with other imaging modalities. METHODS A diode laser with a wavelength of 514 nm was applied with pulse durations of 5.2, 12, 20, and 50 µs. The laser pulse energy was increased so that the visibility of the laser spot by slit-lamp fundus examination (SL) under the irradiator's observation covers from the subvisible to visible range immediately after irradiation. The irradiated areas were then examined by fundus color photography (FC), optical coherence tomography (OCT), fundus autofluorescence (AF), FLIO, and fluorescein angiography (FA). The visibility of a total of over 2200 laser spots was evaluated by two independent researchers, and effective dose (ED) 50 laser pulse energy values were calculated for each imaging modality and compared. RESULTS Among examined modalities, FA showed the lowest mean of ED50 energy value and SL the highest, that is, they had the highest and lowest sensitivity to detect retinal pigment epithalium (RPE)-selective laser spots, respectively. FLIO also detected spots significantly more sensitively than SL at most laser pulse durations and was not significantly inferior to FA. AF was also often more sensitive than SL, but the difference was slightly less significant than FLIO. CONCLUSION Considering its high sensitivity in detecting laser spots and previously reported potential of indicating local wound healing and metabolic changes around laser spots, FLIO may be useful as a non-invasive monitoring tool during and after minimally invasive retinal laser treatment.
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Affiliation(s)
- Svenja Rebecca Sonntag
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Maximilian Hamann
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | | | - Salvatore Grisanti
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Yoko Miura
- Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
- Medical Laser Center Lübeck, Lübeck, Germany.
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.
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Thiemann N, Sonntag SR, Kreikenbohm M, Böhmerle G, Stagge J, Grisanti S, Martinetz T, Miura Y. Artificial Intelligence in Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO) Data Analysis-Toward Retinal Metabolic Diagnostics. Diagnostics (Basel) 2024; 14:431. [PMID: 38396470 PMCID: PMC10888399 DOI: 10.3390/diagnostics14040431] [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: 11/11/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The purpose of this study was to investigate the possibility of implementing an artificial intelligence (AI) approach for the analysis of fluorescence lifetime imaging ophthalmoscopy (FLIO) data even with small data. FLIO data, including the fluorescence intensity and mean fluorescence lifetime (τm) of two spectral channels, as well as OCT-A data from 26 non-smokers and 28 smokers without systemic and ocular diseases were used. The analysis was performed with support vector machines (SVMs), a well-known AI method for small datasets, and compared with the results of convolutional neural networks (CNNs) and autoencoder networks. The SVM was the only tested AI method, which was able to distinguish τm between non-smokers and heavy smokers. The accuracy was about 80%. OCT-A data did not show significant differences. The feasibility and usefulness of the AI in analyzing FLIO and OCT-A data without any apparent retinal diseases were demonstrated. Although further studies with larger datasets are necessary to validate the results, the results greatly suggest that AI could be useful in analyzing FLIO-data even from healthy subjects without retinal disease and even with small datasets. AI-assisted FLIO is expected to greatly advance early retinal diagnosis.
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Affiliation(s)
- Natalie Thiemann
- Institute for Neuro- and Bioinformatics, University of Lübeck, 23538 Lübeck, Germany
| | - Svenja Rebecca Sonntag
- Department of Ophthalmology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Marie Kreikenbohm
- Department of Ophthalmology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Giulia Böhmerle
- Department of Ophthalmology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Jessica Stagge
- Department of Ophthalmology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Thomas Martinetz
- Institute for Neuro- and Bioinformatics, University of Lübeck, 23538 Lübeck, Germany
| | - Yoko Miura
- Department of Ophthalmology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, 23538 Lübeck, Germany
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Sonntag SR, Kreikenbohm M, Böhmerle G, Stagge J, Grisanti S, Miura Y. Impact of cigarette smoking on fluorescence lifetime of ocular fundus. Sci Rep 2023; 13:11484. [PMID: 37460627 DOI: 10.1038/s41598-023-37484-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/22/2023] [Indexed: 07/20/2023] Open
Abstract
Cigarette smoking is known to adversely affect cellular metabolism and is a risk factor for various retinal diseases. Fluorescence lifetime imaging ophthalmoscopy (FLIO) has the potential to detect metabolic changes in the ocular fundus. Aim of this study was to analyze the influence of cigarette smoking on fluorescence lifetime (FLT) of healthy eyes using FLIO. Twenty-six non-smokers and 28 smokers aged between 20 and 37 years without systemic and ocular diseases were investigated by FLIO (excitation: 473 nm, emission: short spectral channel (SSC) 498-560 nm, long spectral channel (LSC) 560-720 nm). The FLT at the ETDRS grid regions were analyzed and compared. In SSC, the mean FLT (τm) of smokers was significantly longer in the ETDRS inner ring region, whereas the τm in LSC was significantly shorter in the outer ring. For the long component (τ2), smokers with pack year < 7.11 showed significantly shorter τ2 in SSC than non-smokers and the smokers with pack year ≥ 7.11. There were no significant differences in retinal thickness. The lack of obvious structural differences implies that the observed FLT changes are likely related to smoking-induced metabolic changes. These results suggest that FLIO may be useful in assessing retinal conditions related to lifestyle and systemic metabolic status.
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Affiliation(s)
- Svenja Rebecca Sonntag
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Marie Kreikenbohm
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Giulia Böhmerle
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jessica Stagge
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Yoko Miura
- Department of Ophthalmology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.
- Medical Laser Center Lübeck, Lübeck, Germany.
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Tang JAH, Granger CE, Kunala K, Parkins K, Huynh KT, Bowles-Johnson K, Yang Q, Hunter JJ. Adaptive optics fluorescence lifetime imaging ophthalmoscopy of in vivo human retinal pigment epithelium. BIOMEDICAL OPTICS EXPRESS 2022; 13:1737-1754. [PMID: 35414970 PMCID: PMC8973160 DOI: 10.1364/boe.451628] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 05/18/2023]
Abstract
The intrinsic fluorescence properties of lipofuscin - naturally occurring granules that accumulate in the retinal pigment epithelium - are a potential biomarker for the health of the eye. A new modality is described here which combines adaptive optics technology with fluorescence lifetime detection, allowing for the investigation of functional and compositional differences within the eye and between subjects. This new adaptive optics fluorescence lifetime imaging ophthalmoscope was demonstrated in 6 subjects. Repeated measurements between visits had a minimum intraclass correlation coefficient of 0.59 Although the light levels were well below maximum permissible exposures, the safety of the imaging paradigm was tested using clinical measures; no concerns were raised. This new technology allows for in vivo adaptive optics fluorescence lifetime imaging of the human RPE mosaic.
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Affiliation(s)
- Janet A. H. Tang
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Contributed equally
| | - Charles E. Granger
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Contributed equally
| | - Karteek Kunala
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Keith Parkins
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Khang T. Huynh
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA
| | - Kristen Bowles-Johnson
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY 14627, USA
| | - Qiang Yang
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Jennifer J. Hunter
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY 14627, USA
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Sonntag SR, Seifert E, Hamann M, Lewke B, Theisen-Kunde D, Grisanti S, Brinkmann R, Miura Y. Fluorescence Lifetime Changes Induced by Laser Irradiation: A Preclinical Study towards the Evaluation of Retinal Metabolic States. Life (Basel) 2021; 11:life11060555. [PMID: 34199212 PMCID: PMC8231852 DOI: 10.3390/life11060555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 12/17/2022] Open
Abstract
Fluorescence Lifetime (FLT) of intrinsic fluorophores may alter under the change in metabolic state. In this study, the FLT of rabbit retina was investigated in vivo after laser irradiation using fluorescence lifetime imaging ophthalmoscopy (FLIO). The retina of the Chinchilla bastard rabbits was irradiated with a 514 nm diode laser. FLIO, fundus photography, and optical coherence tomography (OCT) were conducted 30 min and 1 to 3 weeks after treatment. After strong coagulation, the FLT at laser spots was significantly elongated immediately after irradiation, conversely shortened after more than a week. Histological examination showed eosinophilic substance and melanin clumping in subretinal space at the coagulation spots older than one week. The FLT was also elongated right around the coagulation spots, which corresponded to the discontinuous ellipsoid zone (EZ) on OCT. This EZ change was recovered after one week, and the FLT became the same level as the surroundings. In addition, there was a region around the laser spot where the FLT was temporarily shorter than the surrounding area. When weak pulse energy was applied to selectively destroy only the RPE, a shortening of the FLT was observed immediately around the laser spot within one week after irradiation. FLIO could serve as a tool to evaluate the structural and metabolic response of the retina to laser treatments.
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Affiliation(s)
- Svenja Rebecca Sonntag
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (S.R.S.); (S.G.)
| | - Eric Seifert
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
| | - Maximilian Hamann
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
| | - Britta Lewke
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
| | - Dirk Theisen-Kunde
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (S.R.S.); (S.G.)
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
| | - Yoko Miura
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (S.R.S.); (S.G.)
- Medical Laser Center Lübeck, 23562 Lübeck, Germany; (E.S.); (D.T.-K.); (R.B.)
- Institute of Biomedical Optics, University of Lübeck, 23562 Lübeck, Germany; (M.H.); (B.L.)
- Correspondence:
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