In vivo evaluation of human skin anisotropy by polarization-sensitive optical coherence tomography

Advanced function, design and application of skin substitutes for skin regeneration

The development of skin substitutes aims to replace, mimic, or improve the functions of human skin, regenerate damaged skin tissue, and replace or enhance skin function. This includes artificial skin, scaffolds or devices designed for treatment, imitation, or improvement of skin function in wounds and injuries. Therefore, tremendous efforts have been made to develop functional skin substitutes. However, there is still few reports systematically discuss the relationship between the advanced function and design requirements. In this paper, we review the classification, functions, and design requirements of artificial skin or skin substitutes. Different manufacturing strategies for skin substitutes such as hydrogels, 3D/4D printing, electrospinning, microfluidics are summarized. This review also introduces currently available skin substitutes in clinical trials and on the market and the related regulatory requirements. Finally, the prospects and challenges of skin substitutes in the field of tissue engineering are discussed.

Anisotropic mechanical characterization of human skin by in vivo multi-axial ring suction test

Human skin is a soft tissue behaving as an anisotropic material. The anisotropy emerges from the alignment of collagen fibers in the dermis, which causes the skin to exhibit greater stiffness in a certain direction, known as Langer's line. The importance of determining this anisotropy axis lies in assisting surgeons in making incisions that do not produce undesirable scars. In this paper, we introduce an open-source numerical framework, MARSAC (Multi-Axial Ring Suction for Anisotropy Characterization: https://github.com/aflahelouneg/MARSAC), adapted to a commercial device CutiScan CS 100® that applies a suction load on an annular section, causing a multi-axial stretch in the central zone, where in-plane displacements are captured by a camera. The presented framework receives inputs from a video file and converts them into displacement fields through Digital Image Correlation (DIC) technique. From the latter and based on an analytical model, the method assesses the anisotropic material parameters of human skin: Langer's line ϕ, and the elastic moduli E₁ and E₂ along the principal axes, providing that the Poisson's ratio is fixed. The pipeline was applied to a public data repository, https://search-data.ubfc.fr/femto/FR-18008901306731-2021-08-25_In-vivo-skin-anisotropy-dataset-for-a-young-man.html, containing 30 test series performed on a forearm of a Caucasian subject. As a result, the identified parameter averages, ϕˆ=40.9±8.2^∘ and the anisotropy ratio E₁ˆ/E₂ˆ=3.14±1.60, were in accordance with the literature. The intra-subject analysis showed a reliable assessment of ϕ and E₂. As skin anisotropy varies from site to site and from subject to subject, the novelty of the method consists in (i) an optimal utilization of CutiScan CS 100® probe to measure the Langer's line accurately and rapidly on small areas with a minimum diameter of 14mm, (ii) validation of an analytical model based on deformation ellipticity.

The multiscale characterization and constitutive modeling of healthy and type 2 diabetes mellitus Sprague Dawley rat skin

In type 2 diabetes mellitus (T2DM), elevated glucose level impairs the biochemistry of the skin which may result in alteration of its mechanical and structural properties. The several aspects of structural and mechanical changes in skin due to T2DM remain poorly understood. To fill these research gaps, we developed a non-obese T2DM rat (Sprague Dawley (SD)) model for investigating the effect of T2DM on the in vivo strain stress state, mechanical and structural properties of skin. In vivo strain and mechanical anisotropy of healthy and T2DM skin were measured using the digital imaging correlation (DIC) technique and DIC coupled bulge experiment, respectively. Fluorescence microscopy and histology were used to assess the collagen and elastin fibers microstructure whereas nanoscale structure was captured through atomic force microscopy (AFM). Based on the microstructural observations, skin was modeled as a multilayer membrane where in and out of plane distribution of collagen fibers and planar distribution of elastin fibers were cast in constitutive model. Further, the state of in vivo stresses of healthy and T2DM were measured using model parameters and in vivo strain in the constitutive model. The results showed that T2DM causes significant loss in in vivo stresses (p < 0.01) and increase in anisotropy (p < 0.001) of skin. These changes were found in good correlation with T2DM associated alteration in skin microstructure. Statistical analysis emphasized that increase in blood glucose concentration (HbA1c) was the main cause of impaired biomechanical properties of skin. The presented data in this study can help to understand the skin pathology and to simulate the skin related clinical procedures. STATEMENT OF SIGNIFICANCE: Our study is significant as it presents findings related to the effect of T2DM on the physiologic stress strain, structural and mechanical response of SD rat skin. In this study, we developed a non-obese T2DM SD rat model which mimics the phenotype of Asian type 2 diabetics (non-obese). Several structural and mechanical characterization techniques were explored for multiscale characterization of healthy and T2DM skin. Further, based on microstructural information, we presented the constitutive models that incorporate the real microstructure of skin. The presented results can be helpful to simulate the realistic mechanical response of skin during various clinical trials.

Polarization sensitive optical coherence tomography with single input for imaging depth-resolved collagen organizations

Collagen organization plays an important role in maintaining structural integrity and determining tissue function. Polarization-sensitive optical coherence tomography (PSOCT) is a promising noninvasive three-dimensional imaging tool for mapping collagen organization in vivo. While PSOCT systems with multiple polarization inputs have demonstrated the ability to visualize depth-resolved collagen organization, systems, which use a single input polarization state have not yet demonstrated sufficient reconstruction quality. Herein we describe a PSOCT based polarization state transmission model that reveals the depth-dependent polarization state evolution of light backscattered within a birefringent sample. Based on this model, we propose a polarization state tracing method that relies on a discrete differential geometric analysis of the evolution of the polarization state in depth along the Poincare sphere for depth-resolved birefringent imaging using only one single input polarization state. We demonstrate the ability of this method to visualize depth-resolved myocardial architecture in both healthy and infarcted rodent hearts (ex vivo) and collagen structures responsible for skin tension lines at various anatomical locations on the face of a healthy human volunteer (in vivo).

Engineering Bioactive Scaffolds for Skin Regeneration

Large skin wounds pose a major clinical challenge. Scarcity of donor site and postsurgical scarring contribute to the incomplete or partial loss of function and aesthetic concerns in skin wound patients. Currently, a wide variety of skin grafts are being applied in clinical settings. Scaffolds are used to overcome the issues related to the misaligned architecture of the repaired skin tissues. The current review summarizes the contribution of biomaterials to wound healing and skin regeneration and addresses the existing limitations in skin grafting. Then, the clinically approved biologic and synthetic skin substitutes are extensively reviewed. Next, the techniques for modification of skin grafts aiming for enhanced tissue regeneration are outlined, and a summary of different growth factor delivery systems using biomaterials is presented. Considering the significant progress in biomaterial science and manufacturing technologies, the idea of biomaterial-based skin grafts with the ability for scarless wound healing and reconstructing full skin organ is more achievable than ever.

Orthogonal-polarization-gating optical coherence tomography for human sweat ducts in vivo

We propose an orthogonal-polarization-gating optical coherence tomography (OPG-OCT) for human sweat ducts in vivo. OPG-OCT is composed of the orthogonal linearly polarized light of a sample arm individually interfering with orthogonal linearly polarized lights of the reference arms, where OPG-OCT induces two images, one reflecting the projection intensity and the other the horizontal linear diattenuation (HLD). The results demonstrate that OPG-OCT projection intensity could improve the image quality of sweat ducts. HLD also clearly illustrates the spiral shape of the sweat ducts. Finally, sweat ducts in intensity image are segmented by employing convolutional neural networks (CNN). The proportions of left-handed and right-handed ducts are extracted to characterize the sweat ducts based on HLD. Therefore, the OPG-OCT technique employing CNN for the human sweat glands has the potential to automatically identify the human sweat ducts in vivo.

Collagen Hydrolysate Prepared from Chicken By-Product as a Functional Polymer in Cosmetic Formulation

Chicken stomachs can be processed into collagen hydrolysate usable in cosmetic products. The aim of the study was to verify the effects of a carbopol gel formulation enriched with 1.0% (w/w) chicken hydrolysate on the properties of the skin in the periorbital area after regular application twice a day for eight weeks in volunteers ageed 50 ± 9 years. Skin hydration, transepidermal water loss (TEWL), skin elasticity and skin relief were evaluated. Overall, skin hydration increased by 11.82% and 9.45%, TEWL decreased by 25.70% and 17.80% (always reported for the right and left area). Generally, there was an increase in skin elasticity, a decrease in skin roughness, as the resonance times decreased by 85%. The average reduction of wrinkles was 35.40% on the right and 41.20% on the left. For all results, it can be seen that the longer the cosmetic gel formulation is applied, the better the results. Due to the positive effect on the quality and functionality of the skin, it is possible to apply the cosmetic gel formulation in the periorbital area. The advantage of the product with chicken collagen hydrolysate is also the biocompatibility with the skin and the biodegradability of the formulation.

Attenuation corrected-optical coherence tomography for quantitative assessment of skin wound healing and scar morphology

Imaging the structural modifications of underlying tissues is vital to monitor wound healing. Optical coherence tomography (OCT) images high-resolution sub-surface information, but suffers a loss of intensity with depth, limiting quantification. Hence correcting the attenuation loss is important. We performed swept source-OCT of full-thickness excision wounds for 300 days in mice skin. We used single-scatter attenuation models to determine and correct the attenuation loss in the images. The phantom studies established the correspondence of corrected-OCT intensity (reflectivity) with matrix density and hydration. We histologically validated the corrected-OCT and measured the wound healing rate. We noted two distinct phases of healing-rapid and steady-state. We also detected two compartments in normal scars using corrected OCT that otherwise were not visible in the OCT scans. The OCT reflectivity in the scar compartments corresponded to distinct cell populations, mechanical properties and composition. OCT reflectivity has potential applications in evaluating the therapeutic efficacy of healing and characterizing scars.

Polarization state tracing method to map local birefringent properties in samples using polarization sensitive optical coherence tomography

We propose a method that utilizes the trajectory of output polarization states on the Poincaré sphere to derive depth-resolved birefringent information within samples using a fiber-based polarization sensitive optical coherence tomography. The apparent (or intermediate) optic axis and the local phase retardation are first obtained by fitting a plane to the adjacent output polarization states along depths in the Poincare sphere. A sequence of 3D rotation operation determined by the local birefringent property of the upper layers is then applied to the apparent axis to finally determine the local optic axis. This method requires only one input polarization state and is compatible with both free-space and fiber-based PSOCT systems, simplifying the imaging system setup. The theoretical framework is presented to derive the local phase retardation and optic axis from the output polarization states and then demonstrated by mapping local birefringent information of the mouse thigh tissue in vitro.

In vivo imaging of the depth-resolved optic axis of birefringence in human skin

Recent progress has enabled the reconstruction of the local (i.e., depth-resolved) optic axis (OAx) of biological tissue from measurements made with polarization-sensitive optical coherence tomography (PS-OCT). Here we demonstrate local OAx imaging in healthy human skin in vivo. The images reveal dense, weaving patterns that are imperceptible in OCT intensity tomograms or conventional PS-OCT metrics and that suggest a mesh-like tissue organization, consistent with the morphology of dermal collagen. Using co-registered polarization-sensitive optical coherence microscopy, we furthermore investigated the impact of spatial resolution on the recovered OAx patterns and confirmed their consistency. OAx orientation as a contrast mechanism merits further exploration for applications in dermatology.

Optical phantoms for biomedical polarimetry: a review

Calibration, quantification, and standardization of the polarimetric instrumentation, as well as interpretation and understanding of the obtained data, require the development and use of well-calibrated phantoms and standards. We reviewed the status of tissue phantoms for a variety of applications in polarimetry; more than 500 papers are considered. We divided the phantoms into five groups according to their origin (biological/nonbiological) and fundamental polarimetric properties of retardation, depolarization, and diattenuation. We found that, while biological media are generally depolarizing, retarding, and diattenuating, only one of all the phantoms reviewed incorporated all these properties, and few considered at least combined retardation and depolarization. Samples derived from biological tissue, such as tendon and muscle, remain extremely popular to quickly ascertain a polarimetric system, but do not provide quantifiable results aside from relative direction of their principal optical axis. Microspheres suspensions are the most utilized phantoms for depolarization, and combined with theoretical models can offer true quantification of depolarization or degree of polarization. There is a real paucity of birefringent phantoms despite the retardance being one of the most interesting parameters measurable with polarization techniques. Therefore, future work should be directed at generating truly reliable and repeatable phantoms for this metric determination. Diattenuating phantoms are rare and application-specific. Given that diattenuation is considered to be low in most biological tissues, the lack of such phantoms is seen as less problematic. The heterogeneity of the phantoms reviewed points to a critical need for standardization in this field. Ultimately, all research groups involved in polarimetric studies and instruments development would benefit from sharing a limited set of standardized polarimetric phantoms, as is done earlier in the round robin investigations in ellipsometry.

Machine-learning based segmentation of the optic nerve head using multi-contrast Jones matrix optical coherence tomography with semi-automatic training dataset generation

A pixel-by-pixel tissue classification framework using multiple contrasts obtained by Jones matrix optical coherence tomography (JM-OCT) is demonstrated. The JM-OCT is an extension of OCT that provides OCT, OCT angiography, birefringence tomography, degree-of-polarization uniformity tomography, and attenuation coefficient tomography, simultaneously. The classification framework consists of feature engineering, k-means clustering that generates a training dataset, training of a tissue classifier using the generated training dataset, and tissue classification by the trained classifier. The feature engineering process generates synthetic features from the primary optical contrasts obtained by JM-OCT. The tissue classification is performed in the feature space of the engineered features. We applied this framework to the in vivo analysis of optic nerve heads of posterior eyes. This classified each JM-OCT pixel into prelamina, lamina cribrosa (lamina beam), and retrolamina tissues. The lamina beam segmentation results were further utilized for birefringence and attenuation coefficient analysis of lamina beam.

Multimodal label-free imaging of living dermal equivalents including dermal papilla cells

BACKGROUND

Despite the significant progress in the development of skin equivalents (SEs), the problem of noninvasively assessing the quality of the cell components and the collagen structure of living SEs both before and after transplantation remains. Undoubted preference is given to in vivo methods of noninvasive, label-free monitoring of the state of the SEs. Optical bioimaging methods, such as cross-polarization optical coherence tomography (CP OCT), multiphoton tomography (MPT), and fluorescence lifetime imaging microscopy (FLIM), present particular advantages for the visualization of such SEs.

METHODS

In this study, we simultaneously applied several visualization techniques for skin model examination. We investigated the structure and quality of dermal equivalents containing dermal papilla (DP) cells and dermal fibroblasts (FBs) using CP OCT, MPT, and FLIM. Both the energy metabolism of the cell components and the structuring of the collagen fibrils were addressed.

RESULTS

Based on the data from the fluorescence lifetimes and the contributions of protein-bound NAD(P)H, a bias toward oxidative metabolism was indicated, for the first time, in both the DP cells and FBs on day 14 of SE cultivation. The CP OCT and MPT data also indicated that both DP cells and FBs structured the collagen gel in a similar manner.

CONCLUSION

In this study, multimodal label-free imaging of the structure and quality of living dermal equivalents was implemented for the first time with the use CP OCT, MPT, and FLIM of NAD(P)H. Our data suggest that the combination of different imaging techniques provides an integrated approach to data acquisition regarding the structure and quality of dermal equivalents, minimizes the potential disadvantages of using a single method, and provides an ideal information profile for clinical and research applications.

In vivo polarization-sensitive optical coherence tomography of human burn scars: birefringence quantification and correspondence with histologically determined collagen density

Obtaining adequate information on scar characteristics is important for monitoring their evolution and the effectiveness of clinical treatment. The aberrant type of collagen in scars may give rise to specific birefringent properties, which can be determined using polarization-sensitive optical coherence tomography (PS-OCT). The aim of this pilot study was to evaluate a method to quantify the birefringence of the scanned volume and correlate it with the collagen density as measured from histological slides. Five human burn scars were measured in vivo using a handheld probe and custom-made PS-OCT system. The local retardation caused by the tissue birefringence was extracted using the Jones formalism. To compare the samples, histograms of birefringence values of each volume were produced. After imaging, punch biopsies were harvested from the scar area of interest and sent in for histological evaluation using Herovici polychrome staining. Two-dimensional en face maps showed higher birefringence in scars compared to healthy skin. The Pearson's correlation coefficient for the collagen density as measured by histology versus the measured birefringence was calculated at r=0.80 (p=0.105). In conclusion, the custom-made PS-OCT system was capable of in vivo imaging and quantifying the birefringence of human burn scars, and a nonsignificant correlation between PS-OCT birefringence and histological collagen density was found.

In vivo imaging of human oral hard and soft tissues by polarization-sensitive optical coherence tomography

Since optical coherence tomography (OCT) provides three-dimensional high-resolution images of biological tissue, the benefit of polarization contrast in the field of dentistry is highlighted in this study. Polarization-sensitive OCT (PS OCT) with phase-sensitive recording is used for imaging dental and mucosal tissues in the human oral cavity in vivo. An enhanced polarization contrast of oral structures is reached by analyzing the signals of the co- and crosspolarized channels of the swept source PS OCT system quantitatively with respect to reflectivity, retardation, optic axis orientation, and depolarization. The calculation of these polarization parameters enables a high tissue-specific contrast imaging for the detailed physical interpretation of human oral hard and soft tissues. For the proof-of-principle, imaging of composite restorations and mineralization defects at premolars as well as gingival, lingual, and labial oral mucosa was performed in vivo within the anterior oral cavity. The achieved contrast-enhanced results of the investigated human oral tissues by means of polarization-sensitive imaging are evaluated by the comparison with conventional intensity-based OCT.

Automatic spectral calibration for polarization-sensitive optical coherence tomography

Accurate wavelength assignment is important for Fourier domain polarization-sensitive optical coherence tomography. Incorrect wavelength mapping between the orthogonal horizontal (H) and vertical (V) polarization channels leads to broadening the axial point spread function and generating polarization artifacts. To solve the problem, we propose an automatic spectral calibration method by seeking the optimal calibration coefficient between wavenumber kH and kV. The method first performs a rough calibration to get the relationship between the wavelength λ and the pixel number x of the CCD for each channel. And then a precise calibration is taken to bring both polarization interferograms in the same k range through the optimal calibration coefficient. The optimal coefficient is automatically obtained by evaluating the cross-correlation of A-line signals. Simulations and experiments are implemented to demonstrate the performance of the proposed method. The results show that, compared to the peaks method, the proposed method is suitable in both Gaussian and non-Gaussian spectrums with a higher calibration accuracy.

Three-dimensional multi-contrast imaging of in vivo human skin by Jones matrix optical coherence tomography

A custom made dermatological Jones matrix optical coherence tomography (JM-OCT) is presented. It uses a passive-polarization-delay component based swept-source JM-OCT configuration, but is specially designed for in vivo human skin measurement. The center wavelength of its probe beam is 1310 nm and the A-line rate is 49.6 kHz. The JM-OCT is capable of simultaneously providing birefringence (local retardation) tomography, degree-of-polarization-uniformity tomography, complex-correlation-based optical coherence angiography, and conventional scattering OCT. To evaluate the performance of this JM-OCT, we measured in vivo human skin at several locations. Using the four kinds of OCT contrasts, the morphological characteristics and optical properties of different skin types were visualized.

Noise stochastic corrected maximum a posteriori estimator for birefringence imaging using polarization-sensitive optical coherence tomography

This paper presents a noise-stochastic corrected maximum a posteriori estimator for birefringence imaging using Jones matrix optical coherence tomography. The estimator described in this paper is based on the relationship between probability distribution functions of the measured birefringence and the effective signal to noise ratio (ESNR) as well as the true birefringence and the true ESNR. The Monte Carlo method is used to numerically describe this relationship and adaptive 2D kernel density estimation provides the likelihood for a posteriori estimation of the true birefringence. Improved estimation is shown for the new estimator with stochastic model of ESNR in comparison to the old estimator, both based on the Jones matrix noise model. A comparison with the mean estimator is also done. Numerical simulation validates the superiority of the new estimator. The superior performance of the new estimator was also shown by in vivo measurement of optic nerve head.

Evaluation of Laser-Assisted Trans-Nail Drug Delivery with Optical Coherence Tomography

The nail provides a functional protection to the fingertips and surrounding tissue from external injuries. The nail plate consists of three layers including dorsal, intermediate, and ventral layers. The dorsal layer consists of compact, hard keratins, limiting topical drug delivery through the nail. In this study, we investigate the application of fractional CO₂ laser that produces arrays of microthermal ablation zones (MAZs) to facilitate drug delivery in the nails. We utilized optical coherence tomography (OCT) for real-time monitoring of the laser-skin tissue interaction, sparing the patient from an invasive surgical sampling procedure. The time-dependent OCT intensity variance was used to observe drug diffusion through an induced MAZ array. Subsequently, nails were treated with cream and liquid topical drugs to investigate the feasibility and diffusion efficacy of laser-assisted drug delivery. Our results show that fractional CO₂ laser improves the effectiveness of topical drug delivery in the nail plate and that OCT could potentially be used for in vivo monitoring of the depth of laser penetration as well as real-time observations of drug delivery.

In vivo optical interferometric imaging of human skin utilizing monochromatic light source

We have demonstrated tomographic imaging of in vivo human skin with an optical interferometric imaging technique using a monochromatic light source. The axial resolution of this method is determined by the center wavelength and the NA of the objective and is irrelevant to the bandwidth of the light source in contrast to optical coherence tomography. Our imaging system is constructed with low-priced and small-sized compact disk optical pickup components, a laser diode, a high NA objective, and a voice coil actuator. In spite of its low cost and small size, our imaging system can visualize the structure of human skin as clearly as a commercial reflectance confocal microscope.

Investigating the relationship between changes in collagen fiber orientation during skin aging and collagen/water interactions by polarized-FTIR microimaging

Upon chronological aging, human skin undergoes structural and molecular modifications, especially at the level of type I collagen. This macromolecule is one of the main dermal structural proteins and presents several age-related alterations. It exhibits a triple helical structure and assembles itself to form fibrils and fibers. In addition, water plays an important role in stabilizing the collagen triple helix by forming hydrogen-bonds between collagen residues. However, the influence of water on changes of dermal collagen fiber orientation with age has not been yet understood. Polarized-Fourier Transform Infrared (P-FTIR) imaging is an interesting biophotonic approach to determine in situ the orientation of type I collagen fibers, as we have recently shown by comparing skin samples of different ages. In this work, P-FTIR spectral imaging was performed on skin samples from two age groups (35- and 38-year-old on the one hand, 60- and 66-year-old on the other hand), and our analyses were focused on the effect of H2O/D2O substitution. Spectral data were processed with fuzzy C-means (FCM) clustering in order to distinguish different orientations of collagen fibers. We demonstrated that the orientation was altered with aging, and that D2O treatment, affecting primarily highly bound water molecules, is more marked for the youngest skin samples. Collagen-bound water-related spectral markers were also highlighted. Our results suggest a weakening of water/collagen interactions with age. This non-destructive and label-free methodology allows us to understand better the importance of bound water in collagen fiber orientation alterations occurring with skin aging. Obtaining such structural information could find benefits in dermatology as well as in cosmetics.

Extracellular Matrix and Dermal Fibroblast Function in the Healing Wound

Significance: Fibroblasts play a critical role in normal wound healing. Various extracellular matrix (ECM) components, including collagens, fibrin, fibronectin, proteoglycans, glycosaminoglycans, and matricellular proteins, can be considered potent protagonists of fibroblast survival, migration, and metabolism. Recent Advances: Advances in tissue culture, tissue engineering, and ex vivo models have made the examination and precise measurements of ECM components in wound healing possible. Likewise, the development of specific transgenic animal models has created the opportunity to characterize the role of various ECM molecules in healing wounds. In addition, the recent characterization of new ECM molecules, including matricellular proteins, dermatopontin, and FACIT collagens (Fibril-Associated Collagens with Interrupted Triple helices), further demonstrates our cursory knowledge of the ECM in coordinated wound healing. Critical Issues: The manipulation and augmentation of ECM components in the healing wound is emerging in patient care, as demonstrated by the use of acellular dermal matrices, tissue scaffolds, and wound dressings or topical products bearing ECM proteins such as collagen, hyaluronan (HA), or elastin. Once thought of as neutral structural proteins, these molecules are now known to directly influence many aspects of cellular wound healing. Future Directions: The role that ECM molecules, such as CCN2, osteopontin, and secreted protein, acidic and rich in cysteine, play in signaling homing of fibroblast progenitor cells to sites of injury invites future research as we continue investigating the heterotopic origin of certain populations of fibroblasts in a healing wound. Likewise, research into differently sized fragments of the same polymeric ECM molecule is warranted as we learn that fragments of molecules such as HA and tenascin-C can have opposing effects on dermal fibroblasts.

Birefringence imaging of posterior eye by multi-functional Jones matrix optical coherence tomography

A clinical grade prototype of posterior multifunctional Jones matrix optical coherence tomography (JM-OCT) is presented. This JM-OCT visualized depth-localized birefringence in addition to conventional cumulative phase retardation imaging through local Jones matrix analysis. In addition, it simultaneously provides a sensitivity enhanced scattering OCT, a quantitative polarization uniformity contrast, and OCT-based angiography. The probe beam is at 1-μm wavelength band. The measurement speed and the depth-resolution were 100,000 A-lines/s, and 6.6 μm in tissue, respectively. Normal and pathologic eyes are examined and several clinical features are revealed, which includes high birefringence in the choroid and lamina cribrosa, and birefringent layered structure of the sclera. The theoretical details of the depth-localized birefringence imaging and conventional phase retardation imaging are formulated. This formulation indicates that the birefringence imaging correctly measures a depth-localized single-trip phase retardation of a tissue, while the conventional phase retardation can provide correct single-trip phase retardation only for some specific types of samples.

Optical Coherence Tomography Imaging of Normal, Chronologically Aged, Photoaged and Photodamaged Skin: A Systematic Review

BACKGROUND

Optical coherence tomography (OCT) is capable of providing a noninvasive real-time cross-sectional image of the skin through light-based interferometry, a method sometimes described as "light-based ultrasound." One key application of OCT in dermatology is the visualization of dermal collagen during chronological aging, photoaging, or photodamage. These skin conditions are typically managed by the practitioner's subjective assessment of severity and response to therapy.

OBJECTIVE

The purpose of this review is to present available evidence on the ability of OCT to image normal, chronologically aged, photoaged and photodamaged skin in human subjects.

METHODS AND MATERIALS

The authors have searched Medline, PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane Library databases for published literature on the imaging of skin collagen by OCT using the following search terms: "optical coherence tomography," "OCT," "skin," "collagen," "photoaging," "wrinkles," and "photodamage."

RESULTS

The search resulted in 23 articles investigating OCT-based skin collagen imaging, which met their search criteria.

CONCLUSION

The authors anticipate tremendous growth in the field of OCT-based skin imaging that will parallel the development ultrasound technology has experienced over the past 30 years. They foresee that the use of OCT imaging to evaluate skin aging will not only help identify pathological changes earlier, but will also assist in the evaluation of the response to therapy longitudinally without biopsy.

Optical coherence tomography-guided laser microsurgery for blood coagulation with continuous-wave laser diode

Blood coagulation is the clotting and subsequent dissolution of the clot following repair to the damaged tissue. However, inducing blood coagulation is difficult for some patients with homeostasis dysfunction or during surgery. In this study, we proposed a method to develop an integrated system that combines optical coherence tomography (OCT) and laser microsurgery for blood coagulation. Also, an algorithm for positioning of the treatment location from OCT images was developed. With OCT scanning, 2D/3D OCT images and angiography of tissue can be obtained simultaneously, enabling to noninvasively reconstruct the morphological and microvascular structures for real-time monitoring of changes in biological tissues during laser microsurgery. Instead of high-cost pulsed lasers, continuous-wave laser diodes (CW-LDs) with the central wavelengths of 450 nm and 532 nm are used for blood coagulation, corresponding to higher absorption coefficients of oxyhemoglobin and deoxyhemoglobin. Experimental results showed that the location of laser exposure can be accurately controlled with the proposed approach of imaging-based feedback positioning. Moreover, blood coagulation can be efficiently induced by CW-LDs and the coagulation process can be monitored in real-time with OCT. This technology enables to potentially provide accurate positioning for laser microsurgery and control the laser exposure to avoid extra damage by real-time OCT imaging.

Recent advances in clinical application of optical coherence tomography of human skin

Optical coherence tomography (OCT) is an emerging noninvasive imaging method that uses infrared light and interferometric techniques. The method has become increasingly popular in skin research as well as daily dermatology practice. In the present brief review, we focused on recent (2009-2014) OCT studies on the human skin, which included a reasonable sample size and statistics. Twenty-five papers were selected and briefly described OCT of epidermal thickness, skin appendages, wound healing, extracellular matrix and skin fibrosis, vascular malformations, and skin tumors such as basal cell carcinoma, actinic keratoses, and malignant melanoma.

An overview of optical coherence tomography for ovarian tissue imaging and characterization

Ovarian cancer has the lowest survival rate among all the gynecologic cancers because it is predominantly diagnosed at late stages due to the lack of reliable symptoms and efficacious screening techniques. Optical coherence tomography (OCT) is an emerging technique that provides high-resolution images of biological tissue in real time, and demonstrates great potential for imaging of ovarian tissue. In this article, we review OCT studies for visualization and diagnosis of human ovaries as well as quantitative extraction of ovarian tissue optical properties for classifying normal and malignant ovaries. OCT combined with other imaging modalities to further improve ovarian tissue diagnosis is also reviewed.

Feasibility of ablative fractional laser-assisted drug delivery with optical coherence tomography

Fractional resurfacing creates hundreds of microscopic wounds in the skin without injuring surrounding tissue. This technique allows rapid wound healing owing to small injury regions, and has been proven as an effective method for repairing photodamaged skin. Recently, ablative fractional laser (AFL) treatment has been demonstrated to facilitate topical drug delivery into skin. However, induced fractional photothermolysis depends on several parameters, such as incident angle, exposure energy, and spot size of the fractional laser. In this study, we used fractional CO2 laser to induce microscopic ablation array on the nail for facilitating drug delivery through the nail. To ensure proper energy delivery without damaging tissue structures beneath the nail plate, optical coherence tomography (OCT) was implemented for quantitative evaluation of induced microscopic ablation zone (MAZ). Moreover, to further study the feasibility of drug delivery, normal saline was dripped on the exposure area of fingernail and the speckle variance in OCT signal was used to observe water diffusion through the ablative channels into the nail plate. In conclusion, this study establishes OCT as an effective tool for the investigation of fractional photothermolysis and water/drug delivery through microscopic ablation channels after nail fractional laser treatment.

Investigation of temporal vascular effects induced by focused ultrasound treatment with speckle-variance optical coherence tomography

Focused ultrasound (FUS) can be used to locally and temporally enhance vascular permeability, improving the efficiency of drug delivery from the blood vessels into the surrounding tissue. However, it is difficult to evaluate in real time the effect induced by FUS and to noninvasively observe the permeability enhancement. In this study, speckle-variance optical coherence tomography (SVOCT) was implemented for the investigation of temporal effects on vessels induced by FUS treatment. With OCT scanning, the dynamic change in vessels during FUS exposure can be observed and studied. Moreover, the vascular effects induced by FUS treatment with and without the presence of microbubbles were investigated and quantitatively compared. Additionally, 2D and 3D speckle-variance images were used for quantitative observation of blood leakage from vessels due to the permeability enhancement caused by FUS, which could be an indicator that can be used to determine the influence of FUS power exposure. In conclusion, SVOCT can be a useful tool for monitoring FUS treatment in real time, facilitating the dynamic observation of temporal effects and helping to determine the optimal FUS power.

Bayesian maximum likelihood estimator of phase retardation for quantitative polarization-sensitive optical coherence tomography

This paper presents the theory and numerical implementation of a maximum likelihood estimator for local phase retardation (i.e., birefringence) measured using Jones-matrix-based polarization sensitive optical coherence tomography. Previous studies have shown conventional mean estimations of phase retardation and birefringence are significantly biased in the presence of system noise. Our estimator design is based on a Bayes' rule that relates the distributions of the measured birefringence under a particular true birefringence and the true birefringence under a particular measured birefringence. We used a Monte-Carlo method to calculate the likelihood function that describes the relationship between the distributions and numerically implement the estimator. Our numerical and experimental results show that the proposed estimator was asymptotically unbiased even with low signal-to-noise ratio and/or for the true phase retardations close to the edge of the measurement range. The estimator revealed detailed clinical features when applied to the in vivo anterior human eye.

Scleral birefringence as measured by polarization-sensitive optical coherence tomography and ocular biometric parameters of human eyes in vivo

The relationship between scleral birefringence and biometric parameters of human eyes in vivo is investigated. Scleral birefringence near the limbus of 21 healthy human eyes was measured using polarization-sensitive optical coherence tomography. Spherical equivalent refractive error, axial eye length, and intraocular pressure (IOP) were measured in all subjects. IOP and scleral birefringence of human eyes in vivo was found to have statistically significant correlations (r = -0.63, P = 0.002). The slope of linear regression was -2.4 × 10(-2) deg/μm/mmHg. Neither spherical equivalent refractive error nor axial eye length had significant correlations with scleral birefringence. To evaluate the direct influence of IOP to scleral birefringence, scleral birefringence of 16 ex vivo porcine eyes was measured under controlled IOP of 5-60 mmHg. In these ex vivo porcine eyes, the mean linear regression slope between controlled IOP and scleral birefringence was -9.9 × 10(-4) deg/μm/mmHg. In addition, porcine scleral collagen fibers were observed with second-harmonic-generation (SHG) microscopy. SHG images of porcine sclera, measured on the external surface at the superior side to the cornea, showed highly aligned collagen fibers parallel to the limbus. In conclusion, scleral birefringence of healthy human eyes was correlated with IOP, indicating that the ultrastructure of scleral collagen was correlated with IOP. It remains to show whether scleral collagen ultrastructure of human eyes is affected by IOP as a long-term effect.

Age-dependent biomechanical properties of the skin

The skin fulfills one of its most important functions, that is protection from mechanical injuries, due to the mechanism of reversible deformation of the structure. Human skin is a complex living material but in biomechanical tests it reveals its homogeneous nature. Biomechanical skin parameters change with time. Results of thickness measurements, where the skin was subjected to pressure, revealed that the Young's modulus increased linearly with age. The process of ageing is the reason why the skin becomes thinner, stiffer, less tense and less flexible. Skin tension measured during in vivo uniaxial load and the elasticity modulus are higher in children than in elderly adults. Furthermore, mean ultimate skin deformation before bursting is 75% for newborns and 60% for the elderly. Several types of the main lines were distinguished on the skin. The static lines, described by Langer, correspond to the lines of maximum tension, the Kraissl's lines correspond to the movements of the skin during muscle work, whereas the Borges lines are the relaxed skin tension lines. Biomechanical tests of the human skin help to quantify the effectiveness of dermatological products, detect skin diseases, schedule and plan surgical and dermatological interventions and treatments.

Optical coherence tomography (OCT) of collagen in normal skin and skin fibrosis

Optical coherence tomography (OCT) is a non-invasive imaging modality that is transforming clinical diagnosis in dermatology and other medical fields. OCT provides a cross-sectional evaluation of the epidermis and dermis and allows in vivo imaging of skin collagen. Upregulated collagen content is a key feature of fibrotic skin diseases. These diseases are often managed by the practitioner's subjective assessment of disease severity and response to therapies. The purpose of this review is to provide an overview of the principles of OCT and present available evidence on the ability of OCT to image skin collagen in vivo for the diagnosis and management of diseases characterized by skin fibrosis. We review OCT studies that characterize the collagen content in normal skin and fibrotic skin diseases including systemic sclerosis and hypertrophic scars secondary to burn, trauma, and other injury. We also highlight several limitations of OCT and suggest enhancements to improve OCT imaging of skin fibrosis. We conclude that OCT imaging has the potential to serve as an objective, non-invasive measure of collagen's status and disease progression for use in both research trials and clinical practice. The future use of OCT imaging as a quantitative imaging biomarker of fibrosis will help identify fibrosis and facilitate clinical examination in monitoring response to treatment longitudinally without relying on serial biopsies. The use of OCT technology for quantification of fibrosis is in the formative stages and we foresee tremendous growth potential, similar to the ultrasound development paradigm that evolved over the past 30 years.

Monitoring of wound healing process of human skin after fractional laser treatments with optical coherence tomography

Fractional photothermolysis induced by non-ablative fractional lasers (NAFLs) or ablative fractional lasers (AFLs) can remodel the skin, regenerate collagen, and remove tumor tissue. However, fractional laser treatments may result in severe side effects, and multiple treatments are required to achieve the expected outcome. Thus, the treatment outcome and downtime after fractional laser treatments are key issues to determine the following treatment strategy. In this study, an optical coherence tomography (OCT) system was implemented for in vivo studies of wound healing after NAFL and AFL treatments. According to the OCT scanning results, the laser-induced photothermolysis including volatilization and coagulation could be morphologically identified. To continue monitoring the wound healing process, the treated regions were scanned with OCT at different time points, and the en-face images at various tissue depths were extracted from three-dimensional OCT images. Furthermore, to quantitatively evaluate the morphological changes at different tissue depths during wound healing, an algorithm was developed to distinguish the backscattering properties of untreated and treated tissues. The results showed that the coagulation damage induced by the NAFLs could be rapidly healed in 6 days. In contrast, the tissue volatilization induced by AFLs required a longer recovery time of 14 days. In conclusion, this study establishes the feasibility of this methodology as a means of clinically monitoring treatment outcomes and wound healing after fractional laser treatments.

Dental optical coherence tomography

This review paper describes the applications of dental optical coherence tomography (OCT) in oral tissue images, caries, periodontal disease and oral cancer. The background of OCT, including basic theory, system setup, light sources, spatial resolution and system limitations, is provided. The comparisons between OCT and other clinical oral diagnostic methods are also discussed.

Anisotropic alteration of scleral birefringence to uniaxial mechanical strain

PURPOSE

To investigate the relationship between scleral mechanical properties, its birefringence, and the anisotropy of birefringence alteration in respect of the direction of the strain by using PS-OCT.

METHODS

The scleral birefringence of thirty-nine porcine eyes was measured with a prototype PS-OCT. A rectangle strip of sclera with a width of 4 mm was dissected at the temporal region 5 mm apart from the optic nerve head. The strain and force were measured with a uniaxial tension tester as the sample was stretched with a speed of 1.8 mm/min after preconditioning. The birefringence of the sample was measured by PS-OCT at the center of the sample before applying, denoted as inherent birefringence, and after applying stretching of 6.5% strain. The birefringence alteration was obtained by these two measurements and correlations between birefringence and elastic parameters, tangent modulus, and structural stiffness were examined. Twenty and 19 porcine eyes were stretched in meridional or equatorial directions, respectively.

RESULTS

A moderate positive correlation was found between the inherent birefringence and the structural stiffness. A moderate positive correlation was also found between the inherent birefringence and the tangent modulus. The birefringence increased by strains. Marginal significance was found in the birefringence alteration between meridional and equatorial strains, where the mean birefringence elevation by meridional strain was higher than that by equatorial strain.

CONCLUSIONS

The birefringence was found to be altered by applying strain and also be related with inherent birefringence. This implies the birefringence of the sclera of the in vivo eye also could be affected by its mechanical property.

Integrated multimodal optical microscopy for structural and functional imaging of engineered and natural skin

An integrated multimodal optical microscope is demonstrated for high-resolution, structural and functional imaging of engineered and natural skin. This microscope incorporates multiple imaging modalities including optical coherence (OCM), multi-photon (MPM), and fluorescence lifetime imaging microscopy (FLIM), enabling simultaneous visualization of multiple contrast sources and mechanisms from cells and tissues. Spatially co-registered OCM/MPM/FLIM images of multi-layered skin tissues are obtained, which are formed based on complementary information provided by different modalities, i.e., scattering information from OCM, molecular information from MPM, and functional cellular metabolism states from FLIM. Cellular structures in both the dermis and epidermis, especially different morphological and physiological states of keratinocytes from different epidermal layers, are revealed by mutually-validating images. In vivo imaging of human skin is also investigated, which demonstrates the potential of multimodal microscopy for in vivo investigation during engineered skin engraftment. This integrated imaging technique and microscope show the potential for investigating cellular dynamics in developing engineered skin and following in vivo grafting, which will help refine the control and culturing conditions necessary to obtain more robust and physiologically-relevant engineered skin substitutes.