Corneal biometry from volumetric SDOCT and comparison with existing clinical modalities

Effect of fixational eye movements in corneal topography measurements with optical coherence tomography

There is an increasing interest in applying optical coherence tomography (OCT) to quantify the topography of ocular structures. However, in its most usual configuration, OCT data is acquired sequentially while a beam is scanned through the region of interest, and the presence of fixational eye movements can affect the accuracy of the technique. Several scan patterns and motion correction algorithms have been proposed to minimize this effect, but there is no consensus on the ideal parameters to obtain a correct topography. We have acquired corneal OCT images with raster and radial patterns, and modeled the data acquisition in the presence of eye movements. The simulations replicate the experimental variability in shape (radius of curvature and Zernike polynomials), corneal power, astigmatism, and calculated wavefront aberrations. The variability of the Zernike modes is highly dependent on the scan pattern, with higher variability in the direction of the slow scan axis. The model can be a useful tool to design motion correction algorithms and to determine the variability with different scan patterns.

Biometric Measurement of Anterior Segment: A Review

Biometric measurement of the anterior segment is of great importance for the ophthalmology, human eye modeling, contact lens fitting, intraocular lens design, etc. This paper serves as a comprehensive review on the historical development and basic principles of the technologies for measuring the geometric profiles of the anterior segment. Both the advantages and drawbacks of the current technologies are illustrated. For in vivo measurement of the anterior segment, there are two main challenges that need to be addressed to achieve high speed, fine resolution, and large range imaging. One is the motion artefacts caused by the inevitable and random human eye movement. The other is the serious multiple scattering effects in intraocular turbid media. The future research perspectives are also outlined in this paper.

The effect of sodium fluorescein on anterior eye surface measurements

PURPOSE

During image acquisition, certain topographers require the addition of sodium fluorescein (NaFl) dye to the tear film. This study investigates the effect of NaFl dye on corneal topography and tear surface quality.

METHOD

The E300 corneal topographer (Medmont International Pty Ltd., Victoria, Australia) was used to measure ocular surface topography and quality of 57 eyes of 57 healthy individuals without dry eye symptoms, age 35.1 ± 15.2 years (mean ± standard deviation) ranging between 19 and 65 years. The mean of three simulated keratometry values, a variety of corneal shape descriptors, and Tear Film Surface Quality (TFSQ) were measured under three different conditions; without NaFl (baseline), with the addition of a single dose NaFl, and using a double dose of NaFl.

RESULTS

Compared to baseline, the Inferior-Superior (IS) index decreased significantly after a single dose (P = 0.034) or double dose of NaFl (P = 0.030). The corneal surface was significantly more regular without NaFl (P = 0.003) or one insertion of NaFl (P = 0.024) when compared to two doses of NaFl. There was no association with age, or dry eye signs or symptoms on the variance observed in any of the indices between baseline, intervention I, and intervention II (P > 0.05). Agreement between corneal surface indices reduced following the addition of NaFl.

CONCLUSION

In comparison to measurements taken without an ocular dye, one dose of NaFl resulted in increased reliability and consistency in corneal topography measurements using the E300 topographer, but 2 doses decreased reliability and consistency. Practitioners ought to be aware that tear film surface regularity and inferior-superior corneal power changed significantly following the addition of NaFl in those with healthy corneas. Its effect in diseased corneas is unknown.

Topography and pachymetry maps for mouse corneas using optical coherence tomography

The majority of the eye's refractive power lies in the cornea, and pathological changes in its shape can affect vision. Small animal models offer an unparalleled degree of control over genetic and environmental factors that can help elucidate mechanisms of diseases affecting corneal shape. However, there is not currently a method to characterize the corneal shape of small animal eyes with topography or pachymetry maps, as is done clinically for humans. We bridge this gap by demonstrating methods using optical coherence tomography (OCT) to generate the first topography and pachymetry (thickness) maps of mouse corneas. Radii of curvature acquired using OCT were validated using calibration spheres as well as in vivo mouse corneas with a mouse keratometer. The resulting topography and pachymetry maps are analogous to those used diagnostically in clinic and potentially allow for characterization of genetically modified mice that replicate key features of human corneal disease.

Accurate tissue interface segmentation via adversarial pre-segmentation of anterior segment OCT images

Optical Coherence Tomography (OCT) is an imaging modality that has been widely adopted for visualizing corneal, retinal and limbal tissue structure with micron resolution. It can be used to diagnose pathological conditions of the eye, and for developing pre-operative surgical plans. In contrast to the posterior retina, imaging the anterior tissue structures, such as the limbus and cornea, results in B-scans that exhibit increased speckle noise patterns and imaging artifacts. These artifacts, such as shadowing and specularity, pose a challenge during the analysis of the acquired volumes as they substantially obfuscate the location of tissue interfaces. To deal with the artifacts and speckle noise patterns and accurately segment the shallowest tissue interface, we propose a cascaded neural network framework, which comprises of a conditional Generative Adversarial Network (cGAN) and a Tissue Interface Segmentation Network (TISN). The cGAN pre-segments OCT B-scans by removing undesired specular artifacts and speckle noise patterns just above the shallowest tissue interface, and the TISN combines the original OCT image with the pre-segmentation to segment the shallowest interface. We show the applicability of the cascaded framework to corneal datasets, demonstrate that it precisely segments the shallowest corneal interface, and also show its generalization capacity to limbal datasets. We also propose a hybrid framework, wherein the cGAN pre-segmentation is passed to a traditional image analysis-based segmentation algorithm, and describe the improved segmentation performance. To the best of our knowledge, this is the first approach to remove severe specular artifacts and speckle noise patterns (prior to the shallowest interface) that affects the interpretation of anterior segment OCT datasets, thereby resulting in the accurate segmentation of the shallowest tissue interface. To the best of our knowledge, this is the first work to show the potential of incorporating a cGAN into larger deep learning frameworks for improved corneal and limbal OCT image segmentation. Our cGAN design directly improves the visualization of corneal and limbal OCT images from OCT scanners, and improves the performance of current OCT segmentation algorithms.

Wide-field whole eye OCT system with demonstration of quantitative retinal curvature estimation

Current conventional clinical OCT systems image either only the anterior or the posterior eye during a single acquisition. This localized imaging limits conventional OCT's use for characterizing global ocular morphometry and biometry, which requires knowledge of spatial relationships across the entire eye. We developed a "whole eye" optical coherence tomography system that simultaneously acquires volumes with a wide field-of-view for both the anterior chamber (14 x 14 mm) and retina (55°) using a single source and detector. This system was used to measure retinal curvature in a pilot population and compared against curvature of the same eyes measured with magnetic resonance imaging.

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

We propose a numerical three-dimensional (3D) ray-tracing model for the analysis of advanced corneal refractive errors. The 3D modeling was based on measured corneal elevation data by means of Scheimpflug photography. A mathematical description of the measured corneal surfaces from a keratoconus (KC) patient was used for the 3D ray tracing, based on Snell's law of refraction. A model of a commercial intraocular lens (IOL) was included in the analysis. By modifying the posterior IOL surface, it was shown that the imaging quality could be significantly improved. The RMS values were reduced by approximately 50% close to the retina, both for on- and off-axis geometries. The 3D ray-tracing model can constitute a basis for simulation of customized IOLs that are able to correct the advanced, irregular refractive errors in KC.

Optical coherence tomography accurately measures corneal power change from laser refractive surgery

PURPOSE

To determine the ability of motion-corrected optical coherence tomography (OCT) to measure the corneal refractive power change due to LASIK.

DESIGN

Evaluation of a diagnostic test or technology in a cohort.

SUBJECTS

A total of 70 eyes from 37 subjects undergoing LASIK were measured preoperatively. A total of 39 eyes from 22 subjects were measured postoperatively and completed the study.

METHODS

Consecutive patients undergoing LASIK at the Duke Eye Center who consented to participate were imaged with Placido-ring topography, Scheimpflug photography, and OCT on the day of their surgery. Patients were then reimaged with the same imaging systems at the postoperative month 3 visit. Change in preoperative to postoperative corneal refractive power as measured by each of the imaging modalities was compared with the preoperative to postoperative change in manifest refraction (MRx) using the t test with generalized estimating equations.

MAIN OUTCOME MEASURES

Corneal refractive power change due to LASIK as measured by Placido-ring topography, Scheimpflug photography, and OCT compared with the MRx change vertexed to the corneal plane. The change in MRx should correspond to the change in the corneal refractive power from LASIK and was considered the reference measurement.

RESULTS

In 22 individuals (39 eyes) returning after LASIK, we found no significant difference between the clinically measured pre- to post-LASIK change in MRx and both Scheimpflug photography (P = 0.714) and OCT (P = 0.216). In contrast, keratometry values from Placido-ring topography were found to be significantly different from the measured refractive change (P < 0.001). In addition, of the 3 imaging modalities, OCT recorded the smallest mean absolute difference from the reference measurement with the least amount of variability.

CONCLUSIONS

Motion-corrected OCT more accurately measures the change in corneal refractive power due to laser refractive surgery than other currently available clinical devices. By offering accurate corneal refractive power measurements in normal and surgically modified subjects, OCT offers a compelling alternative to current clinical devices for determining corneal refractive power.

Quantitative single and multi-surface clinical corneal topography utilizing optical coherence tomography

Successful surgical treatment of ocular astigmatism requires accurate characterization of both magnitude and axis of the astigmatism. Keratometry and topography are clinically widely used for this measurement; however, their analysis is limited to the anterior corneal surface. Unlike these techniques, optical coherence tomography (OCT) offers the advantage of measuring both the anterior and posterior corneal surface contributions. We present a technique to combine the local curvatures of both surfaces into a single pseudosurface suitable for clinical application. Building on prior work in distributed scanning OCT (DSOCT) to remove corrupting patient motion artifacts, we present the results of a pilot patient study where extracted values of clinical corneal astigmatic power magnitude and direction from DSOCT corneal volumes were comparable to standard clinical measures of corneal astigmatism.

Efficient sweep buffering in swept source optical coherence tomography using a fast optical switch

We describe a novel buffering technique for increasing the A-scan rate of swept source optical coherence tomography (SSOCT) systems employing low duty cycle swept source lasers. This technique differs from previously reported buffering techniques in that it employs a fast optical switch, capable of switching in 60 ns, instead of a fused fiber coupler at the end of the buffering stage, and is therefore appreciably more power efficient. The use of the switch also eliminates patient exposure to light that is not used for imaging that occurs at the end of the laser sweep, thereby increasing the system sensitivity. We also describe how careful management of polarization can remove undesirable artifacts due to polarization mode dispersion. In addition, we demonstrate how numerical compensation techniques can be used to modify the signal from a Mach-Zehnder interferometer (MZI) clock obtained from the original sweep to recalibrate the buffered sweep, thereby reducing the complexity of systems employing lasers with integrated MZI clocks. Combining these methods, we constructed an SSOCT system employing an Axsun technologies laser with a sweep rate of 100kHz and 6dB imaging range of 5.5mm. The sweep rate was doubled with sweep buffering to 200 kHz, and the imaging depth was extended to 9 mm using coherence revival. We demonstrated the feasibility of this system by acquiring images of the anterior segments and retinas of healthy human volunteers.

Distributed scanning volumetric SDOCT for motion corrected corneal biometry

We present a method, termed distributed scanning OCT (DSOCT), which reduces the effects of patient motion on corneal biometry utilizing current-generation clinically available spectral domain optical coherence tomography (SDOCT) systems. We first performed a pilot study of the power spectrum of normal patient axial eye motion based on repeated (M-mode) SDOCT. Using DSOCT to reduce the effects of patient motion, we conducted a preliminary patient study comparing the measured anterior and posterior corneal curvatures and the calculated corneal power to both corneal topography and Scheimpflug photography in normal subjects. The repeatability for the measured radius of curvature of both anterior and posterior surfaces as well as calculated corneal refractive power using DSOCT was comparable to those of both topography and Scheimpflug photography.