Evolution of adaptive optics retinal imaging [Invited]

Morphologic and Functional Assessment of Photoreceptors in Laser-Induced Retinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy and Microperimetry

PURPOSE

To assess the cone photoreceptors' morphology and associated retinal sensitivity in laser-induced retinopathy (LIR) using adaptive optics scanning laser ophthalmoscopy (AO-SLO) and microperimetry (MP).

DESIGN

Cohort study.

METHODS

This study included 13 patients (15 eyes) with LIR and 38 age-matched healthy volunteers (38 eyes). Participants underwent comprehensive evaluations including AO-SLO, MP, and spectral-domain OCT. Lesion morphology, cone density, dispersion, and regularity in AO-SLO were assessed and correlated with visual function.

RESULTS

In AO-SLO images, LIR lesions were predominantly characterized by hyporeflective regions, suggesting potential cone loss at the fovea, accompanied by the presence of sizable clumps of hyperreflective material within these lesions. The average size of lesions in affected eyes was 97,128±107,478 µm², ranging from 6705 to 673,348 µm². Compared with the healthy contralateral eye and control group, LIR demonstrated significantly reduced cone density, increased cone dispersion, and notably decreased cone regularity in all 4 quadrants at 3° eccentricity (all P values < .05). Lesion morphology in AO-SLO correlated with ellipsoid zone defects observed in OCT, showing a positive correlation in size (r = 0.84, P < .001) but not with retinal sensitivities (P = .09). Similarly, cone density at 3° eccentricity did not correlate with retinal sensitivities (P = .13).

CONCLUSIONS AND RELEVANCE

The study provides crucial insights into the morphologic and functional impacts of LIR on cone photoreceptors, revealing significant morphologic changes in cones that do not consistently align with functional outcomes. This research highlights the need for continued exploration into the relationship between retinal structure and function in LIR, and the importance of heightened public awareness and preventive strategies to mitigate the risk of LIR.

Extended-period AOSLO imaging in the living human retina without pupil dilation: a feasibility study

In vivo imaging using an adaptive optics scanning laser ophthalmoscope (AOSLO) is challenging, especially over extended periods. Pharmacological agents, administered as eye drops, are commonly used to dilate the pupil and paralyse accommodation, to improve image quality. However, they are contraindicated in some scenarios. Here, we evaluate the feasibility and reproducibility of performing AOSLO imaging without pharmacological pupil dilation over 1.5 hours with visual stimulation. Through statistical analysis and theoretical modelling using a dataset of retinal and pupil images collected from six healthy, young, near-emmetropic participants between the ages of 20-30 years, we validate that the retinal image quality does not change significantly with time in the experimental session (p = 0.33), and that pupil size has a strong effect on image quality but is not the only contributing factor.

Measurement of retinal blood flow precision in the human eye with multimodal adaptive optics imaging

Impaired retinal blood flow (RBF) autoregulation plays a key role in the development and progression of several ocular diseases, including glaucoma and diabetic retinopathy. Clinically, reproducible RBF quantitation could significantly improve early diagnosis and disease management. Several non-invasive techniques have been developed but are limited for retinal microvasculature flow measurements due to their low signal-to-noise ratio and poor lateral resolution. In this study, we demonstrate reproducible vessel caliber and retinal blood flow velocity measurements in healthy human volunteers using a high-resolution (spatial and temporal) multimodal adaptive optics system with scanning laser ophthalmoscopy and optical coherence tomography.

In vivo imaging of human retinal ganglion cells using optical coherence tomography without adaptive optics

Retinal ganglion cells play an important role in human vision, and their degeneration results in glaucoma and other neurodegenerative diseases. Imaging these cells in the living human retina can greatly improve the diagnosis and treatment of glaucoma. However, owing to their translucent soma and tight packing arrangement within the ganglion cell layer (GCL), successful imaging has only been achieved with sophisticated research-grade adaptive optics (AO) systems. For the first time we demonstrate that GCL somas can be resolved and cell morphology can be quantified using non-AO optical coherence tomography (OCT) devices with optimal parameter configuration and post-processing.

Modeling Human Macular Cone Photoreceptor Spatial Distribution

Purpose

The purpose of this study was to investigate the spatial distribution of human cone photoreceptors and examine cone density differences between the retinal meridians and quadrants.

Method

Using adaptive optics scanning laser ophthalmoscopy, the maculae were imaged in 17 eyes of 11 subjects with normal chorioretinal health aged 54 to 72 years. We measured cone density at 325 points within the central 10 degrees radius of the retina. Cone density spatial distributions along the primary retinal meridians and in four macular quadrants (superior-nasal, superior-temporal, inferior-temporal, and inferior-nasal) were analytically modeled using the polynomial function to assess the meridional and quadrantal difference.

Results

The mean and 95% confidence interval for the prediction of cone density along the primary retinal meridians was modeled with a 7-degree one-variable polynomial (R2 = 0.9761, root mean squared error [RMSE] = 0.0585). In the 4 retinal quadrants, cone density distribution was described by a 2-variable polynomial with X degree 3 and Y degree 4 (R² = 0.9834, RMSE = 0.0377). The models suggest no statistically significant difference between medians and between quadrants. However, cone density difference at corresponding spatial locations in different areas can be up to 25.6%. The superior-nasal region has more areas with high cone density, followed by quadrants of inferior-nasal, inferior-temporal, and superior-temporal.

Conclusions

Analytical modeling provides comprehensive knowledge of cone distribution across the entire macula. Although modeling analysis suggests no statistically significant difference between medians and between quadrants, the remarkable cone density discrepancies in certain regions should be accounted for in applications requiring sensitive detection of cone variation.

Quantitative Analysis of the Vasculature and Cone Photoreceptors in Subjects With Diabetes Without Diabetic Retinopathy

PURPOSE

To characterize any differences in the vasculature and cone photoreceptor packing geometry (CPG) between subjects with diabetes without/no diabetic retinopathy (NDR) and healthy controls.

METHODS

Eight NDR and five controls were enrolled. Optical coherence tomography angiography (OCTA) taken at the macula was used to measure vessel density, vessel length density, and vessel density index (VDI) in three vascular plexuses, namely, the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus (DCP). The choriocapillaris (CC) flow deficit (FD) was also measured. OCTA images were binarized and processed to extrapolate the parafovea and parafoveal quadrants and the OCTA indices mentioned above. The CC was processed with six different radii to quantify FD. Adaptive optics - scanning laser ophthalmoscopy images were acquired and processed to extract CPG indices, i.e., cone density (CD), cone-to-cone spacing (CS), linear dispersion index, heterogeneity packing index and percent of cells with six neighbors at 3.6° in the temporal retina.

RESULTS

In all eyes, statistically significant differences were found (i) in parafoveal FD across the six radii (p < 0.001) and (ii) in the correlation between the parafoveal temporal quadrant (PTQ) DCP VDI and CS (r = 0.606, p = 0.048). No other significant correlations were found. For OCTA or CPG indices, no significant differences were found between the cohorts in the parafovea or parafoveal quadrants.

CONCLUSIONS

CS is the most sensitive CPG index for detecting alterations in the cone mosaic. The DCP and the cone photoreceptors are significantly correlated, indicating that alterations in the DCP can affect the cones. Future work elucidating the vascular alterations and neurodegeneration present in diabetic eyes should focus on the DCP and multiple CPG indices, not solely CD. Moreover, such alterations are highly localized, hence using larger regions e.g. parafovea versus smaller areas, such as the PTQ, will potentially mask significant correlations.

"Hidden phase" in two-wavelength adaptive optics

Two-wavelength adaptive optics (AO), where sensing and correcting (from a beacon) are performed at one wavelength λ B and compensation and observation (after transmission through the atmosphere) are performed at another λ T , has historically been analyzed and practiced assuming negligible irradiance fluctuations (i.e., weak scintillation). Under these conditions, the phase corrections measured at λ B are robust over a relatively large range of wavelengths, resulting in a negligible decrease in AO performance. In weak-to-moderate scintillation conditions, which result from distributed-volume atmospheric aberrations, the pupil-phase function becomes discontinuous, producing what Fried called the "hidden phase" because it is not sensed by traditional least-squares phase reconstructors or unwrappers. Neglecting the hidden phase has a significant negative impact on AO performance even with perfect least-squares phase compensation. To the authors' knowledge, the hidden phase has not been studied in the context of two-wavelength AO. In particular, how does the hidden phase sensed at λ B relate to the compensation (or observation) wavelength λ T ? If the hidden phase is highly correlated across λ B and λ T , like the least-squares phase, it is worth sensing and correcting; otherwise, it is not. Through a series of wave optics simulations, we find an approximate expression for the hidden-phase correlation coefficient as a function of λ B , λ T , and the scintillation strength. In contrast to the least-squares phase, we determine that the hidden phase (when present) is correlated over a small band of wavelengths centered on λ T . Over the range λ B ,λ T ∈[1,3]µm and in weak-to-moderate scintillation conditions (spherical-wave log-amplitude variance σ χ2∈[0.1,0.5]), we find the average hidden-phase correlation linewidth to be approximately 0.35 µm. Consequently, for |λ B -λ T | greater than this linewidth, including the hidden phase does not significantly improve AO performance over least-squares phase compensation.

Cone-Opponent Ganglion Cells in the Primate Fovea Tuned to Noncardinal Color Directions

A long-standing question in vision science is how the three cone photoreceptor types-long (L), medium (M), and short (S) wavelength sensitive-combine to generate our perception of color. Hue perception can be described along two opponent axes: red-green and blue-yellow. Psychophysical measurements of color appearance indicate that the cone inputs to the red-green and blue-yellow opponent axes are M vs. L + S and L vs. M + S, respectively. However, the "cardinal directions of color space" revealed by psychophysical measurements of color detection thresholds following adaptation are L vs. M and S vs. L + M. These cardinal directions match the most common cone-opponent retinal ganglion cells (RGCs) in the primate retina. Accordingly, the cone opponency necessary for color appearance is thought to be established in the cortex. While neurons with the appropriate M vs. L + S and L vs. M + S opponency have been reported in the retina and lateral geniculate nucleus, their existence continues to be debated. Resolving this long-standing debate is necessary because a complete account of the cone opponency in the retinal output is critical for understanding how downstream neural circuits process color. Here, we performed adaptive optics calcium imaging to noninvasively measure foveal RGC light responses in the living Macaca fascicularis eye. We confirm the presence of L vs. M + S and M vs. L + S neurons with noncardinal cone opponency and demonstrate that cone-opponent signals in the retinal output are more diverse than classically thought.

Semi-supervised generative adversarial learning for denoising adaptive optics retinal images

This study presents denoiseGAN, a novel semi-supervised generative adversarial network, for denoising adaptive optics (AO) retinal images. By leveraging both synthetic and real-world data, denoiseGAN effectively addresses various noise sources, including blur, motion artifacts, and electronic noise, commonly found in AO retinal imaging. Experimental results demonstrate that denoiseGAN outperforms traditional image denoising methods and the state-of-the-art conditional GAN model, preserving retinal cell structures and enhancing image contrast. Moreover, denoiseGAN aids downstream analysis, improving cell segmentation accuracy. Its 30% faster computational efficiency makes it a potential choice for real-time AO image processing in ophthalmology research and clinical practice.

Substrip-based registration and automatic montaging of adaptive optics retinal images

Precise registration and montage are critical for high-resolution adaptive optics retinal image analysis but are challenged by rapid eye movement. We present a substrip-based method to improve image registration and facilitate the automatic montaging of adaptive optics scanning laser ophthalmoscopy (AOSLO). The program first batches the consecutive images into groups based on a translation threshold and selects an image with minimal distortion within each group as the reference. Within each group, the software divides each image into multiple strips and calculates the Normalized Cross-Correlation with the reference frame using two substrips at both ends of the whole strip to estimate the strip translation, producing a registered image. Then, the software aligns the registered images of all groups also using a substrip based registration, thereby generating a montage with cell-for-cell precision in the overlapping areas of adjacent frames. The algorithm was evaluated with AOSLO images acquired in human subjects with normal macular health and patients with age-related macular degeneration (AMD). Images with a motion amplitude of up to 448 pixels in the fast scanner direction over a frame of 512 × 512 pixels can be precisely registered. Automatic montage spanning up to 22.6 degrees on the retina was achieved on a cell-to-cell precision with a low misplacement rate of 0.07% (11/16,501 frames) in normal eyes and 0.51% (149/29,051 frames) in eyes with AMD. Substrip based registration significantly improved AOSLO registration accuracy.

Multifunctional adaptive optics optical coherence tomography allows cellular scale reflectometry, polarimetry, and angiography in the living human eye

Clinicians are unable to detect glaucoma until substantial loss or dysfunction of retinal ganglion cells occurs. To this end, novel measures are needed. We have developed an optical imaging solution based on adaptive optics optical coherence tomography (AO-OCT) to discern key clinical features of glaucoma and other neurodegenerative diseases at the cellular scale in the living eye. Here, we test the feasibility of measuring AO-OCT-based reflectance, retardance, optic axis orientation, and angiogram at specifically targeted locations in the living human retina and optic nerve head. Multifunctional imaging, combined with focus stacking and global image registration algorithms, allows us to visualize cellular details of retinal nerve fiber bundles, ganglion cell layer somas, glial septa, superior vascular complex capillaries, and connective tissues. These are key histologic features of neurodegenerative diseases, including glaucoma, that are now measurable in vivo with excellent repeatability and reproducibility. Incorporating this noninvasive cellular-scale imaging with objective measurements will significantly enhance existing clinical assessments, which is pivotal in facilitating the early detection of eye disease and understanding the mechanisms of neurodegeneration.

Two-photon excitation fluorescence in ophthalmology: safety and improved imaging for functional diagnostics

Two-photon excitation fluorescence (TPEF) is emerging as a powerful imaging technique with superior penetration power in scattering media, allowing for functional imaging of biological tissues at a subcellular level. TPEF is commonly used in cancer diagnostics, as it enables the direct observation of metabolism within living cells. The technique is now widely used in various medical fields, including ophthalmology. The eye is a complex and delicate organ with multiple layers of different cell types and tissues. Although this structure is ideal for visual perception, it generates aberrations in TPEF eye imaging. However, adaptive optics can now compensate for these aberrations, allowing for improved imaging of the eyes of animal models for human diseases. The eye is naturally built to filter out harmful wavelengths, but these wavelengths can be mimicked and thereby utilized in diagnostics via two-photon (2Ph) excitation. Recent advances in laser-source manufacturing have made it possible to minimize the exposure of in vivo measurements within safety, while achieving sufficient signals to detect for functional images, making TPEF a viable option for human application. This review explores recent advances in wavefront-distortion correction in animal models and the safety of use of TPEF on human subjects, both of which make TPEF a potentially powerful tool for ophthalmological diagnostics.

Adaptive optics imaging in inherited retinal diseases: A scoping review of the clinical literature

Adaptive optics (AO) imaging enables direct, objective assessments of retinal cells. Applications of AO show great promise in advancing our understanding of the etiology of inherited retinal disease (IRDs) and discovering new imaging biomarkers. This scoping review systematically identifies and summarizes clinical studies evaluating AO imaging in IRDs. Ovid MEDLINE and EMBASE were searched on February 6, 2023. Studies describing AO imaging in monogenic IRDs were included. Study screening and data extraction were performed by 2 reviewers independently. This review presents (1) a broad overview of the dominant areas of research; (2) a summary of IRD characteristics revealed by AO imaging; and (3) a discussion of methodological considerations relating to AO imaging in IRDs. From 140 studies with AO outcomes, including 2 following subretinal gene therapy treatments, 75% included fewer than 10 participants with AO imaging data. Of 100 studies that included participants' genetic diagnoses, the most common IRD genes with AO outcomes are CNGA3, CNGB3, CHM, USH2A, and ABCA4. Confocal reflectance AO scanning laser ophthalmoscopy was the most reported imaging modality, followed by flood-illuminated AO and split-detector AO. The most common outcome was cone density, reported quantitatively in 56% of studies. Future research areas include guidelines to reduce variability in the reporting of AO methodology and a focus on functional AO techniques to guide the development of therapeutic interventions.

Evaluation of Foveal Cone and Müller Cells in Epiretinal Membrane using Adaptive Optics OCT

Objective

To investigate cellular-level morphological alterations in the retinal neuroglia in eyes with epiretinal membrane (ERM).

Design

Prospective cross-sectional, observational study (November 2020-May 2022).

Subjects and Controls

We included 41 eyes with unilateral idiopathic ERM and 33 healthy eyes of healthy volunteers.

Methods

We examined the foveal microstructures in all eyes using adaptive optics OCT (AO-OCT) with axial and lateral resolutions of 3.4 and 3.0 μm, respectively. Adaptive optics OCT images were acquired for a 2.5° (728 μm) area at the foveal center.

Main Outcome Measures

Foveal microstructures on AO-OCT images, best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution units, and associations between these parameters.

Results

Adaptive optics OCT imaging of healthy eyes and eyes with ERM revealed sharp hyperreflective lines of the external limiting membrane (ELM), accompanied by hyporeflective gaps, individual nuclei of the foveal cone photoreceptors, and Müller cell bodies. The arrangement of Müller cell bodies was more vertical in eyes with ERM than in normal eyes. Epiretinal membranes adhered to foveal Müller cells via the internal limiting membrane (ILM), exerting vertical traction that pulled the foveal cones anteriorly. Adaptive optics OCT also enabled visualization of outer segment (OS) discs. Hyperreflective changes in the OS discs were observed beneath the vertically thickened ellipsoid zone (EZ) in 15 eyes (36.6%) with ERM. For eyes with ERM, multiple regression analysis showed that the length from ILM to the inner border of the outer nuclear layer and the EZ thickness were significantly associated with BCVA (β = 5.3 × 10-4 and 82.7 × 10-4, respectively), with associated 95% confidence intervals of 1.3 × 10-4 to 9.3 × 10-4 (P = 0.011) and 39.0 × 10-4 to 126.5 × 10-4 (P < 0.001), respectively. The EZ thickness was significantly and positively associated with the length from ELM to the retinal pigment epithelium (β = 23.9 × 10-2, 95% confidence interval: 4.8 × 10-2 to 42.9 × 10-2; P = 0.015).

Conclusions

Cellular imaging of retinal neuroglia by AO-OCT may suggest possible mechanisms associated with visual impairment in patients with ERM, which could potentially contribute to the growing body of knowledge on its pathophysiology. However, these insights require further validation through extensive studies to fully ascertain their significance.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Cone Density Is Correlated to Outer Segment Length and Retinal Thickness in the Human Foveola

Purpose

Assessment of the relationship between in vivo foveolar cone density, cone outer segment length (OSL), and foveal retinal thickness (RT).

Methods

Foveolar cone density maps covering the central ±300 µm of the retina were derived from adaptive optics scanning laser ophthalmoscopy images. The corresponding maps of foveal cone OSL and RT were derived from high-resolution optical coherence tomography volume scans. Alignment of the two-dimensional maps containing OSL and RT with the cone density map was achieved by placing the location of maximum OSL on the cone density centroid (CDC).

Results

Across 10 participants (27 ± 9 years; 6 female), cone density at the CDC was found to be between 147,038 and 215,681 cones/mm². The maximum OSL and minimum RT were found to lie between 31 and 40, and 193 and 226 µm, respectively. A significant correlation was observed between cone density at the CDC and maximum OSL (P = 0.001), as well as the minimal RT (P < 0.05). Across all participants, the best fit for the relationship between normalized cone density and normalized OSL within the central 300 µm was given by a quadratic function.

Conclusions

Using optical coherence tomography-derived measurements of OSL enables to estimate CDC cone density and two-dimensional foveal cone density maps for example in patient eyes unsuitable for adaptive optics imaging. Furthermore, the observation of a fixed relationship between the normalized OSL and cone density points to a conserved mechanism shaping the foveal pit.

Adaptive vessel tracing and segmentation in OCT enables the robust detection of wall-to-lumen ratio abnormalities in 5xFAD mice

The wall-to-lumen ratio (WLR) of retinal blood vessels promises a sensitive marker for the physiological assessment of eye conditions. However, in vivo measurement of vessel wall thickness and lumen diameter is still technically challenging, hindering the wide application of WLR in research and clinical settings. In this study, we demonstrate the feasibility of using optical coherence tomography (OCT) as one practical method for in vivo quantification of WLR in the retina. Based on three-dimensional vessel tracing, lateral en face and axial B-scan profiles of individual vessels were constructed. By employing adaptive depth segmentation that adjusts to the individual positions of each blood vessel for en face OCT projection, the vessel wall thickness and lumen diameter could be reliably quantified. A comparative study of control and 5xFAD mice confirmed WLR as a sensitive marker of the eye condition.

Cellular-Level Visualization of Retinal Pathology in Multiple Sclerosis With Adaptive Optics

Purpose

To apply adaptive optics-optical coherence tomography (AO-OCT) to quantify multiple sclerosis (MS)-induced changes in axonal bundles in the macular nerve fiber layer, ganglion cell somas, and macrophage-like cells at the vitreomacular interface.

Methods

We used AO-OCT imaging in a pilot study of MS participants (n = 10), including those without and with a history of optic neuritis (ON, n = 4), and healthy volunteers (HV, n = 9) to reveal pathologic changes to inner retinal cells and structures affected by MS.

Results

We found that nerve fiber layer axonal bundles had 38% lower volume in MS participants (1.5 × 10-3 mm3) compared to HVs (2.4 × 10-3 mm3; P < 0.001). Retinal ganglion cell (RGC) density was 51% lower in MS participants (12.3 cells/mm2 × 1000) compared to HVs (25.0 cells/mm2 × 1000; P < 0.001). Spatial differences across the macula were observed in RGC density. RGC diameter was 15% higher in MS participants (11.7 µm) compared to HVs (10.1 µm; P < 0.001). A nonsignificant trend of higher density of macrophage-like cells in MS eyes was also observed. For all AO-OCT measures, outcomes were worse for MS participants with a history of ON compared to MS participants without a history of ON. AO-OCT measures were associated with key visual and physical disabilities in the MS cohort.

Conclusions

Our findings demonstrate the utility of AO-OCT for highly sensitive and specific detection of neurodegenerative changes in MS. Moreover, the results shed light on the mechanisms that underpin specific neuronal pathology that occurs when MS attacks the retina. The new findings support the further development of AO-based biomarkers for MS.

Cone-Opponent Ganglion Cells in the Primate Fovea Tuned to Non-Cardinal Color Directions

A long-standing question in vision science is how the three cone photoreceptor types - long (L), medium (M) and short (S) wavelength sensitive - combine to generate our perception of color. Hue perception can be described along two opponent axes: red-green and blue-yellow. Psychophysical measurements of color appearance indicate that the cone inputs to the red-green and blue-yellow opponent axes are M vs. L+S and L vs. M+S, respectively. However, the "cardinal directions of color space" revealed by psychophysical measurements of color detection thresholds are L vs. M and S vs. L+M. The cardinal directions match the most common cone-opponent retinal ganglion cells (RGCs) in the primate retina. Accordingly, the cone opponency necessary for color appearance is thought to be established in cortex. However, small populations with the appropriate M vs. L+S and L vs. M+S cone-opponency have been reported in large surveys of cone inputs to primate RGCs and their projections to the lateral geniculate nucleus (LGN) yet their existence continues to be debated. Resolving this long-standing open question is needed as a complete account of the cone-opponency in the retinal output is critical for efforts to understand how downstream neural circuits process color. Here, we performed adaptive optics calcium imaging to longitudinally and noninvasively measurements of the foveal RGC light responses in the living macaque eye. We confirm the presence of L vs. M+S and M vs. L+S neurons with non-cardinal cone-opponency and demonstrate that cone-opponent signals in the retinal output are substantially more diverse than classically thought.

Characteristics of Rare Inherited Retinal Dystrophies in Adaptive Optics-A Study on 53 Eyes

Inherited retinal dystrophies (IRDs) are genetic disorders that lead to the bilateral degeneration of the retina, causing irreversible vision loss. These conditions often manifest during the first and second decades of life, and their primary symptoms can be non-specific. Diagnostic processes encompass assessments of best-corrected visual acuity, fundoscopy, optical coherence tomography, fundus autofluorescence, fluorescein angiography, electrophysiological tests, and genetic testing. This study focuses on the application of adaptive optics (AO), a non-invasive retinal examination, for the assessment of patients with IRDs. AO facilitates the high-quality, detailed observation of retinal photoreceptor structures (cones and rods) and enables the quantitative analysis of parameters such as cone density (DM), cone spacing (SM), cone regularity (REG), and Voronoi analysis (N%6). AO examinations were conducted on eyes diagnosed with Stargardt disease (STGD, N=36), cone dystrophy (CD, N=9), and cone-rod dystrophy (CRD, N=8), and on healthy eyes (N=14). There were significant differences in the DM, SM, REG, and N%6 parameters between the healthy and IRD-affected eyes (p<0.001 for DM, SM, and REG; p=0.008 for N%6). The mean DM in the CD, CRD, and STGD groups was 8900.39/mm2, 9296.32/mm2, and 16,209.66/mm2, respectively, with a significant inter-group difference (p=0.006). The mean SM in the CD, CRD, and STGD groups was 12.37 μm, 14.82 μm, and 9.65 μm, respectively, with a significant difference observed between groups (p=0.002). However, no significant difference was found in REG and N%6 among the CD, CRD, and STGD groups. Significant differences were found in SM and DM between CD and STGD (p=0.014 for SM; p=0.003 for DM) and between CRD and STGD (p=0.027 for SM; p=0.003 for DM). Our findings suggest that AO holds significant potential as an impactful diagnostic tool for IRDs.

Introduction to Visual and Physiological Optics feature issue of Biomedical Optics Express and JOSA A

This feature issue collects articles presented at the tenth Visual and Physiological Optics meeting (VPO2022), held August 29-31, 2022, in Cambridge, UK. This joint feature issue between Biomedical Optics Express and Journal of the Optical Society of America A includes articles that cover the broad range of topics addressed at the meeting and examples of the current state of research in the field.

Visual and Physiological Optics: introduction to the joint feature issue in Biomedical Optics Express and Journal of the Optical Society of America A

This feature issue collects articles presented at the tenth Visual and Physiological Optics meeting (VPO2022), held August 29-31, 2022, in Cambridge, UK. This joint feature issue between Biomedical Optics Express and Journal of the Optical Society of America A includes articles that cover the broad range of topics addressed at the meeting and examples of the current state of research in the field.

Introduction to the Feature Issue on Adaptive Optics for Biomedical Applications

The guest editors introduce a feature issue commemorating the 25th anniversary of adaptive optics in biomedical research.