Three-dimensional ray-tracing model for the study of advanced refractive errors in keratoconus

Microscope integrated optical coherence tomography system combined with augmented reality

One of the disadvantages in microscope-integrated optical coherence tomography (MI-OCT) systems is that medical images acquired via different modalities are usually displayed independently. Hence, surgeons have to match two-dimensional and three-dimensional images of the same operative region subjectively. In this paper, we propose a simple registration method to overcome this problem by using guided laser points. This method combines augmented reality with an existing MI-OCT system. The basis of our idea is to introduce a guiding laser into the system, which allows us to identify fiducials in microscopic images. At first, the applied voltages of the scanning galvanometer mirror are used to calculate the fiducials' coordinates in an OCT model. After gathering data at the corresponding points' coordinates, the homography matrix and camera parameters are used to superimpose a reconstructed model on microscopic images. After performing experiments with artificial and animal eyes, we successfully obtain two-dimensional microscopic images of scanning regions with depth information. Moreover, the registration error is 0.04 mm, which is within the limits of medical and surgical errors. Our proposed method could have many potential applications in ophthalmic procedures.

Adaptive Optical Two-Photon Microscopy for Surface-Profiled Living Biological Specimens

We developed adaptive optical (AO) two-photon excitation microscopy by introducing a spatial light modulator (SLM) in a commercially available microscopy system. For correcting optical aberrations caused by refractive index (RI) interfaces at a specimen's surface, spatial phase distributions of the incident excitation laser light were calculated using 3D coordination of the RI interface with a 3D ray-tracing method. Based on the calculation, we applied a 2D phase-shift distribution to a SLM and achieved the proper point spread function. AO two-photon microscopy improved the fluorescence image contrast in optical phantom mimicking biological specimens. Furthermore, it enhanced the fluorescence intensity from tubulin-labeling dyes in living multicellular tumor spheroids and allowed successful visualization of dendritic spines in the cortical layer V of living mouse brains in the secondary motor region with a curved surface. The AO approach is useful for observing dynamic physiological activities in deep regions of various living biological specimens with curved surfaces.

Applications of augmented reality in ophthalmology [Invited]

Throughout the last decade, augmented reality (AR) head-mounted displays (HMDs) have gradually become a substantial part of modern life, with increasing applications ranging from gaming and driver assistance to medical training. Owing to the tremendous progress in miniaturized displays, cameras, and sensors, HMDs are now used for the diagnosis, treatment, and follow-up of several eye diseases. In this review, we discuss the current state-of-the-art as well as potential uses of AR in ophthalmology. This review includes the following topics: (i) underlying optical technologies, displays and trackers, holography, and adaptive optics; (ii) accommodation, 3D vision, and related problems such as presbyopia, amblyopia, strabismus, and refractive errors; (iii) AR technologies in lens and corneal disorders, in particular cataract and keratoconus; (iv) AR technologies in retinal disorders including age-related macular degeneration (AMD), glaucoma, color blindness, and vision simulators developed for other types of low-vision patients.

Ray tracing 3D spectral scenes through human optics models

Scientists and engineers have created computations and made measurements that characterize the first steps of seeing. ISETBio software integrates such computations and data into an open-source software package. The initial ISETBio implementations modeled image formation (physiological optics) for planar or distant scenes. The ISET3d software described here extends that implementation, simulating image formation for three-dimensional scenes. The software system relies on a quantitative computer graphics program that ray traces the scene radiance through the physiological optics to the retinal irradiance. We describe and validate the implementation for several model eyes. Then, we use the software to quantify the impact of several physiological optics parameters on three-dimensional image formation. ISET3d is integrated with ISETBio, making it straightforward to convert the retinal irradiance into cone excitations. These methods help the user compute the predictions of optics models for a wide range of spatially rich three-dimensional scenes. They can also be used to evaluate the impact of nearby visual occlusion, the information available to binocular vision, or the retinal images expected from near-field and augmented reality displays.

Keratoconic eyes with stable corneal tomography could benefit more from custom intraocular lens design than normal eyes

We investigated whether eyes with keratoconic corneal tomography pattern could benefit more from aberration correction with custom intraocular lenses (IOLs) than normal cataractous eyes despite the effect of misalignment on the correction of aberrations. Custom IOLs (cIOLs) were calculated for twelve normal and twelve keratoconic eyes using personalized numerical ray tracing models. The Stiles-Crawford weighted root-mean-square spot-size (wRMS) at the virtual fovea was evaluated for cIOLs and aberration-neutral IOLs (nIOLs) in a simulated clinical study with 500 virtual IOL implantations per eye and per IOL. IOL misalignment (decentration, tilt, rotation) and pupillary ectopia (4.5 mm iris aperture) were varied upon each virtual implantation. The nIOLs achieved average wRMS of 16.4 ± 4.3 μm for normal, and 92.7 ± 34.4 μm for keratoconic eyes (mean ± standard deviation). The cIOLs reduced the average wRMS to 10.3 ± 5.8 μm for normal, and 28.5 ± 18.6 μm for keratoconic eyes. The cIOLs produced smaller wRMS than nIOLs in most virtual implantations (86.7% for normal and 99.4% for keratoconic eyes). IOL misalignment resulted in larger wRMS variations in the keratoconus group than in the normal group. Custom freeform IOL-optics-design may become a promising option for the correction of advanced aberrations in eyes with non-progressive keratoconic corneal tomography pattern.

Aberration correction considering curved sample surface shape for non-contact two-photon excitation microscopy with spatial light modulator

In this paper, excitation light wavefront modulation is performed considering the curved sample surface shape to demonstrate high-quality deep observation using two-photon excitation microscopy (TPM) with a dry objective lens. A large spherical aberration typically occurs when the refractive index (RI) interface between air and the sample is a plane perpendicular to the optical axis. Moreover, the curved sample surface shape and the RI mismatch cause various aberrations, including spherical ones. Consequently, the fluorescence intensity and resolution of the obtained image are degraded in the deep regions. To improve them, we designed a pre-distortion wavefront for correcting the aberration caused by the curved sample surface shape by using a novel, simple optical path length difference calculation method. The excitation light wavefront is modulated to the pre-distortion wavefront by a spatial light modulator incorporated in the TPM system before passing through the interface, where the RI mismatch occurs. Thus, the excitation light is condensed without aberrations. Blood vessels were thereby observed up to an optical depth of 2,000 μm in a cleared mouse brain by using a dry objective lens.

Analysis of long-term visual quality with numerical 3D ray tracing after corneal crosslinking treatment

A numerical 3D ray tracing model was used to evaluate the long-term visual effects of two regimens of corneal crosslinking (CXL) treatment of 48 patients with the corneal degeneration keratoconus. The 3D ray tracing analyses were based on corneal elevation data measured by Scheimpflug photography. Twenty-two patients were treated with standard CXL applied uniformly across the corneal surface, whereas 26 patients underwent a customized, refined treatment only at local zones on the cornea (photorefractive intrastromal CXL; PiXL). Spot diagrams, spot root-mean-square (RMS) values, and Strehl ratios were evaluated for the patients prior to and 1, 3, 6, and 12 months after treatment. It was found that the group of patients treated with PiXL, on average, tended to attain a long-term improvement of the corneal optical performance, whereas only minor changes of the optical parameters were found for group treated with standard CXL. Our results confirmed that standard CXL treatment stabilizes the corneal optical quality over time, and thus halts the progression of the corneal degeneration. In addition to stabilization, the results showed that a significantly higher proportion of subjects treated with PiXL improved in RMS, 3, 6, and 12 months after treatment, compared to with CXL (p<0.05). This finding indicates that the PiXL treatment might improve optical quality over time.

Optimization of an intraocular lens for correction of advanced corneal refractive errors

Based on numerical 3D ray tracing, we propose a new procedure to optimize personalized intra-ocular lenses (IOLs). The 3D ray tracing was based on measured corneal elevation data from patients who suffered from advanced keratoconus. A mathematical shape description of the posterior IOL surface, by means of a tensor product cubic Hermite spline, was implemented. The optimized lenses provide significantly reduced aberrations. Our results include a trade-off study that suggests that it is possible to considerably reduce the aberrations with only minor perturbations of an ideal spherical lens. The proposed procedure can be applied for correction of aberrations of any optical system by modifying a single surface.