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Graven-Nielsen M, Dubra A, Dodd RL, Hamann S, Moss HE. Application of novel non-invasive ophthalmic imaging to visualize peripapillary wrinkles, retinal folds and peripapillary hyperreflective ovoid mass-like structures associated with elevated intracranial pressure. Front Neurol 2024; 15:1383210. [PMID: 38957348 PMCID: PMC11217179 DOI: 10.3389/fneur.2024.1383210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/13/2024] [Indexed: 07/04/2024] Open
Abstract
Background Elevated intracranial pressure (ICP) is a serious and potentially life-threatening condition, for which clinically useful non-invasive measures have been elusive, in some cases due to their inadequate sensitivity and specificity. Our aim was to evaluate novel non-invasive ophthalmic imaging of selected pathological features seen in elevated ICP, namely peripapillary hyperreflective ovoid mass-like structures (PHOMS), peripapillary wrinkles (PPW) and retinal folds (RF) as potential biomarkers of elevated ICP. Methods This single-center pilot study included subjects with untreated or incompletely treated high ICP. The retinas of these subjects were evaluated with averaged en-face optical coherence tomography (OCT), OCT retinal cross-sections (OCT B-scans), adaptive optics scanning light ophthalmoscopy (AOSLO), and fundus photos. Results Seven subjects were included in the study. 6 subjects with high ICP (5 idiopathic intracranial hypertension, 1 medication induced, 30.8 ± 8.6 years, 75% female, 5 with papilledema) and 1 control (20-25 years) were included. PHOMS, PPW and RF were present in all subjects with papilledema, but neither in the high ICP subject without papilledema nor in the control subject. Averaged en-face OCT scans and AOSLO were more sensitive for PPW and RF than OCT B-scans and commercial fundus photos. Conclusion PPW, RF and PHOMS volume have potential as non-invasive biomarkers of ICP. Novel imaging modalities may improve sensitivity. However, lack of automated image acquisition and processing limits current widespread adoption in clinical settings. Further research is needed to validate these structures as biomarkers for elevated ICP and improve clinical utility.
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Affiliation(s)
- Michaela Graven-Nielsen
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
| | - Robert L. Dodd
- Department of Neurosurgery, Stanford University, Palo Alto, CA, United States
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heather E. Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, United States
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Huang BB, Fawzi AA. Hypertension Likely Drives Arteriolar Wall Thickening in Preclinical Diabetic Retinopathy While Diabetes Drives Wall Thickness in Clinical Retinopathy. Transl Vis Sci Technol 2024; 13:8. [PMID: 38874974 PMCID: PMC11182368 DOI: 10.1167/tvst.13.6.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose Both hypertension and diabetes are known to increase the wall-to-lumen ratio (WLR) of retinal arterioles, but the differential effects are unknown. Here, we study the timing and relative impact of hypertension versus diabetes on the WLR in diabetic retinopathy (DR) to address this unresolved question. Methods This prospective cross-sectional study compared the retinal arteriolar WLR in 17 healthy eyes, 15 with diabetes but no apparent DR (DM no DR), and 8 with diabetic macular edema (DME) and either nonproliferative or proliferative DR. We imaged each arteriole using adaptive optics scanning laser ophthalmoscopy and measured the WLR using ImageJ. Multiple linear regression (MLR) was performed to estimate the effects of hypertension, diabetes, and age on the WLR. Results Both subjects with DM no DR and subjects with DME had significantly higher WLR than healthy subjects (0.36 ± 0.08 and 0.42 ± 0.08 vs. 0.29 ± 0.07, 1-way ANOVA P = 0.0009). MLR in healthy subjects and subjects with DM no DR showed hypertension had the strongest effect (regression coefficient = 0.08, P = 0.009), whereas age and diabetes were not significantly correlated with WLR. MLR in all three groups together (healthy, DM no DR, and DME) showed diabetes had the strongest effect (regression coefficient = 0.05, P = 0.02), whereas age and hypertension were not significantly correlated with WLR. Conclusions Hypertension may be an early driver of retinal arteriolar wall thickening in preclinical DR, independent of age or diabetes, whereas changes specific to DR may drive wall thickening in DME and later DR stages. Translational Relevance We offer a framework for understanding the relative contributions of hypertension and diabetes on the vascular wall, and emphasize the importance of hypertension control early in diabetes even before DR onset.
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Affiliation(s)
- Bonnie B. Huang
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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3
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Ching-Roa VD, Huang CZ, Giacomelli MG. Suppression of Subpixel Jitter in Resonant Scanning Systems With Phase-locked Sampling. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:2159-2168. [PMID: 38265914 PMCID: PMC11147734 DOI: 10.1109/tmi.2024.3358191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Resonant scanning is critical to high speed and in vivo imaging in many applications of laser scanning microscopy. However, resonant scanning suffers from well-known image artifacts due to scanner jitter, limiting adoption of high-speed imaging technologies. Here, we introduce a real-time, inexpensive and all electrical method to suppress jitter more than an order of magnitude below the diffraction limit that can be applied to most existing microscope systems with no software changes. By phase-locking imaging to the resonant scanner period, we demonstrate an 86% reduction in pixel jitter, a 15% improvement in point spread function with resonant scanning and show that this approach enables two widely used models of resonant scanners to achieve comparable accuracy to galvanometer scanners running two orders of magnitude slower. Finally, we demonstrate the versatility of this method by retrofitting a commercial two photon microscope and show that this approach enables significant quantitative and qualitative improvements in biological imaging.
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Moon B, Linebach G, Yang A, Jenks SK, Rucci M, Poletti M, Rolland JP. High refresh rate display for natural monocular viewing in AOSLO psychophysics experiments. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.26.595808. [PMID: 38854135 PMCID: PMC11160679 DOI: 10.1101/2024.05.26.595808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
By combining an external display operating at 360 frames per second with an Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO) for human foveal imaging, we demonstrate color stimulus delivery at high spatial and temporal resolution in AOSLO psychophysics experiments. A custom pupil relay enables viewing of the stimulus through a 3-mm effective pupil diameter and provides refractive error correction from -8 to +4 diopters. Performance of the assembled and aligned pupil relay was validated by measuring the wavefront error across the field of view and correction range, and the as-built Strehl ratio was 0.64 or better. High-acuity stimuli were rendered on the external display and imaged through the pupil relay to demonstrate that spatial frequencies up to 54 cycles per degree, corresponding to 20/11 visual acuity, are resolved. The completed external display was then used to render fixation markers across the field of view of the monitor, and a continuous retinal montage spanning 9.4 by 5.4 degrees of visual angle was acquired with the AOSLO. We conducted eye-tracking experiments during free-viewing and high-acuity tasks with polychromatic images presented on the external display. Sub-arcminute eye position uncertainty was achieved, enabling precise localization of the line of sight on the monitor while simultaneously imaging the fine structure of the human central fovea. This high refresh rate display overcomes the temporal, spectral, and field of view limitations of AOSLO-based stimulus presentation, enabling natural monocular viewing of stimuli in psychophysics experiments conducted with AOSLO.
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Follett HM, Warr E, Grieshop J, Yu CT, Gaffney M, Bowie OR, Lee JW, Tarima S, Merriman DK, Carroll J. Chemically induced cone degeneration in the 13-lined ground squirrel. Vis Neurosci 2024; 41:E002. [PMID: 38725382 PMCID: PMC11106521 DOI: 10.1017/s0952523824000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 05/23/2024]
Abstract
Animal models of retinal degeneration are critical for understanding disease and testing potential therapies. Inducing degeneration commonly involves the administration of chemicals that kill photoreceptors by disrupting metabolic pathways, signaling pathways, or protein synthesis. While chemically induced degeneration has been demonstrated in a variety of animals (mice, rats, rabbits, felines, 13-lined ground squirrels (13-LGS), pigs, chicks), few studies have used noninvasive high-resolution retinal imaging to monitor the in vivo cellular effects. Here, we used longitudinal scanning light ophthalmoscopy (SLO), optical coherence tomography, and adaptive optics SLO imaging in the euthermic, cone-dominant 13-LGS (46 animals, 52 eyes) to examine retinal structure following intravitreal injections of chemicals, which were previously shown to induce photoreceptor degeneration, throughout the active season of 2019 and 2020. We found that iodoacetic acid induced severe pan-retinal damage in all but one eye, which received the lowest concentration. While sodium nitroprusside successfully induced degeneration of the outer retinal layers, the results were variable, and damage was also observed in 50% of contralateral control eyes. Adenosine triphosphate and tunicamycin induced outer retinal specific damage with varying results, while eyes injected with thapsigargin did not show signs of degeneration. Given the variability of damage we observed, follow-up studies examining the possible physiological origins of this variability are critical. These additional studies should further advance the utility of chemically induced photoreceptor degeneration models in the cone-dominant 13-LGS.
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Affiliation(s)
- Hannah M. Follett
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emma Warr
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenna Grieshop
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ching Tzu Yu
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mina Gaffney
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Owen R. Bowie
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jong Won Lee
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sergey Tarima
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dana K. Merriman
- Department of Biology, University of Wisconsin Oshkosh, Oshkosh, Wisconsin, USA
| | - Joseph Carroll
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Brennan BD, Heitkotter H, Carroll J, Tarima S, Cooper RF. Quantifying image quality in AOSLO images of photoreceptors. BIOMEDICAL OPTICS EXPRESS 2024; 15:2849-2862. [PMID: 38855680 PMCID: PMC11161361 DOI: 10.1364/boe.516477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 06/11/2024]
Abstract
The use of "quality" to describe the usefulness of an image is ubiquitous but is often subject to domain specific constraints. Despite its continued use as an imaging modality, adaptive optics scanning light ophthalmoscopy (AOSLO) lacks a dedicated metric for quantifying the quality of an image of photoreceptors. Here, we present an approach to evaluating image quality that extracts an estimate of the signal to noise ratio. We evaluated its performance in 528 images of photoreceptors from two AOSLOs, two modalities, and healthy or diseased retinas. The algorithm was compared to expert graders' ratings of the images and previously published image quality metrics. We found no significant difference in the SNR and grades across all conditions. The SNR and the grades of the images were moderately correlated. Overall, this algorithm provides an objective measure of image quality that closely relates to expert assessments of quality in both confocal and split-detector AOSLO images of photoreceptors.
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Affiliation(s)
- Brea D. Brennan
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heather Heitkotter
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Carroll
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Ophthalmology and Visual Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sergey Tarima
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robert F. Cooper
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Ophthalmology and Visual Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Pedersen HR, Gilson SJ, Hagen LA, Holtan JP, Bragadottir R, Baraas RC. Multimodal in-vivo maps as a tool to characterize retinal structural biomarkers for progression in adult-onset Stargardt disease. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1384473. [PMID: 38984108 PMCID: PMC11182093 DOI: 10.3389/fopht.2024.1384473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/04/2024] [Indexed: 07/11/2024]
Abstract
Purpose To characterize retinal structural biomarkers for progression in adult-onset Stargardt disease from multimodal retinal imaging in-vivo maps. Methods Seven adult patients (29-69 years; 3 males) with genetically-confirmed and clinically diagnosed adult-onset Stargardt disease and age-matched healthy controls were imaged with confocal and non-confocal Adaptive Optics Scanning Light Ophthalmoscopy (AOSLO), optical coherence tomography (OCT), fundus infrared (FIR), short wavelength-autofluorescence (FAF) and color fundus photography (CFP). Images from each modality were scaled for differences in lateral magnification before montages of AOSLO images were aligned with en-face FIR, FAF and OCT scans to explore changes in retinal structure across imaging modalities. Photoreceptors, retinal pigment epithelium (RPE) cells, flecks, and other retinal alterations in macular regions were identified, delineated, and correlated across imaging modalities. Retinal layer-thicknesses were extracted from segmented OCT images in areas of normal appearance on clinical imaging and intact outer retinal structure on OCT. Eccentricity dependency in cell density was compared with retinal thickness and outer retinal layer thickness, evaluated across patients, and compared with data from healthy controls. Results In patients with Stargardt disease, alterations in retinal structure were visible in different image modalities depending on layer location and structural properties. The patients had highly variable foveal structure, associated with equally variable visual acuity (-0.02 to 0.98 logMAR). Cone and rod photoreceptors, as well as RPE-like structures in some areas, could be quantified on non-confocal split-detection AOSLO images. RPE cells were also visible on dark field AOSLO images close to the foveal center. Hypo-reflective gaps of non-waveguiding cones (dark cones) were seen on confocal AOSLO in regions with clinically normal CFP, FIR, FAF and OCT appearance and an intact cone inner segment mosaic in three patients. Conclusion Dark cones were identified as a possible first sign of retinal disease progression in adult-onset Stargardt disease as these are observed in retinal locations with otherwise normal appearance and outer retinal thickness. This corroborates a previous report where dark cones were proposed as a first sign of progression in childhood-onset Stargardt disease. This also supports the hypothesis that, in Stargardt disease, photoreceptor degeneration occurs before RPE cell death.
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Affiliation(s)
- Hilde R Pedersen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Stuart J Gilson
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Lene A Hagen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Josephine Prener Holtan
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnheidur Bragadottir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
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Xu P, Cooper RF, Jiang YY, Morgan JIW. Parafoveal cone function in choroideremia assessed with adaptive optics optoretinography. Sci Rep 2024; 14:8339. [PMID: 38594294 PMCID: PMC11004114 DOI: 10.1038/s41598-024-58059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Choroideremia (CHM) is an X-linked retinal degeneration leading to loss of the photoreceptors, retinal pigment epithelium (RPE), and choroid. Adaptive optics optoretinography is an emerging technique for noninvasive, objective assessment of photoreceptor function. Here, we investigate parafoveal cone function in CHM using adaptive optics optoretinography and compare with cone structure and clinical assessments of vision. Parafoveal cone mosaics of 10 CHM and four normal-sighted participants were imaged with an adaptive optics scanning light ophthalmoscope. While acquiring video sequences, a 2 s 550Δ10 nm, 450 nW/deg2 stimulus was presented. Videos were registered and the intensity of each cone in each frame was extracted, normalized, standardized, and aggregated to generate the population optoretinogram (ORG) over time. A gamma-pdf was fit to the ORG and the peak was extracted as ORG amplitude. CHM ORG amplitudes were compared to normal and were correlated with bound cone density, ellipsoid zone to RPE/Bruch's membrane (EZ-to-RPE/BrM) distance, and foveal sensitivity using Pearson correlation analysis. ORG amplitude was significantly reduced in CHM compared to normal (0.22 ± 0.15 vs. 1.34 ± 0.31). In addition, CHM ORG amplitude was positively correlated with cone density, EZ-to-RPE/BrM distance, and foveal sensitivity. Our results demonstrate promise for using ORG as a biomarker of photoreceptor function.
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Affiliation(s)
- Peiluo Xu
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert F Cooper
- Department of Ophthalmology, Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University and Medical College of Wisconsin, Milwaukee, WI, 53233, USA
| | - Yu You Jiang
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jessica I W Morgan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Untaroiu A, Reis LM, Higgins BP, Walesa A, Zacharias S, Nikezic D, Costakos DM, Carroll J, Semina EV. In Vivo Assessment of Retinal Phenotypes in Axenfeld-Rieger Syndrome. Invest Ophthalmol Vis Sci 2024; 65:20. [PMID: 38587439 PMCID: PMC11005067 DOI: 10.1167/iovs.65.4.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Axenfeld-Rieger syndrome (ARS) is characterized by ocular anomalies including posterior embryotoxon, iridocorneal adhesions, corectopia/iris hypoplasia, and developmental glaucoma. Although anterior segment defects and glaucoma contribute to decreased visual acuity, the role of potential posterior segment abnormalities has not been explored. We used high-resolution retinal imaging to test the hypothesis that individuals with ARS have posterior segment pathology. Methods Three individuals with FOXC1-ARS and 10 with PITX2-ARS completed slit-lamp and fundus photography, optical coherence tomography (OCT), OCT angiography, and adaptive optics scanning light ophthalmoscopy (AOSLO). Quantitative metrics were compared to previously published values for individuals with normal vision. Results All individuals demonstrated typical anterior segment phenotypes. Average ganglion cell and inner plexiform layer thickness was lower in PITX2-ARS, consistent with the glaucoma history in this group. A novel phenotype of foveal hypoplasia was noted in 40% of individuals with PITX2-ARS (but none with FOXC1-ARS). Moreover, the depth and volume of the foveal pit were significantly lower in PITX2-ARS compared to normal controls, even excluding individuals with foveal hypoplasia. Analysis of known foveal hypoplasia genes failed to identify an alternative explanation. Foveal cone density was decreased in one individual with foveal hypoplasia and normal in six without foveal hypoplasia. Two individuals (one from each group) demonstrated non-foveal retinal irregularities with regions of photoreceptor anomalies on OCT and AOSLO. Conclusions These findings implicate PITX2 in the development of the posterior segment, particularly the fovea, in humans. The identified posterior segment phenotypes may contribute to visual acuity deficits in individuals with PITX2-ARS.
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Affiliation(s)
- Ana Untaroiu
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Linda M. Reis
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Brian P. Higgins
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Ashleigh Walesa
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Serena Zacharias
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Danica Nikezic
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Deborah M. Costakos
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph Carroll
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Elena V. Semina
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin and Childrens Wisconsin, Milwaukee, Wisconsin, United States
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Bowles Johnson KE, Tang JAH, Kunala K, Huynh KT, Parkins K, Yang Q, Hunter JJ. Fluorescence Lifetime Imaging of Human Retinal Pigment Epithelium in Pentosan Polysulfate Toxicity Using Adaptive Optics Scanning Light Ophthalmoscopy. Invest Ophthalmol Vis Sci 2024; 65:27. [PMID: 38630675 PMCID: PMC11044828 DOI: 10.1167/iovs.65.4.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/16/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Fluorescence lifetime ophthalmoscopy (FLIO) is an emerging clinical modality that could provide biomarkers of retinal health beyond fluorescence intensity. Adaptive optics (AO) ophthalmoscopy provides the confocality to measure fluorescence lifetime (FL) primarily from the retinal pigment epithelium (RPE) whereas clinical FLIO has greater influence from fluorophores in the inner retina and lens. Adaptive optics fluorescence lifetime ophthalmoscopy (AOFLIO) measures of FL in vivo could provide insight into RPE health at different stages of disease. In this study, we assess changes in pentosan polysulfate sodium (PPS) toxicity, a recently described toxicity that has clinical findings similar to advanced age-related macular degeneration. Methods AOFLIO was performed on three subjects with PPS toxicity (57-67 years old) and six age-matched controls (50-64 years old). FL was analyzed with a double exponential decay curve fit and with phasor analysis. Regions of interest (ROIs) were subcategorized based on retinal features on optical coherence tomography (OCT) and compared to age-matched controls. Results Twelve ROIs from PPS toxicity subjects met the threshold for analysis by curve fitting and 15 ROIs met the threshold for phasor analysis. Subjects with PPS toxicity had prolonged FL compared to age-matched controls. ROIs of RPE degeneration had the longest FLs, with individual pixels extending longer than 900 ps. Conclusions Our study shows evidence that AOFLIO can provide meaningful information in outer retinal disease beyond what is obtainable from fluorescence intensity alone. More studies are needed to determine the prognostic value of AOFLIO.
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Affiliation(s)
| | - Janet A. H. Tang
- Center for Visual Science, University of Rochester, Rochester, New York, United States
- The Institute of Optics, University of Rochester, Rochester, New York, United States
| | - Karteek Kunala
- Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Khang T. Huynh
- Center for Visual Science, University of Rochester, Rochester, New York, United States
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, United States
| | - Keith Parkins
- Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Qiang Yang
- Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Jennifer J. Hunter
- Flaum Eye Institute, University of Rochester, Rochester, New York, United States
- Center for Visual Science, University of Rochester, Rochester, New York, United States
- The Institute of Optics, University of Rochester, Rochester, New York, United States
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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11
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Wynne N, Jiang YY, Aleman TS, Morgan JIW. FOVEAL PHENOTYPES IN CHOROIDEREMIA ON ADAPTIVE OPTICS SCANNING LIGHT OPHTHALMOSCOPY. Retina 2024; 44:659-668. [PMID: 38531059 PMCID: PMC10972540 DOI: 10.1097/iae.0000000000003995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE Choroideremia is an X-linked inherited retinal degeneration involving the choriocapillaris, retinal pigment epithelium, and photoreceptors. Adaptive optics scanning light ophthalmoscopy allows visualization of retinal structure at the level of individual cells and is well poised to provide insight into the pathophysiologic mechanisms underpinning the retinal degeneration in choroideremia. METHODS Foveal adaptive optics scanning light ophthalmoscopy images of 102 eyes of 54 individuals with choroideremia were analyzed. Measures were compared with those from standard clinical imaging. Visual acuity was also measured and compared with quantitative foveal metrics. RESULTS The 3 distinct phenotypes observed were: relatively normal (5 eyes, 4 individuals), spiderweb (9 eyes, 7 individuals), and salt and pepper (87 eyes, 47 individuals). Peak cone density (86 eyes of 51 individuals) was significantly lower in choroideremia than in healthy retinas (P < 0.0001, range: 29,382-157,717 cones/mm2). Peak cone density was significantly related to extent of retained ellipsoid zone on en face optical coherence tomography (r2 = 0.47, P = 0.0009) and inversely related to visual acuity (r2 = 0.20, P = 0.001). CONCLUSION Distinct phenotypes can be observed on adaptive optics scanning light ophthalmoscopy imaging in choroideremia that cannot always be discerned on standard clinical imaging. Quantitative measures on adaptive optics imaging are related to the structural and functional severity of disease.
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Affiliation(s)
- Niamh Wynne
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Yu You Jiang
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
| | - Tomas S Aleman
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
| | - Jessica IW Morgan
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
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Daich Varela M, Dixit M, Kalitzeos A, Michaelides M. Adaptive Optics Retinal Imaging in RDH12-Associated Early Onset Severe Retinal Dystrophy. Invest Ophthalmol Vis Sci 2024; 65:9. [PMID: 38466282 PMCID: PMC10929749 DOI: 10.1167/iovs.65.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/03/2023] [Indexed: 03/12/2024] Open
Abstract
Purpose RDH12 is among the most common genes found in individuals with early-onset severe retinal (EOSRD). Adaptive optics scanning light ophthalmoscopy (AOSLO) enables resolution of individual rod and cone photoreceptors in the retina. This study presents the first AOSLO imaging of individuals with RDH12-associated EOSRD. Methods Case series of patients who attended Moorfields Eye Hospital (London, UK). Spectral-domain optical coherence tomography, near-infrared reflectance (NIR), and blue autofluorescence imaging were analyzed. En face image sequences of photoreceptors were recorded using either of two AOSLO modalities. Cross-sectional analysis was undertaken for seven patients and longitudinal analysis for one patient. Results Nine eyes from eight patients are presented in this case series. The mean age at the time of the assessment was 11.2 ± 6.5 years of age (range 7-29). A subfoveal continuous ellipsoid zone (EZ) line was present in eight eyes. Posterior pole AOSLO revealed patches of cone mosaics. Average cone densities at regions of interest 0.5° to the fovea ranged from 12,620 to 23,660 cells/mm2, whereas intercell spacing ranged from 7.0 to 9.7 µm. Conclusions This study demonstrates that AOSLO can provide useful high-quality images in patients with EOSRD, even during childhood, with nystagmus, and early macular atrophy. Cones at the posterior pole can appear as scattered islands or, possibly later in life, as a single subfoveal conglomerate. Detailed image analysis suggests that retinal pigment epithelial stress and dysfunction may be the initial step toward degeneration, with NIR being a useful tool to assess retinal well-being in RDH12-associated EOSRD.
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Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Mira Dixit
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Angelos Kalitzeos
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
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13
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Lee S, Choi SS, Meleppat RK, Zawadzki RJ, Doble N. High-speed, phase contrast retinal and blood flow imaging using an adaptive optics partially confocal multi-line ophthalmoscope. BIOMEDICAL OPTICS EXPRESS 2024; 15:1815-1830. [PMID: 38495707 PMCID: PMC10942708 DOI: 10.1364/boe.507449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/18/2023] [Accepted: 01/14/2024] [Indexed: 03/19/2024]
Abstract
High-speed, phase contrast retinal and blood flow imaging using an adaptive optics partially confocal multi-line ophthalmosocope (AO-pcMLO) is described. It allows for simultaneous confocal and phase contrast imaging with various directional multi-line illumination by using a single 2D camera and a digital micromirror device (DMD). Both vertical and horizontal line illumination directions were tested, for photoreceptor and vascular imaging. The phase contrast imaging provided improved visualization of retinal structures such as cone inner segments, vessel walls and red blood cells with images being acquired at frame rates up to 500 Hz. Blood flow velocities of small vessels (<40 µm in diameter) were measured using kymographs for capillaries and cross-correlation between subsequent images for arterioles or venules. Cardiac-related pulsatile patterns were observed with normal resting heart-beat rate, and instantaneous blood flow velocities from 0.7 to 20 mm/s were measured.
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Affiliation(s)
- Soohyun Lee
- College of Optometry, The Ohio State University, 338 West 10th Avenue, Columbus, Ohio 43210, USA
| | - Stacey S. Choi
- College of Optometry, The Ohio State University, 338 West 10th Avenue, Columbus, Ohio 43210, USA
- Department of Ophthalmology and Visual Sciences, Havener Eye Institute, The Ohio State University, 915 Olentangy River Road, Suite 5000, Ohio 43212, USA
| | - Ratheesh K. Meleppat
- UC Davis Eye Center, Department of Ophthalmology and Vision Science, University of California, Davis, 4860 Y Street, Suite 2400, Sacramento, California 95817, USA
- UC Davis EyePod Small Animal Ocular Imaging Laboratory, Department of Cell Biology and Human Anatomy, University of California, Davis, 4320 Tupper Hall, Davis, California 95616, USA
| | - Robert J. Zawadzki
- UC Davis Eye Center, Department of Ophthalmology and Vision Science, University of California, Davis, 4860 Y Street, Suite 2400, Sacramento, California 95817, USA
- UC Davis EyePod Small Animal Ocular Imaging Laboratory, Department of Cell Biology and Human Anatomy, University of California, Davis, 4320 Tupper Hall, Davis, California 95616, USA
| | - Nathan Doble
- College of Optometry, The Ohio State University, 338 West 10th Avenue, Columbus, Ohio 43210, USA
- Department of Ophthalmology and Visual Sciences, Havener Eye Institute, The Ohio State University, 915 Olentangy River Road, Suite 5000, Ohio 43212, USA
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14
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Vienola KV, Holmes JA, Glasso Z, Rossi EA. Head stabilization apparatus for high-resolution ophthalmic imaging. APPLIED OPTICS 2024; 63:940-944. [PMID: 38437390 PMCID: PMC11210293 DOI: 10.1364/ao.513801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/23/2023] [Indexed: 03/06/2024]
Abstract
Head movement must be stabilized to enable high-quality data collection from optical instrumentation such as eye trackers and ophthalmic imaging devices. Though critically important for imaging, head stabilization is often an afterthought in the design of advanced ophthalmic imaging systems, and experimental devices often adapt used and/or discarded equipment from clinical devices for this purpose. Alternatively, those seeking the most stable solution possible, including many users of adaptive optics ophthalmoscopy systems, utilize bite bars. Bite bars can provide excellent stability but are time consuming to fabricate, decreasing imaging efficiency, and uncomfortable for many patients, especially the elderly and/or those with prosthodontics such as dentures who may refuse participation in a study that requires one. No commercial vendors specifically offer head mount solutions for experimental ophthalmic imaging devices, resulting in nearly every custom device having a different solution for this commonly encountered problem. Parallelizing the head stabilization apparatus across different custom devices may improve standardization of experimental imaging systems for clinical trials and other multicenter investigations. Here we introduce a head mount design for ophthalmic imaging that is modular, adjustable, and customizable to the constraints of different experimental imaging configurations. The three points of head contact in our solution provide excellent stabilization across a range of head sizes and shapes from small children to adults, and the ease of adjustment afforded by our design minimizes the time to get participants stabilized and comfortable.
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Affiliation(s)
- Kari V. Vienola
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - John A. Holmes
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Zolten Glasso
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Ethan A. Rossi
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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15
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Huang BB, Fukuyama H, Burns SA, Fawzi AA. Imaging the Retinal Vascular Mural Cells In Vivo: Elucidating the Timeline of Their Loss in Diabetic Retinopathy. Arterioscler Thromb Vasc Biol 2024; 44:465-476. [PMID: 38152885 PMCID: PMC10842708 DOI: 10.1161/atvbaha.123.320169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Vascular mural cells (VMCs) are integral components of the retinal vasculature with critical homeostatic functions such as maintaining the inner blood-retinal barrier and vascular tone, as well as supporting the endothelial cells. Histopathologic donor eye studies have shown widespread loss of pericytes and smooth muscle cells, the 2 main VMC types, suggesting these cells are critical to the pathogenesis of diabetic retinopathy (DR). There remain, however, critical gaps in our knowledge regarding the timeline of VMC demise in human DR. METHODS In this study, we address this gap using adaptive optics scanning laser ophthalmoscopy to quantify retinal VMC density in eyes with no retinal disease (healthy), subjects with diabetes without diabetic retinopathy, and those with clinical DR and diabetic macular edema. We also used optical coherence tomography angiography to quantify capillary density of the superficial and deep capillary plexuses in these eyes. RESULTS Our results indicate significant VMC loss in retinal arterioles before the appearance of classic clinical signs of DR (diabetes without diabetic retinopathy versus healthy, 5.0±2.0 versus 6.5±2.0 smooth muscle cells per 100 µm; P<0.05), while a significant reduction in capillary VMC density (5.1±2.3 in diabetic macular edema versus 14.9±6.0 pericytes per 100 µm in diabetes without diabetic retinopathy; P=0.01) and capillary density (superficial capillary plexus vessel density, 37.6±3.8 in diabetic macular edema versus 45.5±2.4 in diabetes without diabetic retinopathy; P<0.0001) is associated with more advanced stages of clinical DR, particularly diabetic macular edema. CONCLUSIONS Our results offer a new framework for understanding the pathophysiologic course of VMC compromise in DR, which may facilitate the development and monitoring of therapeutic strategies aimed at VMC preservation and potentially the prevention of clinical DR and its associated morbidity. Imaging retinal VMCs provides an unparalleled opportunity to visualize these cells in vivo and may have wider implications in a range of diseases where these cells are disrupted.
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Affiliation(s)
- Bonnie B. Huang
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hisashi Fukuyama
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | | | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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16
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Moon B, Poletti M, Roorda A, Tiruveedhula P, Liu SH, Linebach G, Rucci M, Rolland JP. Alignment, calibration, and validation of an adaptive optics scanning laser ophthalmoscope for high-resolution human foveal imaging. APPLIED OPTICS 2024; 63:730-742. [PMID: 38294386 PMCID: PMC11062499 DOI: 10.1364/ao.504283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
In prior art, advances in adaptive optics scanning laser ophthalmoscope (AOSLO) technology have enabled cones in the human fovea to be resolved in healthy eyes with normal vision and low to moderate refractive errors, providing new insight into human foveal anatomy, visual perception, and retinal degenerative diseases. These high-resolution ophthalmoscopes require careful alignment of each optical subsystem to ensure diffraction-limited imaging performance, which is necessary for resolving the smallest foveal cones. This paper presents a systematic and rigorous methodology for building, aligning, calibrating, and testing an AOSLO designed for imaging the cone mosaic of the central fovea in humans with cellular resolution. This methodology uses a two-stage alignment procedure and thorough system testing to achieve diffraction-limited performance. Results from retinal imaging of healthy human subjects under 30 years of age with refractive errors of less than 3.5 diopters using either 680 nm or 840 nm light show that the system can resolve cones at the very center of the fovea, the region where the cones are smallest and most densely packed.
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Affiliation(s)
- Benjamin Moon
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Martina Poletti
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY 14627, USA
- Department of Neuroscience, University of Rochester, Rochester, NY 14627, USA
| | - Austin Roorda
- Herbert Wertheim School of Optometry and Vision Science, University of California Berkeley, Berkeley, CA 94720, USA
| | - Pavan Tiruveedhula
- Herbert Wertheim School of Optometry and Vision Science, University of California Berkeley, Berkeley, CA 94720, USA
| | - Soh Hang Liu
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Glory Linebach
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Michele Rucci
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY 14627, USA
| | - Jannick P. Rolland
- 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
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17
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Ayubi GA, Dubra A. Robust real-time estimation of non-uniform angular velocity and sub-pixel jitter in images captured with resonant scanners. OPTICS EXPRESS 2023; 31:44199-44211. [PMID: 38178497 DOI: 10.1364/oe.512233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
Images captured with resonant scanners are affected by angular velocity fluctuations that result in image distortion and by poor synchronization between scanning and light detection that creates jitter between image rows. We previously demonstrated that both problems can be mitigated in post-processing by recording the scanner orientation in synchrony with the image capture, followed by data resampling [Opt. Express30, 112 (2022)10.1364/OE.446162]. Here we introduce more robust algorithms for estimation of both angular velocity fluctuation and jitter in the presence of random and deterministic noise. We also show linearization of the scanner oscillation model to reduce calculation times by two orders of magnitude, reaching 65,000 jitter estimations per second when using 2,800 samples per image row, and 500,000 when using only 500 samples, easily supporting real-time generation of jitter-corrected images.
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18
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Akhavanrezayat A, Khatri A, Onghanseng NGL, Halim MS, Or C, Sredar N, Razeen M, Hasanreisoglu M, Regenold J, Thng ZX, Mohammadi SS, Jain T, Yavari N, Bazojoo V, Gupta AS, Mobasserian A, Yasar C, Than NTT, Uludag Kirimli G, Karaca I, Shin YU, Yoo WS, Ghoraba H, Do DV, Dubra A, Nguyen QD. Structural and Functional Changes in Non-Paraneoplastic Autoimmune Retinopathy. Diagnostics (Basel) 2023; 13:3376. [PMID: 37958272 PMCID: PMC10649684 DOI: 10.3390/diagnostics13213376] [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: 09/27/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND To describe longitudinal changes in patients with non-paraneoplastic autoimmune retinopathy (npAIR) by utilizing different diagnostic modalities/tests. METHODS The index study is a retrospective longitudinal review of sixteen eyes of eight patients from a tertiary care eye hospital diagnosed with npAIR. Multiple diagnostic modalities such as wide-angle fundus photography (WAFP), WA fundus autofluorescence (WAFAF), spectral-domain optical coherence tomography (SD-OCT), Goldmann visual field (GVF) perimetry, microperimetry (MP), electrophysiologic testing, and adaptive optics scanning laser ophthalmoscopy (AOSLO) were reviewed and analyzed. RESULTS At the baseline visits, anomalies were detected by multimodal diagnostic tests on all patients. Subjects were followed up for a median duration of 11.5 [3.0-18.7] months. Structural changes at the baseline were detected in 14 of 16 (87.5%) eyes on WAFP and WAFAF and 13 of 16 (81.2%) eyes on SD-OCT. Eight of the ten (80%) eyes that underwent AOSLO imaging depicted structural changes. Functional changes were detected in 14 of 16 (87.5%) eyes on GVF, 15 of 16 (93.7%) eyes on MP, and 11 of 16 (68.7%) eyes on full-field electroretinogram (ff-ERG). Multifocal electroretinogram (mf-ERG) and visual evoked potential (VEP) tests were performed in 14 eyes, of which 12 (85.7%) and 14 (100%) of the eyes demonstrated functional abnormalities, respectively, at baseline. Compared to all the other structural diagnostic tools, AOSLO had a better ability to demonstrate deterioration in retinal microstructures occurring at follow-ups. Functional deterioration at follow-up was detected on GVF in 8 of 10 (80%) eyes, mf-ERG in 4 of 8 (50%) eyes, and MP in 7 of 16 (43.7%) eyes. The ff-ERG and VEP were stable in the majority of cases at follow-up. CONCLUSIONS The utilization of multimodal imaging/tests in the diagnosing and monitoring of npAIR patients can aid in identifying anomalous changes over time. Analysis of both the anatomical and functional aspects by these devices can be supportive of detecting the changes early in such patients. AOSLO shows promise as it enables the capture of high-resolution images demonstrating quantifiable changes to retinal microstructure.
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Affiliation(s)
- Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Anadi Khatri
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Birat Aankha Aspatal, Biratnagar 56613, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar 45200, Nepal
| | - Neil Gregory L. Onghanseng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Makati Medical Center, Manila 1229, Philippines
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Ocular Imaging Research and Reading Center, Sunnyvale, CA 94085, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Nripun Sredar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Moataz Razeen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Murat Hasanreisoglu
- Department of Ophthalmology, Koc University School of Medicine, 34450 Istanbul, Turkey
- Koc University Research Center for Translational Medicine, Koc University, 34450 Istanbul, Turkey
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Zheng Xian Thng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - S. Saeed Mohammadi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Tanya Jain
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Dr. Shroff Charity Eye Hospital, New Delhi 110002, India
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Vahid Bazojoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Ankur Sudhir Gupta
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Ngoc Trong Tuong Than
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Gunay Uludag Kirimli
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Duke University, Durham, NC 27705, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Yong-Un Shin
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Woong-Sun Yoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Diana V. Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Alfredo Dubra
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
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19
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Giacomelli MG. Optimal real-time resonant scanner linearization using filtered Hermite interpolation. BIOMEDICAL OPTICS EXPRESS 2023; 14:5861-5869. [PMID: 38021131 PMCID: PMC10659797 DOI: 10.1364/boe.504764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
High-speed laser scanning microscopy frequently relies on resonant scanners due to their order of magnitude increase in imaging rate compared to conventional galvanometer scanners. However, the use of a nonlinear scan trajectory introduces distortion that must be corrected. This manuscript derives a new algorithm based on filtered Hermite polynomial interpolation that provides the optimal shot-noise-limited SNR for a fixed number of photons and provides higher spatial accuracy than previous methods. An open-source library is presented using the Intel advanced vector instruction set (AVX) to process up to 32 samples in parallel. Using this approach, I simultaneously demonstrate lower shot noise variance, moderately higher spatial accuracy and greater than 1 gigapixel per second interpolation rate on a desktop CPU.
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Affiliation(s)
- Michael G. Giacomelli
- Department of Biomedical Engineering, University of Rochester, 207 Goergen Hall, Box 270168, Rochester, NY 14627, USA
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20
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Xu P, Jiang YY, Morgan JIW. Cone Photoreceptor Morphology in Choroideremia Assessed Using Non-Confocal Split-Detection Adaptive Optics Scanning Light Ophthalmoscopy. Invest Ophthalmol Vis Sci 2023; 64:36. [PMID: 37504961 PMCID: PMC10383007 DOI: 10.1167/iovs.64.10.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose Choroideremia (CHM) is an X-linked inherited retinal degeneration causing loss of the photoreceptors, retinal pigment epithelium, and choriocapillaris, although patients typically retain a central island of relatively preserved, functioning retina until late-stage disease. Here, we investigate cone photoreceptor morphology within the retained retinal island by examining cone inner segment area, density, circularity, and intercone space. Methods Using a custom-built, multimodal adaptive optics scanning light ophthalmoscope, nonconfocal split-detection images of the photoreceptor mosaic were collected at 1°, 2°, and 4° temporal to the fovea from 13 CHM and 12 control subjects. Cone centers were manually identified, and cone borders were segmented. A custom MATLAB script was used to extract area and circularity for each cone and calculate the percentage of intercone space in each region of interest. Bound cone density was also calculated. An unbalanced two-way ANOVA and Bonferroni post hoc tests were used to assess statistical differences between the CHM and control groups and along retinal eccentricity. Results Cone density was lower in the CHM group than in the control group (P < 0.001) and decreased with eccentricity from the fovea (P < 0.001). CHM cone inner segments were larger in area (P < 0.001) and more circular (P = 0.042) than those of the controls. Intercone space in CHM was also higher than in the controls (P < 0.001). Conclusions Cone morphology is altered in CHM compared to control, even within the centrally retained, functioning retinal area. Further studies are required to determine whether such morphology is a precursor to cone degeneration.
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Affiliation(s)
- Peiluo Xu
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Yu You Jiang
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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21
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Soltanian-Zadeh S, Liu Z, Liu Y, Lassoued A, Cukras CA, Miller DT, Hammer DX, Farsiu S. Deep learning-enabled volumetric cone photoreceptor segmentation in adaptive optics optical coherence tomography images of normal and diseased eyes. BIOMEDICAL OPTICS EXPRESS 2023; 14:815-833. [PMID: 36874491 PMCID: PMC9979662 DOI: 10.1364/boe.478693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/11/2023]
Abstract
Objective quantification of photoreceptor cell morphology, such as cell diameter and outer segment length, is crucial for early, accurate, and sensitive diagnosis and prognosis of retinal neurodegenerative diseases. Adaptive optics optical coherence tomography (AO-OCT) provides three-dimensional (3-D) visualization of photoreceptor cells in the living human eye. The current gold standard for extracting cell morphology from AO-OCT images involves the tedious process of 2-D manual marking. To automate this process and extend to 3-D analysis of the volumetric data, we propose a comprehensive deep learning framework to segment individual cone cells in AO-OCT scans. Our automated method achieved human-level performance in assessing cone photoreceptors of healthy and diseased participants captured with three different AO-OCT systems representing two different types of point scanning OCT: spectral domain and swept source.
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Affiliation(s)
| | - Zhuolin Liu
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Yan Liu
- School of Optometry, Indiana University, Bloomington, IN 47405, USA
| | - Ayoub Lassoued
- School of Optometry, Indiana University, Bloomington, IN 47405, USA
| | - Catherine A. Cukras
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Donald T. Miller
- School of Optometry, Indiana University, Bloomington, IN 47405, USA
| | - Daniel X. Hammer
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
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22
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Heitkotter H, Patterson EJ, Woertz EN, Cava JA, Gaffney M, Adhan I, Tam J, Cooper RF, Carroll J. Extracting spacing-derived estimates of rod density in healthy retinae. BIOMEDICAL OPTICS EXPRESS 2023; 14:1-17. [PMID: 36698662 PMCID: PMC9842010 DOI: 10.1364/boe.473101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 05/02/2023]
Abstract
Quantification of the rod photoreceptor mosaic using adaptive optics scanning light ophthalmoscopy (AOSLO) remains challenging. Here we demonstrate a method for deriving estimates of rod density and rod:cone ratio based on measures of rod spacing, cone numerosity, and cone inner segment area. Twenty-two AOSLO images with complete rod visualization were used to validate this spacing-derived method for estimating density. The method was then used to estimate rod metrics in an additional 105 images without complete rod visualization. The spacing-derived rod mosaic metrics were comparable to published data from histology. This method could be leveraged to develop large normative databases of rod mosaic metrics, though limitations persist with intergrader variability in assessing cone area and numerosity.
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Affiliation(s)
- Heather Heitkotter
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- These authors contributed equally to this work
| | - Emily J. Patterson
- UCL Institute of Ophthalmology, University College London, London, UK
- These authors contributed equally to this work
| | - Erica N. Woertz
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Jenna A. Cava
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mina Gaffney
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iniya Adhan
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Johnny Tam
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert F. Cooper
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
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23
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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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24
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Li J, Wang D, Pottenburgh J, Bower AJ, Asanad S, Lai EW, Simon C, Im L, Huryn LA, Tao Y, Tam J, Saeedi OJ. Visualization of erythrocyte stasis in the living human eye in health and disease. iScience 2022; 26:105755. [PMID: 36594026 PMCID: PMC9803835 DOI: 10.1016/j.isci.2022.105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/25/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Blood cells trapped in stasis have been reported within the microcirculation, but their relevance to health and disease has not been established. In this study, we introduce an in vivo imaging approach that reveals the presence of a previously-unknown pool of erythrocytes in stasis, located within capillary segments of the CNS, and present in 100% of subjects imaged. These results provide a key insight that blood cells pause as they travel through the choroidal microvasculature, a vascular structure that boasts the highest blood flow of any tissue in the body. Demonstration of clinical utility using deep learning reveals that erythrocyte stasis is altered in glaucoma, indicating the possibility of more widespread changes in choroidal microvascular than previously realized. The ability to monitor the choroidal microvasculature at the single cell level may lead to novel strategies for tracking microvascular health in glaucoma, age-related macular degeneration, and other neurodegenerative diseases.
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Affiliation(s)
- Joanne Li
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dongyi Wang
- Bioimaging and Machine Vision Laboratory, Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Jessica Pottenburgh
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew J. Bower
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric W. Lai
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Caroline Simon
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lily Im
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laryssa A. Huryn
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yang Tao
- Bioimaging and Machine Vision Laboratory, Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Johnny Tam
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Osamah J. Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author
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25
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Warner RL, Brainard DH, Morgan JIW. Repeatability and reciprocity of the cone optoretinogram. BIOMEDICAL OPTICS EXPRESS 2022; 13:6561-6573. [PMID: 36589578 PMCID: PMC9774868 DOI: 10.1364/boe.471990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 05/02/2023]
Abstract
Optoretinography has enabled noninvasive visualization of physiological changes in cone photoreceptors exposed to light. Understanding the cone optoretinogram in healthy subjects is essential for establishing it as a biomarker for cone function in disease. Here, we measure the population cone intensity optoretinogram in healthy adults, for multiple irradiance/duration combinations of visible stimuli with equal energy. We study the within and between session repeatability and reciprocity of the ORG in five healthy subjects. We find the cone optoretinogram exhibits equivalent amplitudes for equal-energy stimuli. We also find good within-subject repeatability, which allows us to show differences across the five subjects.
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Affiliation(s)
- R. L. Warner
- Scheie Eye Institute, Department of
Ophthalmology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - D. H. Brainard
- Psychology Department, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - J. 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
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26
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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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27
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Li K, Yin Q, Ren J, Song H, Zhang J. Automatic quantification of cone photoreceptors in adaptive optics scanning light ophthalmoscope images using multi-task learning. BIOMEDICAL OPTICS EXPRESS 2022; 13:5187-5201. [PMID: 36425624 PMCID: PMC9664876 DOI: 10.1364/boe.471426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 05/02/2023]
Abstract
Adaptive optics scanning light ophthalmoscope (AO-SLO) can directly image the cone photoreceptor mosaic in the living human retina, which offers a potentially great tool to detect cone-related ocular pathologies by quantifying the changes in the cone mosaic. However, manual quantification is very time-consuming and automation is highly desirable. In this paper, we developed a fully automatic method based on multi-task learning to identify and quantify cone photoreceptors. By including cone edges in the labels as the third dimension of the classification, our method provided more accurate and reliable results than the two previously reported methods. We trained and validated our network in an open data set consisting of over 200,000 cones, and achieved a 99.20% true positive rate, 0.71% false positive rate, and 99.24% Dice's coefficient on the test set consisting of 44,634 cones. All are better than the reported methods. In addition, the reproducibility of all three methods was also tested and compared, and the result showed the performance of our method was generally closer to the gold standard. Bland-Altman plots show that our method was more stable and accurate than the other two methods. Then ablation experiment was further done, and the result shows that multi-task learning is essential to achieving accurate quantifications. Finally, our method was also extended to segment the cones to extract the size information. Overall, the method proposed here demonstrated great performance in terms of accuracy and reliability, which can be used to efficiently quantify the subtle changes associated with the progression of many diseases affecting cones.
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Affiliation(s)
- Kaiwen Li
- Advanced Ophthalmology Laboratory (AOL), Robotrak Technologies, Nanjing, 210000, China
| | - Qi Yin
- Advanced Ophthalmology Laboratory (AOL), Robotrak Technologies, Nanjing, 210000, China
| | - Ji Ren
- Advanced Ophthalmology Laboratory (AOL), Robotrak Technologies, Nanjing, 210000, China
| | - Hongxin Song
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Jie Zhang
- Advanced Ophthalmology Laboratory (AOL), Robotrak Technologies, Nanjing, 210000, China
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28
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Widespread subclinical cellular changes revealed across a neural-epithelial-vascular complex in choroideremia using adaptive optics. Commun Biol 2022; 5:893. [PMID: 36100689 PMCID: PMC9470576 DOI: 10.1038/s42003-022-03842-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractChoroideremia is an X-linked, blinding retinal degeneration with progressive loss of photoreceptors, retinal pigment epithelial (RPE) cells, and choriocapillaris. To study the extent to which these layers are disrupted in affected males and female carriers, we performed multimodal adaptive optics imaging to better visualize the in vivo pathogenesis of choroideremia in the living human eye. We demonstrate the presence of subclinical, widespread enlarged RPE cells present in all subjects imaged. In the fovea, the last area to be affected in choroideremia, we found greater disruption to the RPE than to either the photoreceptor or choriocapillaris layers. The unexpected finding of patches of photoreceptors that were fluorescently-labeled, but structurally and functionally normal, suggests that the RPE blood barrier function may be altered in choroideremia. Finally, we introduce a strategy for detecting enlarged cells using conventional ophthalmic imaging instrumentation. These findings establish that there is subclinical polymegathism of RPE cells in choroideremia.
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29
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Hu X, Yang Q. Real-time correction of image rotation with adaptive optics scanning light ophthalmoscopy. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2022; 39:1663-1672. [PMID: 36215635 DOI: 10.1364/josaa.465889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
Fixational eye motion includes typical translation and torsion. In the registration of images from adaptive optics scanning light ophthalmoscopy (AOSLO), image rotation due to eye torsion and/or head rotation is often ignored because (a) the amount of rotation is trivial compared to translation within a short duration of imaging or recording time and (b) computational cost increases substantially when the registration algorithm involves simultaneous detection of rotation and translation. However, it becomes critically important under cases such as long exposure, functional measurements, and precise motion tracking. We developed a fast method to detect and correct rotation from AOSLO images, together with the detection of strip-level motion translation. The computational cost for rotation detection and correction alone is about 5 ms/frame (512×512 pixels) on an nVidia GTX960M GPU. Image quality is compared with and without rotation correction from 10 healthy human subjects and 8 diseased eyes with a total of 180 videos. The results show that residual image motions between the reference images and the registered images with rotation correction are a fraction of those without rotation correction, and the ratio is 0.74-0.89 at the image center and 0.37-0.51 at the four corners of the images.
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30
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Chen M, Jiang YY, Gee JC, Brainard DH, Morgan JIW. Automated Assessment of Photoreceptor Visibility in Adaptive Optics Split-Detection Images Using Edge Detection. Transl Vis Sci Technol 2022; 11:25. [PMID: 35608855 PMCID: PMC9145033 DOI: 10.1167/tvst.11.5.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Adaptive optics scanning laser ophthalmoscopy (AOSLO) is a high-resolution imaging modality that allows measurements of cellular-level retinal changes in living patients. In retinal diseases, the visibility of photoreceptors in AOSLO images is affected by pathology, patient motion, and optics, which can lead to variability in analyses of the photoreceptor mosaic. Current best practice for AOSLO mosaic quantification requires manual assessment of photoreceptor visibility across overlapping images, a laborious and time-consuming task. Methods We propose an automated measure for quantification of photoreceptor visibility in AOSLO. Our method detects salient edge features, which can represent visible photoreceptor boundaries in each image. We evaluate our measure against two human graders and two standard automated image quality assessment algorithms. Results We evaluate the accuracy of pairwise ordering (PO) and the correlation of ordinal rankings (ORs) of photoreceptor visibility in 29 retinal regions, taken from five subjects with choroideremia. The proposed measure had high association with manual assessments (Grader 1: PO = 0.71, OR = 0.61; Grader 2: PO = 0.67, OR = 0.62), which is comparable with intergrader reliability (PO = 0.76, OR = 0.75) and outperforms the top standard approach (PO = 0.57; OR = 0.46). Conclusions Our edge-based measure can automatically assess photoreceptor visibility and order overlapping images within AOSLO montages. This can significantly reduce the manual labor required to generate high-quality AOSLO montages and enables higher throughput for quantitative studies of photoreceptors. Translational Relevance Automated assessment of photoreceptor visibility allows us to more rapidly quantify photoreceptor morphology in the living eye. This has applications to ophthalmic medicine by allowing detailed characterization of retinal degenerations, thus yielding potential biomarkers of treatment safety and efficacy.
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Affiliation(s)
- Min Chen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Yu You Jiang
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - James C Gee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David H Brainard
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica I W Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA.,Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
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31
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Giannini JP, Lu R, Bower AJ, Fariss R, Tam J. Visualizing retinal cells with adaptive optics imaging modalities using a translational imaging framework. BIOMEDICAL OPTICS EXPRESS 2022; 13:3042-3055. [PMID: 35774328 PMCID: PMC9203084 DOI: 10.1364/boe.454560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 05/18/2023]
Abstract
Adaptive optics reflectance-based retinal imaging has proved a valuable tool for the noninvasive visualization of cells in the living human retina. Many subcellular features that remain at or below the resolution limit of current in vivo techniques may be more easily visualized with the same modalities in an ex vivo setting. While most microscopy techniques provide significantly higher resolution, enabling the visualization of fine cellular detail in ex vivo retinal samples, they do not replicate the reflectance-based imaging modalities of in vivo retinal imaging. Here, we introduce a strategy for imaging ex vivo samples using the same imaging modalities as those used for in vivo retinal imaging, but with increased resolution. We also demonstrate the ability of this approach to perform protein-specific fluorescence imaging and reflectance imaging simultaneously, enabling the visualization of nearly transparent layers of the retina and the classification of cone photoreceptor types.
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32
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Gill JS, Theofylaktopoulos V, Mitsios A, Houston S, Hagag AM, Dubis AM, Moosajee M. Investigating Biomarkers for USH2A Retinopathy Using Multimodal Retinal Imaging. Int J Mol Sci 2022; 23:ijms23084198. [PMID: 35457016 PMCID: PMC9024786 DOI: 10.3390/ijms23084198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 12/13/2022] Open
Abstract
Pathogenic mutations in USH2A are a leading cause of visual loss secondary to non-syndromic or Usher syndrome-associated retinitis pigmentosa (RP). With an increasing number of RP-targeted clinical trials in progress, we sought to evaluate the photoreceptor topography underlying patterns of loss observed on clinical retinal imaging to guide surrogate endpoint selection in USH2A retinopathy. In this prospective cross-sectional study, twenty-five patients with molecularly confirmed USH2A-RP underwent fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT) and adaptive optics scanning laser ophthalmoscopy (AOSLO) retinal imaging. Analysis comprised measurement of FAF horizontal inner (IR) and outer (OR) hyperautofluorescent ring diameter; SD-OCT ellipsoid zone (EZ) and external limiting membrane (ELM) width, normalised EZ reflectance; AOSLO foveal cone density and intact macular photoreceptor mosaic (IMPM) diameter. Thirty-two eyes from 16 patients (mean age ± SD, 36.0 ± 14.2 years) with USH2A-associated Usher syndrome type 2 (n = 14) or non-syndromic RP (n = 2) met the inclusion criteria. Spatial alignment was observed between IR-EZ and OR-ELM diameters/widths (p < 0.001). The IMPM border occurred just lateral to EZ loss (p < 0.001), although sparser intact photoreceptor inner segments were detected until ELM disruption. EZ width and IR diameter displayed a biphasic relationship with cone density whereby slow cone loss occurred until retinal degeneration reached ~1350 μm from the fovea, beyond which greater reduction in cone density followed. Normalised EZ reflectance and cone density were significantly associated (p < 0.001). As the strongest correlate of cone density (p < 0.001) and best-corrected visual acuity (p < 0.001), EZ width is the most sensitive biomarker of structural and functional decline in USH2A retinopathy, rendering it a promising trial endpoint.
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Affiliation(s)
- Jasdeep S. Gill
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (J.S.G.); (V.T.); (A.M.); (S.H.); (A.M.H.); (A.M.D.)
| | - Vasileios Theofylaktopoulos
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (J.S.G.); (V.T.); (A.M.); (S.H.); (A.M.H.); (A.M.D.)
| | - Andreas Mitsios
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (J.S.G.); (V.T.); (A.M.); (S.H.); (A.M.H.); (A.M.D.)
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Sarah Houston
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (J.S.G.); (V.T.); (A.M.); (S.H.); (A.M.H.); (A.M.D.)
| | - Ahmed M. Hagag
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (J.S.G.); (V.T.); (A.M.); (S.H.); (A.M.H.); (A.M.D.)
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Adam M. Dubis
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (J.S.G.); (V.T.); (A.M.); (S.H.); (A.M.H.); (A.M.D.)
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
- Global Business School for Health, University College London, London WC1E 6BT, UK
| | - Mariya Moosajee
- Institute of Ophthalmology, University College London, London EC1V 9EL, UK; (J.S.G.); (V.T.); (A.M.); (S.H.); (A.M.H.); (A.M.D.)
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- Correspondence: ; Tel.: +44-207-608-6971
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33
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Morgan JIW, Jiang YY, Vergilio GK, Serrano LW, Pearson DJ, Bennett J, Maguire AM, Aleman TS. Short-term Assessment of Subfoveal Injection of Adeno-Associated Virus-Mediated hCHM Gene Augmentation in Choroideremia Using Adaptive Optics Ophthalmoscopy. JAMA Ophthalmol 2022; 140:411-420. [PMID: 35266957 PMCID: PMC8914909 DOI: 10.1001/jamaophthalmol.2022.0158] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Subretinal injection for gene augmentation in retinal degenerations forcefully detaches the neural retina from the retinal pigment epithelium, potentially damaging photoreceptors and/or retinal pigment epithelium cells. Objective To use adaptive optics scanning light ophthalmoscopy (AOSLO) to assess the short-term integrity of the cone mosaic following subretinal injections of adeno-associated virus vector designed to deliver a functional version of the CHM gene (AAV2-hCHM) in patients with choroideremia. Design, Setting, and Participants This longitudinal case series study enrolled adult patients with choroideremia from February 2015 to January 2016 in the US. To be included in the study, study participants must have received uniocular subfoveal injections of low-dose (5 × 1010 vector genome per eye) or high-dose (1 × 1011 vector genome per eye) AAV2-hCHM. Analysis began February 2015. Main Outcomes and Measures The macular regions of both eyes were imaged before and 1 month after injection using a custom-built multimodal AOSLO. Postinjection cone inner segment mosaics were compared with preinjection mosaics at multiple regions of interest. Colocalized spectral-domain optical coherence tomography and dark-adapted cone sensitivity was also acquired at each time point. Results Nine study participants ranged in age from 26 to 50 years at the time of enrollment, and all were White men. Postinjection AOSLO images showed preservation of the cone mosaic in all 9 AAV2-hCHM-injected eyes. Mosaics appeared intact and contiguous 1 month postinjection, with the exception of foveal disruption in 1 patient. Optical coherence tomography showed foveal cone outer segment shortening postinjection. Cone-mediated sensitivities were unchanged in 8 of 9 injected and 9 of 9 uninjected eyes. One participant showed acute loss of foveal optical coherence tomography cone outer segment-related signals along with cone sensitivity loss that colocalized with disruption of the mosaic on AOSLO. Conclusions and Relevance Integrity of the cone mosaic is maintained following subretinal delivery of AAV2-hCHM, providing strong evidence in support of the safety of the injections. Minor foveal thinning observed following surgery corresponds with short-term cone outer segment shortening rather than cone cell loss. Foveal cone loss in 1 participant raises the possibility of individual vulnerability to the subretinal injection.
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Affiliation(s)
- Jessica I W Morgan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Yu You Jiang
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Grace K Vergilio
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Leona W Serrano
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Denise J Pearson
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Jean Bennett
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Albert M Maguire
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Tomas S Aleman
- Scheie Eye Institute, University of Pennsylvania, Philadelphia.,Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
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Migacz JV, Otero-Marquez O, Zhou R, Rickford K, Murillo B, Zhou DB, Castanos MV, Sredar N, Dubra A, Rosen RB, Chui TYP. Imaging of vitreous cortex hyalocyte dynamics using non-confocal quadrant-detection adaptive optics scanning light ophthalmoscopy in human subjects. BIOMEDICAL OPTICS EXPRESS 2022; 13:1755-1773. [PMID: 35414987 PMCID: PMC8973177 DOI: 10.1364/boe.449417] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/20/2022] [Accepted: 02/20/2022] [Indexed: 05/06/2023]
Abstract
Vitreous cortex hyalocytes are resident macrophage cells that help maintain the transparency of the media, provide immunosurveillance, and respond to tissue injury and inflammation. In this study, we demonstrate the use of non-confocal quadrant-detection adaptive optics scanning light ophthalmoscopy (AOSLO) to non-invasively visualize the movement and morphological changes of the hyalocyte cell bodies and processes over 1-2 hour periods in the living human eye. The average velocity of the cells 0.52 ± 0.76 µm/min when sampled every 5 minutes and 0.23 ± 0.29 µm/min when sampled every 30 minutes, suggesting that the hyalocytes move in quick bursts. Understanding the behavior of these cells under normal physiological conditions may lead to their use as biomarkers or suitable targets for therapy in eye diseases such as diabetic retinopathy, preretinal fibrosis and glaucoma.
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Affiliation(s)
- Justin V. Migacz
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Oscar Otero-Marquez
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Rebecca Zhou
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Kara Rickford
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Brian Murillo
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Davis B. Zhou
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Maria V. Castanos
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Nripun Sredar
- Department of Ophthalmology, Stanford University, Palo Alto, CA 94303, USA
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, CA 94303, USA
| | - Richard B. Rosen
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Toco Y. P. Chui
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
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35
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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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36
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Condor Montes SY, Bennett D, Bensinger E, Rani L, Sherkat Y, Zhao C, Helft Z, Roorda A, Green AJ, Sheehy CK. Characterizing Fixational Eye Motion Variance Over Time as Recorded by the Tracking Scanning Laser Ophthalmoscope. Transl Vis Sci Technol 2022; 11:35. [PMID: 35201339 PMCID: PMC8883154 DOI: 10.1167/tvst.11.2.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to characterize the benign biological variance of fixational microsaccades in a control population using a tracking scanning laser ophthalmoscope (TSLO), accounting for machine accuracy and precision, to determine ideal testing conditions to detect pathologic change in fixational eye motion (FEM). Methods We quantified the accuracy and precision of the TSLO, analyzing measurements made by three operators on a model eye. Repeated, 10-second retinal motion traces were then recorded in 17 controls, 3 times a day (morning, afternoon, and evening), on 3 separate days. Microsaccade metrics (MMs) of frequency, average amplitude, peak velocity, and peak acceleration were extracted. Trace to trace, interday, and intraday variability were calculated across all subjects. Results Intra-operator and machine variation contributed minimally to total variation, with only 0.007% and 0.14% contribution for frequency and amplitude respectively. Bias was detected, with lower accuracy for higher amplitudes. Participants had an average (SD) microsaccade frequency of 0.84 Hz (0.52 Hz), amplitude of 0.32 degrees (0.11 degrees), peak velocity of 43.68 degrees/s (14.02 degrees/s), and peak acceleration of 13,920.04 degrees/s2 (4,186.84 degrees/s2). The first trace recorded within a session significantly differed from the second two in both microsaccade acceleration and velocity (P < 0.05), and frequency was 0.098 Hz higher in the evenings (P < 0.05). There was no MM difference between days and no evidence of a session-level learning effect (P > 0.05). Conclusions The TSLO is both accurate and precise. However, biological inter- and intra-individual variance is present. Trace to trace variability and time of day should be accounted for to optimize detection of pathologic change.
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Affiliation(s)
| | - Daniel Bennett
- University of California - San Francisco, Department of Neurology, San Francisco, CA, USA
| | - Ethan Bensinger
- University of California Berkeley, Vision Science Graduate Group, Berkeley, CA, USA.,University of California Berkeley, School of Optometry, Berkeley, CA, USA
| | - Lakshmisahithi Rani
- University of California - San Francisco, Department of Neurology, San Francisco, CA, USA
| | - Younes Sherkat
- University of California Berkeley, College of Engineering, Berkeley, CA, USA
| | - Chao Zhao
- University of California - San Francisco, Department of Neurology, San Francisco, CA, USA
| | | | - Austin Roorda
- University of California Berkeley, Vision Science Graduate Group, Berkeley, CA, USA.,University of California Berkeley, School of Optometry, Berkeley, CA, USA
| | - Ari J Green
- University of California - San Francisco, Department of Neurology, San Francisco, CA, USA.,University of California - San Francisco, Department of Ophthalmology, San Francisco, CA, USA
| | - Christy K Sheehy
- University of California - San Francisco, Department of Neurology, San Francisco, CA, USA.,C. Light Technologies, Inc. Berkeley, CA, USA
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37
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Langlo CS, Trotter A, Reddi HV, Schilter KF, Tyler RC, Udani R, Neitz M, Carroll J, Connor TB. Long-term retinal imaging of a case of suspected congenital rubella infection. Am J Ophthalmol Case Rep 2022; 25:101241. [PMID: 34977425 PMCID: PMC8688893 DOI: 10.1016/j.ajoc.2021.101241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/16/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Many retinal disorders present with pigmentary retinopathy, most of which are progressive conditions. Here we present over nine years of follow up on a case of stable pigmentary retinopathy that is suspected to stem from a congenital rubella infection. Parafoveal cone photoreceptors were tracked through this period to gain insight into photoreceptor disruption in this pigmentary retinopathy. Methods The patient was examined at 8 visits spanning a total of 111 months. Examination at baseline included clinical fundus examination, full-field electroretinography (ERG), kinetic visual field assessment (Goldmann), and best corrected visual acuity; all of these except ERG were repeated at follow up visits. Imaging was performed with fundus photography, spectral-domain optical coherence tomography (SD-OCT) and confocal adaptive optics scanning light ophthalmoscopy (AOSLO). For the latter four time points AOSLO imaging also included split-detector imaging. Results There were no defects in hearing or cardiac health found in this patient. There were minimal visual deficits found at baseline, with mild rod suppression on ERG; best corrected visual acuity was 20/25 OD and 20/20 OS at baseline, which was stable throughout the follow-up period. Retinal thickness as measured by OCT was within the normal range, though foveal hypoplasia was present and outer nuclear layer thickness was slightly below the normal range at all time points. Cone density was relatively stable throughout the follow-up period. A number of cones were non-reflective when observed with confocal AOSLO imaging and density was markedly lower than expected values (foveal cone density was 43,782 cones/mm2 on average). Genetic analysis revealed no causative variations explaining the phenotype. Conclusions and Importance This patient appears to have a stable pigmentary retinopathy. This case is likely due to a congenital insult, rather than progressive retinal disease. This finding of stability agrees with other reports of rubella pigmentary retinopathy. Imaging with AOSLO enabled observation of two notable phenotypic features. First is the observation of dark cones, which are seen in many retinal disorders including color vision defects and degenerative retinal disease. Second, the cone density is well below what is expected – this is especially interesting as this patient has near-normal visual acuity despite this greatly decreased number of normally-waveguiding cones in the fovea.
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Affiliation(s)
- Christopher S Langlo
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alana Trotter
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA
| | - Honey V Reddi
- Precision Medicine Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kala F Schilter
- Precision Medicine Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebecca C Tyler
- Precision Medicine Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rupa Udani
- Precision Medicine Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maureen Neitz
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Joseph Carroll
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas B Connor
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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38
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Kowalski B, Akondi V, Dubra A. Correction of non-uniform angular velocity and sub-pixel jitter in optical scanning. OPTICS EXPRESS 2022; 30:112-124. [PMID: 35201185 PMCID: PMC8970701 DOI: 10.1364/oe.446162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 05/08/2023]
Abstract
Optical scanners are widely used in high-resolution scientific, medical, and industrial devices. The accuracy and precision of these instruments are often limited by angular speed fluctuations due to rotational inertia and by poor synchronization between scanning and light detection, respectively. Here we demonstrate that both problems can be mitigated by recording scanner orientation in synchrony with light detection, followed by data resampling. This approach is illustrated with synthetic and experimental data from a point-scanning microscope with a resonant scanner and a non-resonant scanner. Fitting of the resonant scanner orientation data to a cosine model was used to correct image warping and sampling jitter, as well as to precisely interleave image lines collected during the clockwise and counterclockwise resonant scanner portions of the rotation cycle. Vertical scanner orientation data interpolation was used to correct image distortion due to angular speed fluctuations following abrupt control signal changes.
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Affiliation(s)
| | - Vyas Akondi
- 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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39
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Akondi V, Kowalski B, Dubra A. Dynamic wavefront distortion in resonant scanners. APPLIED OPTICS 2021; 60:11189-11195. [PMID: 35201107 PMCID: PMC8887785 DOI: 10.1364/ao.443972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/13/2021] [Indexed: 06/14/2023]
Abstract
Dynamic mirror deformation can substantially degrade the performance of optical instruments using resonant scanners. Here, we evaluate two scanners with resonant frequencies >12kHz with low dynamic distortion. First, we tested an existing galvanometric motor with a novel, to the best of our knowledge, mirror substrate material, silicon carbide, which resonates at 13.8 kHz. This material is stiffer than conventional optical glasses and has lower manufacturing toxicity than beryllium, the stiffest material currently used for this application. Then, we tested a biaxial microelectromechanical (MEMS) scanner with the resonant axis operating at 29.4 kHz. Dynamic deformation measurements show that wavefront aberrations in the galvanometric scanner are dominated by linear oblique astigmatism (90%), while wavefront aberrations in the MEMS scanner are dominated by horizontal coma (30%) and oblique trefoil (27%). In both scanners, distortion amplitude increases linearly with deflection angle, yielding diffraction-limited performance over half of the maximum possible deflection for wavelengths longer than 450 nm and over the full deflection range for wavelengths above 850 nm. Diffraction-limited performance for shorter wavelengths or over larger fractions of the deflection range can be achieved by reducing the beam diameter at the mirror surface. The small dynamic distortion of the MEMS scanner offers a promising alternative to galvanometric resonant scanners with desirable but currently unattainably high resonant frequencies.
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40
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Tang EM, Tao YK. Modeling and optimization of galvanometric point-scanning temporal dynamics. BIOMEDICAL OPTICS EXPRESS 2021; 12:6701-6716. [PMID: 34858675 PMCID: PMC8606146 DOI: 10.1364/boe.430586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 05/02/2023]
Abstract
Galvanometers are ubiquitous in point-scanning applications in optical imaging, display, ranging, manufacturing, and therapeutic technologies. However, galvanometer performance is constrained by finite response times related to mirror size and material properties. We present a model-driven approach for optimizing galvanometer response characteristics by tuning the parameters of the closed-loop galvanometer controller and demonstrate settling time reduction by over 50%. As an imaging proof-of-concept, we implement scan waveforms that take advantage of the optimized galvanometer frequency response to increase linear field-of-view, signal-to-noise ratio, contrast-to-noise ratio, and speed. The hardware methods presented may be directly implemented on galvanometer controllers without the need for specialized equipment and used in conjunction with customized scan waveforms to further optimize scanning performance.
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41
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Heitkotter H, Salmon A, Linderman R, Porter J, Carroll J. Theoretical versus empirical measures of retinal magnification for scaling AOSLO images. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2021; 38:1400-1408. [PMID: 34612970 PMCID: PMC8647682 DOI: 10.1364/josaa.435917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The adaptive optics scanning light ophthalmoscope (AOSLO) allows cellular resolution imaging of the living retina. The accuracy of many quantitative measurements made from these images requires accurate estimates of the lateral scale of the images. Here, we used trial lenses, which are known to affect the relative magnification of the retinal image, to compare empirical measures of image scale with theoretical estimates from a four-surface optical model. The theoretical optical model overestimated the empirically determined change in image scale in 70% of the subjects examined, albeit to varying degrees. While the origin for the differences between subjects is not known, residual accommodation during imaging likely contributes to this variability in retinal magnification. These data provide an opportunity to derive improved lateral scaling error estimates for structural metrics extracted from AOSLO retinal images.
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Affiliation(s)
- H. Heitkotter
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - A.E. Salmon
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
- Translational Imaging Innovations, Inc., 112 Mariners Point Ln. Hickory, NC 28601, USA
| | - R.E. Linderman
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - J. Porter
- College of Optometry, University of Houston, 4901 Calhoun Rd, Houston, TX 77204, USA
| | - J. Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, 925 N 87th St, Milwaukee, WI 53226, USA
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42
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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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Gaffney M, Cooper RF, Cava JA, Follett HM, Salmon AE, Freling S, Yu CT, Merriman DK, Carroll J. Cone photoreceptor reflectance variation in the northern tree shrew and thirteen-lined ground squirrel. Exp Biol Med (Maywood) 2021; 246:2192-2201. [PMID: 34308656 DOI: 10.1177/15353702211029582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In vivo images of human cone photoreceptors have been shown to vary in their reflectance both spatially and temporally. While it is generally accepted that the unique anatomy and physiology of the photoreceptors themselves drives this behavior, the exact mechanisms have not been fully elucidated as most studies on these phenomena have been limited to the human retina. Unlike humans, animal models offer the ability to experimentally manipulate the retina and perform direct in vivo and ex vivo comparisons. The thirteen-lined ground squirrel and northern tree shrew are two emerging animal models being used in vision research. Both models feature cone-dominant retinas, overcoming a key limitation of traditional rodent models. Additionally, each possesses unique but well-documented anatomical differences in cone structure compared to human cones, which can be leveraged to further constrain theoretical models of light propagation within photoreceptors. Here we sought to characterize the spatial and temporal reflectance behavior of cones in these species. Adaptive optics scanning light ophthalmoscopy (AOSLO) was used to non-invasively image the photoreceptors of both species at 5 to 10 min intervals over the span of 18 to 25 min. The reflectance of individual cone photoreceptors was measured over time, and images at individual time points were used to assess the variability of cone reflectance across the cone mosaic. Variability in spatial and temporal photoreceptor reflectance was observed in both species, with similar behavior to that seen in human AOSLO images. Despite the unique cone structure in these animals, these data suggest a common origin of photoreceptor reflectance behavior across species. Such data may help constrain models of the cellular origins of photoreceptor reflectance signals. These animal models provide an experimental platform to further explore the morphological origins of light capture and propagation.
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Affiliation(s)
- Mina Gaffney
- Department of Ophthalmology & Visual Sciences, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Robert F Cooper
- Department of Ophthalmology & Visual Sciences, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA.,Department of Biomedical Engineering, 5505Marquette University, Milwaukee, WI 53233, USA
| | - Jenna A Cava
- Department of Ophthalmology & Visual Sciences, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Hannah M Follett
- Department of Ophthalmology & Visual Sciences, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Alexander E Salmon
- Department of Cell Biology, Neurobiology, & Anatomy, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA.,Translational Imaging Innovations, Inc., Hickory, NC 28601, USA
| | - Susan Freling
- 164174Max Planck Florida Institute for Neuroscience, Jupiter, FL 33458, USA
| | - Ching T Yu
- Department of Cell Biology, Neurobiology, & Anatomy, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dana K Merriman
- Department of Biology, 14752University of Wisconsin Oshkosh, Oshkosh, WI 54901, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA.,Department of Biomedical Engineering, 5505Marquette University, Milwaukee, WI 53233, USA.,Department of Cell Biology, Neurobiology, & Anatomy, 5506Medical College of Wisconsin, Milwaukee, WI 53226, USA
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44
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Litts KM, Woertz EN, Wynne N, Brooks BP, Chacon A, Connor TB, Costakos D, Dumitrescu A, Drack AV, Fishman GA, Hauswirth WW, Kay CN, Lam BL, Michaelides M, Pennesi ME, Stepien KE, Strul S, Summers CG, Carroll J. Examining Whether AOSLO-Based Foveal Cone Metrics in Achromatopsia and Albinism Are Representative of Foveal Cone Structure. Transl Vis Sci Technol 2021; 10:22. [PMID: 34111268 PMCID: PMC8132001 DOI: 10.1167/tvst.10.6.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Adaptive optics scanning light ophthalmoscopy (AOSLO) imaging in patients with achromatopsia (ACHM) and albinism is not always successful. Here, we tested whether optical coherence tomography (OCT) measures of foveal structure differed between patients for whom AOSLO images were either quantifiable or unquantifiable. Methods The study included 166 subjects (84 with ACHM; 82 with albinism) with previously acquired OCT scans, AOSLO images, and best-corrected visual acuity (BCVA, if available). Foveal OCT scans were assessed for outer retinal structure, outer nuclear layer thickness, and hypoplasia. AOSLO images were graded as quantifiable if a peak cone density could be measured and/or usable if the location of peak density could be identified and the parafoveal mosaic was quantifiable. Results Forty-nine percent of subjects with ACHM and 57% of subjects with albinism had quantifiable AOSLO images. Older age and better BCVA were found in subjects with quantifiable AOSLO images for both ACHM (P = 0.0214 and P = 0.0276, respectively) and albinism (P = 0.0073 and P < 0.0004, respectively). There was a significant trend between ellipsoid zone appearance and ability to quantify AOSLO (P = 0.0028). In albinism, OCT metrics of cone structure did not differ between groups. Conclusions Previously reported AOSLO-based cone density measures in ACHM may not necessarily reflect the degree of remnant cone structure in these patients. Translational Relevance Until AOSLO is successful in all patients with ACHM and albinism, the possibility of the reported data from a particular cohort not being representative of the entire population remains an important issue to consider when interpreting results from AOSLO studies.
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Affiliation(s)
- Katie M Litts
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erica N Woertz
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.,School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Niamh Wynne
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Alicia Chacon
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas B Connor
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Deborah Costakos
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alina Dumitrescu
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Arlene V Drack
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Gerald A Fishman
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kimberly E Stepien
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Sasha Strul
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - C Gail Summers
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
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45
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Retinal alterations in patients with Lafora disease. Am J Ophthalmol Case Rep 2021; 23:101146. [PMID: 34195479 PMCID: PMC8239732 DOI: 10.1016/j.ajoc.2021.101146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 06/12/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Lafora disease is a genetic neurodegenerative metabolic disorder caused by insoluble polyglucosan aggregate accumulation throughout the central nervous system and body. The retina is an accessible neural tissue, which may offer alternative methods to assess neurological diseases quickly and noninvasively. In this way, noninvasive imaging may provide a means to characterize neurodegenerative disease, which enables earlier identification and diagnosis of disease and the ability to monitor disease progression. In this study, we sought to characterize the retina of individuals with Lafora disease using non-invasive retinal imaging. Methods One eye of three individuals with genetically confirmed Lafora disease were imaged with optical coherence tomography (OCT) and adaptive optics scanning light ophthalmoscopy (AOSLO). When possible, OCT volume and line scans were acquired to assess total retinal thickness, ganglion cell-inner plexiform layer thickness, and outer nuclear layer + Henle fiber layer thickness. OCT angiography (OCTA) scans were acquired in one subject at the macula and optic nerve head (ONH). AOSLO was used to characterize the photoreceptor mosaic and examine the retinal nerve fiber layer (RNFL). Results Two subjects with previous seizure activity demonstrated reduced retinal thickness, while one subject with no apparent symptoms had normal retinal thickness. All other clinical measures, as well as parafoveal cone density, were within normal range. Nummular reflectivity at the level of the RNFL was observed using AOSLO in the macula and near the ONH in all three subjects. Conclusions This multimodal retinal imaging approach allowed us to observe a number of retinal structural features in all three individuals. Most notably, AOSLO revealed nummular reflectivity within the inner retina of each subject. This phenotype has not been reported previously and may represent a characteristic change produced by the neurodegenerative process.
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Abstract
The high power of the eye and optical components used to image it result in "static" distortion, remaining constant across acquired retinal images. In addition, raster-based systems sample points or lines of the image over time, suffering from "dynamic" distortion due to the constant motion of the eye. We recently described an algorithm which corrects for the latter problem but is entirely blind to the former. Here, we describe a new procedure termed "DIOS" (Dewarp Image by Oblique Shift) to remove static distortion of arbitrary type. Much like the dynamic correction method, it relies on locating the same tissue in multiple frames acquired as the eye moves through different gaze positions. Here, the resultant maps of pixel displacement are used to form a sparse system of simultaneous linear equations whose solution gives the common warp seen by all frames. We show that the method successfully handles torsional movement of the eye. We also show that the output of the previously described dynamic correction procedure may be used as input for this new procedure, recovering an image of the tissue that is, in principle, a faithful replica free of any type of distortion. The method could be extended beyond ocular imaging, to any kind of imaging system in which the image can move or be made to move across the detector.
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Affiliation(s)
- Phillip Bedggood
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Andrew Metha
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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47
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Salmon AE, Cooper RF, Chen M, Higgins B, Cava JA, Chen N, Follett HM, Gaffney M, Heitkotter H, Heffernan E, Schmidt TG, Carroll J. Automated image processing pipeline for adaptive optics scanning light ophthalmoscopy. BIOMEDICAL OPTICS EXPRESS 2021; 12:3142-3168. [PMID: 34221651 PMCID: PMC8221964 DOI: 10.1364/boe.418079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 06/11/2023]
Abstract
To mitigate the substantial post-processing burden associated with adaptive optics scanning light ophthalmoscopy (AOSLO), we have developed an open-source, automated AOSLO image processing pipeline with both "live" and "full" modes. The live mode provides feedback during acquisition, while the full mode is intended to automatically integrate the copious disparate modules currently used in generating analyzable montages. The mean (±SD) lag between initiation and montage placement for the live pipeline was 54.6 ± 32.7s. The full pipeline reduced overall human operator time by 54.9 ± 28.4%, with no significant difference in resultant cone density metrics. The reduced overhead decreases both the technical burden and operating cost of AOSLO imaging, increasing overall clinical accessibility.
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Affiliation(s)
- Alexander E. Salmon
- Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Translational Imaging Innovations, Inc., Hickory, NC 28601, USA
| | - Robert F. Cooper
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53233, USA
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Min Chen
- Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Higgins
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Jenna A. Cava
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Nickolas Chen
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Hannah M. Follett
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Mina Gaffney
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Heather Heitkotter
- Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Elizabeth Heffernan
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Taly Gilat Schmidt
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53233, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53233, USA
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA
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48
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Muthiah MN, Kalitzeos A, Oprych K, Singh N, Georgiou M, Wright GA, Robson AG, Arno G, Khan K, Michaelides M. Novel disease-causing variant in RDH12 presenting with autosomal dominant retinitis pigmentosa. Br J Ophthalmol 2021; 106:1274-1281. [PMID: 34031043 PMCID: PMC9411907 DOI: 10.1136/bjophthalmol-2020-318034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/06/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022]
Abstract
Aim To describe the clinical and molecular features of a novel, autosomal dominant RDH12-retinopathy. Methods Retrospective cross-sectional study. Twelve individuals from a four-generation British pedigree underwent ophthalmic examination, genotyping using next generation sequencing, including whole genome sequencing and multimodal retinal imaging including fundus photography, optical coherence tomography (OCT), autofluorescence imaging and adaptive optics (AO) scanning light ophthalmoscopy were performed. Visual electrophysiology was performed in a subset. Results Eight family members were confirmed as affected by genotyping heterozygous for RDH12 c.763delG. Visual acuity ranged from −0.1 to 0.2 logMAR. Affected individuals had constricted visual fields. A parafoveal and peripapillary ring of hyper-autofluorescence was seen initially, and with progression the area of perifoveal hypo-autofluorescence increased to involve the parafoveal area. Mild retinal thinning was identified on OCT imaging with reduction in both foveal total retinal and outer nuclear layer thickness. Cone densities along the temporal meridian were reduced in affected individuals compared with normative values at all temporal eccentricities studied. One individual with incomplete penetrance, was identified as clinically affected primarily on the basis of AO imaging. Full-field electroretinography demonstrated a rod-cone pattern of dysfunction and large-field pattern electroretinography identified peripheral macular dysfunction. Conclusions This novel heterozygous variant RDH12 c.763delG is associated with a rod-cone dystrophy with variable expression. Determination of the degree of penetrance may depend on the modality employed to phenotypically characterise an individual. This rare and specific heterozygous (dominant) variant is predicted to result in a gain of function, that causes disease in a gene typically associated with biallelic (recessive) variants.
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Affiliation(s)
- Manickam Nick Muthiah
- Cell and Gene Therapy, University College London Institute of Ophthalmology, London, UK .,Vitreoretinal Research, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Angelos Kalitzeos
- Cell and Gene Therapy, University College London Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Kate Oprych
- Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Navjit Singh
- Cell and Gene Therapy, University College London Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michalis Georgiou
- Cell and Gene Therapy, University College London Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Genevieve Ann Wright
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, Greater London, UK
| | - Anthony G Robson
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, Greater London, UK.,Electrophysiology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gavin Arno
- Cell and Gene Therapy, University College London Institute of Ophthalmology, London, UK.,Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Kamron Khan
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Ophthalmology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Michel Michaelides
- Cell and Gene Therapy, University College London Institute of Ophthalmology, London, UK .,Moorfields Eye Hospital NHS Foundation Trust, London, UK
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49
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Cava JA, Allphin MT, Mastey RR, Gaffney M, Linderman RE, Cooper RF, Carroll J. Assessing Interocular Symmetry of the Foveal Cone Mosaic. Invest Ophthalmol Vis Sci 2021; 61:23. [PMID: 33331861 PMCID: PMC7746960 DOI: 10.1167/iovs.61.14.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose To test the hypothesis that foveal cone topography is symmetrical between contralateral eyes. Methods We used adaptive optics scanning light ophthalmoscopy to acquire images of the foveal cone mosaic in each eye of 58 subjects with normal vision (35 female, 23 male). Cones were semiautomatically identified over a 300 × 300-µm foveal area. From these cone coordinates, maps of cone density were derived, and we extracted estimates of peak cone density from each map. Mosaic regularity was assessed using Voronoi cell area regularity (VCAR). Average roundness and average area of the 70%, 75%, 80%, 85%, and 90% of peak density isodensity contours were evaluated. Results The average peak cone density for right eyes was 180,286 cones/mm2 (n = 49) and for left eyes was 182,397 cones/mm2 (n = 45), with a mean absolute difference of 6363 cones/mm2 (n = 43). Peak density, cone spacing, VCAR, and average area within the isodensity contours of fellow eyes were not significantly different (P = 0.60, P = 0.83, P = 0.30, and P = 0.39, respectively). However, the average roundness of the isodensity contours was 2% more circular in the right eyes than in the left eyes (P = 0.02). Conclusions There is interocular symmetry of peak foveal cone density, mosaic regularity, and area encompassing the most densely packed cells in subjects with normal vision. The origin and significance of the observed interocular difference in average roundness of the isodensity contours are unclear.
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Affiliation(s)
- Jenna A Cava
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Mitchell T Allphin
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Rebecca R Mastey
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Mina Gaffney
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Rachel E Linderman
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Robert F Cooper
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States.,Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph Carroll
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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50
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Huang X, Dubra A. Correction of resonant optical scanner dynamic aberrations using nodal aberration theory. OPTICS EXPRESS 2021; 29:10346-10363. [PMID: 33820171 PMCID: PMC8237933 DOI: 10.1364/oe.414405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
The rapid oscillation of galvanometric resonant optical scanners introduces linear astigmatism that degrades transverse resolution, and in confocal systems, also reduces signal [V. Akondi et al., Optica 7, 1506, 2020]. Here, we demonstrate correction of this aberration by tilting reflective or refractive optical elements for a single vergence or a vergence range, with and without the use of an adaptive wavefront corrector such as a deformable mirror. The approach, based on nodal aberration theory, can generate any desired third order aberration that results from tilting or decentering optical surfaces.
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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, California 94303, USA
| | - Alfredo Dubra
- Byers Eye Institute, Stanford University, Palo Alto, California 94303, USA
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