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ARVO 2015 Annual Meeting Abstracts
414 Novel ophthalmic imaging
Wednesday, May 06, 2015 8:30 AM–10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 4079–4125/B0001–B0047
Organizing Section: Multidisciplinary Ophthalmic Imaging Group
Contributing Section(s): Cornea, Retina, Visual Psychophysics/
Physiological Optics
Program Number: 4079 Poster Board Number: B0001
Presentation Time: 8:30 AM–10:15 AM
Relationship between visual brain connectivity and duration of
blindness depends on onset of visual deprivation
Kevin C. Chan1, 2, Matthew C. Murphy1, 2, Christopher Fisher2,
Seong-Gi Kim1, 4, Joel S. Schuman2, 3, Amy C. Nau2. 1NeuroImaging
Laboratory, University of Pittsburgh, Pittsburgh, PA; 2UPMC
Eye Center, Eye and Ear Institute, Ophthalmology and Visual
Science Research Center, Department of Ophthalmology, School
of Medicine, University of Pittsburgh, Pittsburgh, PA; 3Department
of Bioengineering, Swanson School of Engineering, University
of Pittsburgh, Pittsburgh, PA; 4Center for Neuroscience Imaging
Research, Institute for Basic Science, Sungkyunkwan University,
Suwon, Korea (the Republic of).
Purpose: Visual deprivation is known to induce plasticity of
the visual system, which can be observed through alterations in
functional brain connectivity (FC) by functional MRI (fMRI).
How these FC changes accrue over time in congenital and acquired
blindness remains uncertain. This work aimed to model the effects of
prior visual experience on visual FC in blind subjects.
Methods: Seven congenitally blind and 11 age-matched acquired
blind subjects underwent 8 minutes of fMRI at rest using a 3 Tesla
scanner. A visual FC map was constructed for each subject by
computing the average correlation coefficient between the extrastriate
visual cortex and each voxel in the brain. We then examined the
effects of visual experience by fitting these FC maps with a linear
model with predictors including duration of blindness, a dummy
variable for congenital blindness, and the interaction of these two
effects. T score maps of these effects were thresholded at a familywise error corrected p<0.01.
Results: From the maps of voxel-wise statistical testing (Fig. 1),
more than 6 times as many voxels in the brain show a significant
group by duration interaction effect (row 4) compared to a simple
correlation with duration of blindness (row 2), indicating that
the relationship between visual FC and duration of blindness is
significantly different between congenital and acquired blindness.
In general, the sign of the correlation between FC and duration
of blindness in congenital subjects is opposite to that in acquired
subjects. Similar findings are observed when using striate cortex
instead of extrastriate cortex as the seed region of interest (data not
shown).
Conclusions: This work represents an early step toward
understanding plasticity in the visual system and how it depends upon
prior visual experience. These results suggest that alterations in FC
due to visual deprivation progress over time but in opposite directions
between congenital and acquired blindness. Our findings indicate that
longitudinal measures of FC and not only FC alone may be essential
for characterizing the state of the visual system.
Figure 1. Summary of voxel-wise statistical testing (FWE corrected
p<0.01). Row 1: T score for average visual FC map for all subjects.
Row 2: T score for significant relationship between FC and duration
of blindness. Row 3: T score for group-wise differences. Row 4: T
score for group by duration interaction.
Commercial Relationships: Kevin C. Chan, None; Matthew C.
Murphy, None; Christopher Fisher, None; Seong-Gi Kim, None;
Joel S. Schuman, Zeiss, Inc. (P); Amy C. Nau, None
Support: NIH Grant P30 EY008098 and T32-EY017271 (Bethesda,
MD); US Department of Defense DM090217; Alcon Research
Institute Young Investigator Grant (Basel, Switzerland); Eye and
Ear Foundation (Pittsburgh, PA); Research to Prevent Blindness
(New York, NY); Aging Institute Pilot Seed Grant, University of
Pittsburgh; Louis J. Fox Center for Vision Restoration of UPMC and
the University of Pittsburgh
Program Number: 4080 Poster Board Number: B0002
Presentation Time: 8:30 AM–10:15 AM
In vivo MR Diffusion Weighted Imaging at 7 Tesla – feasibility
study in healthy subjects and patients with different ophthalmic
disease
Tobias Lindner1, Katharina Paul2, Andreas Graessl2, Jan Rieger3, Till
Huelnhagen2, Paul-Christian Krueger4, Anselm Juenemann5, Soenke
Langner4, Thoralf Niendorf2, 3, Oliver Stachs5. 1Preclinical Imaging
Research Group, University Medicine Rostock, Rostock, Germany;
2
Berlin Ultrahigh Field Facility, Max-Delbrueck Center for Molecular
Medicine, Berlin, Germany; 3MRI Tools, Berlin, Germany; 4Institute
for Diagnostic Radiology and Neuroradiology, University Medicine
Greifswald, Greifswald, Germany; 5Department of Ophthalmology,
University Medicine Rostock, Rostock, Germany.
Purpose: Diffusion-weighted imaging (DWI) of the eye and orbit
is an emerging MRI application for ophthalmic research, preclinical
imaging and diagnostic radiology. DWI probes and depicts selfdiffusion of water in tissue on a microscopic scale and holds
the promise to enhance diagnostic accuracy and provide further
physiological information for different ophthalmic disease. The
purpose of this study was to show the feasibility of in vivo DWI at 7
T with diffusion sensitized multi-shot RARE sequences.
Methods: In vivo MR imaging and DWI was performed at 7T in
healthy subjects (n=5), patients with uveal melanoma and/or retinal
detachment (n=5) and a patient with optic nerve glioma. A dedicated
six element transmit and receive coil array was employed at 7.0 T
and high resolution T1 weighted 3D FLASH imaging (TR=710.3ms,
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
TE=3.6ms, spatial resolution = (0.3x0.3x1.0)mm3 and T2-weighted
RARE imaging (TR=2940ms, TE=54ms, spatial resolution =
(0.25x0.28x1.0)mm3 were conducted for anatomical imaging. For
ADC mapping diffusion sensitized multi-shot RARE was used (7.0 T:
TR=3000ms, TE=133ms, spatial resolution = (0.4x0.4x3.0)mm3). For
diffusion sensitization b-values ranging from b=0 s/mm2 to b=400 s/
mm2 were employed. To reduce eye movement during imaging the
subjects followed an optoacoustic trigger protocol.
Results: The in vivo ADC map of patients with ocular mass
clearly delineates hypointense tumor from the surrounding modest
hypointense hemorrhage and the hyperintense vitreous body. These
ADC differences induced an ample contrast between the subretinal
hemorrhage and the tumor. ADC map of orbita in a patient with optic
nerve glioma showed ample ADC contrast versus the subarachnoid
space. The ADC map of the eye and optic nerve yielded a delineation
of the tumor which is superior to the contrast in the T2 weighted
images.
Conclusions: This work demonstrates the feasibility of in vivo
MR microscopy and diffusion sensitized ms-RARE of the eye and
optic nerve at 7.0T including T1w, T2w anatomical imaging along
with DWI and ADC mapping. This study showed that ms-RARE
based techniques offer immunity to B0 inhomogeneities and hence
are particularly suited for ophthalmic DWI. This is of clinical
relevance since single-shot echo planar imaging is prone to magnetic
susceptibility artifacts induced by the air filled nasal cavities and
frontal sinuses surrounding the eye.
Commercial Relationships: Tobias Lindner, None; Katharina
Paul, None; Andreas Graessl, None; Jan Rieger, MRI Tools (E);
Till Huelnhagen, None; Paul-Christian Krueger, None; Anselm
Juenemann, None; Soenke Langner, None; Thoralf Niendorf,
MRI Tools (S); Oliver Stachs, None
Program Number: 4081 Poster Board Number: B0003
Presentation Time: 8:30 AM–10:15 AM
Fundus Changes in Highly Myopic Eyes with Different Shapes
Identified by High-resolution Three-dimensional Magnetic
Resonance Imaging
Xinxing Guo1, Ou Xiao1, Yanxian Chen1, Mingguang He1, 2. 1Division
of Preventive Ophthal, Zhongshan Ophthalmic Center, Guangzhou,
China; 2Centre for Eye Research Australia, University of Melbourne,
Melbourne, VIC, Australia.
Purpose: High myopia is often associated with elongation and
distortion of the globe, and at greater risk of developing pathologic
changes. Lack of topographic and morphologic assessments hinders
the understanding towards the natural history and mechanism in its
development. We evaluated the fundus changes in high myopia by
analyzing the eye shapes using three-dimensional (3D) magnetic
resonance imaging (MRI) in a case series study.
Methods: A total of 95 patients with high myopia (spherical power ≤
-6.00D) in both eyes underwent a series of ophthalmic examinations.
Eye shapes were categorized into spherical, ellipsoidal, cylindrical,
nasal-distorted, temporal-distorted and barrel-shaped according
to the inferior view from T2-weighted 3D MRI images (Achieva
3.0T, Philips Medical Systems, Best, the Netherlands); posterior
staphyloma was also identified. Fundus lesions were determined
using two 45° photos centered at macula and optic nerve by dilated
fundus photography (Canon Inc., Tokyo, Japan). The distributions of
various fundus characteristics in different eye shape categories were
analyzed using one-way ANOVA and Mann-Whitney Wilcoxon tests.
Results: The participants consisted 48.4% females, had a mean age
of 32.0±14.0 years old, spherical equivalence of -11.00±7.44D and
axial length (AL) of 28.18±1.73mm. The same ocular shapes between
the two eyes were observed in 72.6% of the patients. The most
predominant shape in the right eye was spherical (54.3%), followed
by nasal-distorted (16.0%) and cylindrical (14.9%). Barrel-shaped
eyes had the longest AL and most outstanding fundus changes.
Diffuse chorioretinal atrophy and larger peripapillary atrophy (PPA)
were more frequently observed in barrel-shaped (100.0%, 4.7±2.7
disc area, DA) and nasally distorted (73.3%, 2.5±2.5 DA) eyes;
While diffuse (77.3%) and patchy (22.7%) chorioretinal atrophy, as
well as fundus staphyloma (72.7%) were more common in eyes with
posterior staphyloma (n=22) determined by 3D MRI.
Conclusions: Barrel-shaped eyes present most significant visionthreatening conditions, while eyes with posterior staphyloma display
more severe chorioretinal atrophy. Our findings suggest different
topographic and morphologic patterns may be involved in the
development of high myopia.
Different eye shapes and corresponding fundus images
Commercial Relationships: Xinxing Guo, None; Ou Xiao, None;
Yanxian Chen, None; Mingguang He, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 4082 Poster Board Number: B0004
Presentation Time: 8:30 AM–10:15 AM
Eye morphology quantitated by magnetic resonance imaging in
C57Bl/6 mice
Tomasz J. Choragiewicz1, Michal Fiedorowicz2, Marlena WelniakKaminska2, Jaroslaw Orzel2, 3, Piotr Bogorodzki2, 3, Robert Rejdak1,
2
, Pawel Grieb2. 1Department of General Ophthalmology, Medical
University of Lublin, Lublin, Poland; 2Mossakowski Medical
Research Centre, Polish Academy of Sciences, Warsaw, Poland;
3
Faculty of Electronics and Information Technology, Warsaw
University of Technology, Warsaw, Poland.
Purpose: Evaluating eye dimensions is crucial in studies of animal
models of eye diseases. However, performing these measurements
in alive mice is challenging. The aim of this study was to develop a
method for quantitating eye morphology using planar surface MRI
coil.
Methods: Aged (18 months) C57Bl/6 female mice (n=5) were
anaesthetized with isoflurane (4% in oxygen – induction, 1.52% - maintenance) and placed in 7T small animal-dedicated
magnetic resonance tomograph (BioSpec 70/30USR; Bruker
BioSpin, Ettlingen, Germany). Small planar surface receive coil
(internal diameter=10 mm, Bruker BioSpin, Ettlingen, Germany)
was placed over left eye of the imaged animal. High resolution
structural imaging with TURBORARE T2 sequence (TR=2700ms,
TEeff=30ms, RARE factor=8, NA=12, spatial resolution=0.062mm x
0.062mm, slice thickness=0.3mm, slices=7, scan time=16min) was
performed. Basic ocular dimensions and anterior chamber angle were
measured manually using OsiriX software (Pixmeo, SARL, Bernex,
Switzerland).
Results: Mean anterior chamber depth in C57Bl/6 mice was 0.464
mm (SD ±0.040) and anterior chamber angle (ACA) 24.98° (SD
±5.599), vitreous chamber depth (VCD) 0.465 mm (SD ±0.033),
axial length (AL) 3.586 mm (SD ±0.079) and horizontal length (HL)
3.394 mm (SD ±0.061) of the eyeball, lens thickness (LT) 2.146 mm
(SD ±0.059) and optic nerve diameter (ON) 0.250 mm (SD ±0.0520),
retinal thickness (RT) 0.206 mm (SD ±0.018).
Conclusions: High resolution magnetic resonance imaging of the
eye with use of small planar coil provide reproducible and consistent
measures of key dimensions of eyeball. These results are consistent
with results obtained with optical coherence tomography in C57Bl/6
mice [Chou et al. 2011, IOVS 52:3604-3612].
Commercial Relationships: Tomasz J. Choragiewicz, None;
Michal Fiedorowicz, None; Marlena Welniak-Kaminska, None;
Jaroslaw Orzel, None; Piotr Bogorodzki, None; Robert Rejdak,
None; Pawel Grieb, None
Support: The study was supported by Polish National Science
Centre grant No. 2012/07/D/NZ4/04199, Tomasz Choragiewicz was
supported by Allergan European Retina Panel II.
Program Number: 4083 Poster Board Number: B0005
Presentation Time: 8:30 AM–10:15 AM
Through the Eyes of the Retinal Surgeon: Google Glass for
Recording Scleral Buckling Surgery
Michelle E. Wilson, Ehsan Rahimy, Sunir J. Garg. Ophthalmology,
Wills Eye Hospital, Philadelphia, PA.
Purpose: Google Glass (Google Inc., Mountain View, CA), with
its point-of-view (POV)-style recording, has the potential to
revolutionize the field of medical education, allowing trainees to see
the various steps of surgical procedures directly from viewpoint of
the operating surgeon. Unlike intraocular surgery, which benefits
from the video documenting capabilities of modern ophthalmic
surgical microscopes, scleral buckling surgery has traditionally been
difficult to record, limiting access to a valuable educational modality.
We report our experience using the Google Glass to record scleral
buckling surgery.
Methods: We recorded and subsequently reviewed both still images
and videos of 3 primary scleral buckling surgeries. We qualitatively
assessed the ability of the recorded material to document key steps in
the scleral buckling procedure, noting overall image quality as well
as factors limiting image quality.
Results: Google Glass was effective in recording the operative field
during each step of the scleral buckling procedure. Still images
(Figure 1) and video clips (Video, Supplemental) obtained provided
sufficient detail to demonstrate the key steps of the procedure.
Optimal image quality was limited by several factors including overor under- illumination and lack of magnification.
Conclusions: The field of medical education has benefited from
new technologies that allow trainees to visualize complex surgical
procedures from the viewpoint of the primary surgeon. The recent
introduction of Google Glass extends this capability to surgical
procedures that do not require an operating microscope and have
traditionally been difficult to record for the purposes of medical
education. Although limited by lighting and magnification, the
point of view recordings created using Google Glass during retinal
buckling surgery are able to document the key steps of the scleral
buckling procedure, providing a valuable tool for surgical teaching.
Scleral buckling surgery as recorded by Google Glass
Commercial Relationships: Michelle E. Wilson, None; Ehsan
Rahimy, None; Sunir J. Garg, None
Program Number: 4084 Poster Board Number: B0006
Presentation Time: 8:30 AM–10:15 AM
Real-Time Swept-Source Microscope-Integrated versus HandHeld Spectral-Domain Optical Coherence Tomography during
Macular Hole Surgery
Michael I. Seider, Oscar Carrasco-Zevallos, Brenton Keller, Joseph
A. Izatt, Cynthia A. Toth, Christian Viehland. Duke University,
Durham, NC.
Purpose: To compare the clinical utility of a novel real-time
swept-source microscope-integrated optical coherence tomography
(SS-MIOCT) system to hand-held spectral-domain OCT (HH-OCT)
during macular hole repair.
Methods: All patients undergoing macular hole repair from 9/1/2014
– 10/31/2014 at the Duke Eye Center by a senior Vitreoretinal
Surgeon (CT) who gave consent were included. During macular
surgery, SS-MIOCT was used for all patients and allowed realtime imaging through the operating microscope. The system has
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
acquisition and processing rates of 2-10 volumes per second and
permitted the creation of volumetric renderings of surgical maneuvers
over time.
HH-OCT (Bioptigen Inc., Morrisville, NC, USA) was also performed
in the operating room at pauses in surgery immediately before and
at the completion of macular surgery. The images produced by both
systems were compared post-operatively.
Results:
Five female and 1 male patient with average age 70 years were
included, contributing three right and three left eyes in total.
SS-MIOCT was able to obtain high-quality, volumetric renderings
of surgical maneuvers in real-time without causing an interruption
in surgery. Particularly striking images documented instruments
brushing the retinal surface and forceps peeling internal limiting
membrane (ILM). SS-MIOCT scans allowed for the characterization
of anatomy-instrument relationships such as the distance of an
instrument from the retinal surface, the retinal deformation created
during scraping and the characteristics of elevated membranes
volumetrically and over time.
Hand-held OCT produced high-resolution two-dimensional scans
at pauses during surgery. These images allowed for the accurate
characterization of the morphology of the macular holes before and
after ILM peeling, and the confirmation of removal of epiretinal
membranes. For the cases of ILM autografting, HH-OCT created
useful images confirming the location of the autograft over the
macular hole.
Conclusions: SS-MIOCT appears to have significant advantages
over HH-OCT during macular hole surgery. SS-MIOCT was able to
capture volumetric scans of surgical maneuvers in real-time without
interrupting surgery whereas HH-OCT was useful for obtaining highquality static images of retinal anatomy during breaks in surgery.
Commercial Relationships: Michael I. Seider, None; Oscar
Carrasco-Zevallos, None; Brenton Keller, None; Joseph A. Izatt,
None; Cynthia A. Toth, None; Christian Viehland, None
Program Number: 4085 Poster Board Number: B0007
Presentation Time: 8:30 AM–10:15 AM
Real-time 4D Stereoscopic Visualization of Human Ophthalmic
Surgery with Swept-Source Microscope Integrated Optical
Coherence Tomography
Oscar Carrasco-Zevallos1, Brenton Keller1, Christian Viehland1,
Liangbo Shen1, Gar Waterman1, Crystal Chukwurah1, Paul Hahn2,
Anthony N. Kuo2, Cynthia A. Toth2, 1, Joseph A. Izatt1, 2. 1Biomedical
Engineering, Duke University, Durham, NC; 2Opthalmology, Duke
University Medical Center, Durham, NC.
Purpose: Ophthalmic surgery is performed with a microscope that
provides limited depth perception. Surgeons often rely on indirect
cues for depth information. Current intraoperative Spectral-Domain
OCT systems are limited to cross-sectional real-time imaging.
Ophthalmic surgery is performed in a 3D surgical field; therefore,
a real-time 3D micron-scale imaging modality could be useful for
surgical feedback and guidance. We report on the development of
4D (volumetric imaging + time) Microscope Integrated OCT (4D
MIOCT) for real-time volumetric visualization of human ophthalmic
surgery.
Methods: The MIOCT sample arm enabled concurrent OCT and
operating microscope imaging. The system employed a custom
swept-source OCT engine operating at 1060 nm. GPU-based custom
software enabled real-time acquisition, processing, and rendering
of volumetric images at 100k A-lines/second. Volumetric frame
rates varied between 2-10 Hz. A custom microscope integrated
stereoscopic heads-up display (HUD) allowed for visualization
of MIOCT volumes through the surgical binoculars. 4D MIOCT
imaging was performed in 25 human surgeries (7 anterior segment,
18 vitreoretinal). Vitreoretinal cases imaged included macular
hole, retinal detachment, and epi-retinal membrane (ERM)
procedures. Anterior segment cases imaged included cataract, deep
anterior lamellar keratoplasty, and Descemet stripping endothelial
keratoplasty procedures.
Results: Figure 1 shows 4D MIOCT imaging of an ERM peel with
surgical forceps during a macular hole surgical case. The time stamps
for each volume in the time series are in seconds. B-scans are shown
below each corresponding volume. The location of the B-scans is
denoted by the white rectangle on the volume view. Surgical camera
frames are shown as well with a yellow rectangle denoting the
MIOCT field of view. Figure 2 illustrates 4D MIOCT imaging of a
cataract case. A-B depict volumes and B-scans acquired at different
stages of cataract surgery. (A) shows the intact cataract. (B) shows
cataract fragmentation with a phacoemulsification needle (red arrow).
(C) shows the anterior segment after cataract removal. (D) shows
intraocular lens (green arrow) insertion.
Conclusions: Real-time, volumetric, micron-scale visualization of
human ophthalmic surgery was performed with 4D MIOCT.
4D MIOCT imaging of an ERM peel.
4D MIOCT imaging of cataract surgery.
Commercial Relationships: Oscar Carrasco-Zevallos, None;
Brenton Keller, None; Christian Viehland, None; Liangbo Shen,
None; Gar Waterman, None; Crystal Chukwurah, None; Paul
Hahn, None; Anthony N. Kuo, Bioptigen (P); Cynthia A. Toth,
Alcon (P), Bioptigen (F), Duke University (P), Genetech (F); Joseph
A. Izatt, Bioptigen (I), Bioptigen (P), Bioptigen (S)
Support: NIH EY023039
Clinical Trial: NCT01588041
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 4086 Poster Board Number: B0008
Presentation Time: 8:30 AM–10:15 AM
Impact of Microscope Integrated OCT on ophthalmology
resident performance of anterior segment maneuvers in model
eyes
Bozho -. Todorich1, Christine Shieh1, Philip DeSouza1, Oscar
Carrasco-Zevallos2, David Cunefare1, Joseph A. Izatt2, Sina Farsiu1,
Prithvi Mruthyunjaya1, Anthony N. Kuo1, Cynthia A. Toth1, 2.
1
Ophthalmology, Duke University, Durham, NC; 2Bioengineering,
Duke University, Durham, NC.
Purpose: The integration of swept-source optical coherence
tomography (SS OCT) in the operating microscope enables realtime, tissue-level imaging to aid in ophthalmic microsurgery. In
this prospective randomized controlled study, we evaluated the
impact of SS microscope-integrated OCT technology (MI OCT) on
ophthalmology residents’ performance in anterior segment surgery.
Methods: Ophthalmology residents (N=14) were recruited, stratified
by year of training, and randomized to perform the following four
anterior segment maneuvers on porcine eyes without (Group A)
or with (Group B) direct MI OCT guidance: 50% and 90% depth
corneal suture passes, repair of vertical linear corneal laceration via
suturing at 90% thickness, and creation of a tri-planar clear corneal
incision. Both groups of residents then repeated the maneuvers
without MI OCT guidance. Lastly, the non MI-OCT controls (Group
A) repeated all maneuvers under direct MI OCT guidance.
Volumetric OCT scans acquired at the end of each maneuver were
manually segmented to compute point of maximal depth of each
corneal pass and tri-planar corneal incision profile. Differences
between Group A and B were compared using one-way ANOVA
(Figure 1A). Subjective feedback through a survey was also obtained
from each resident after they had completed all maneuvers (Figure
1B).
Results: Figure 1 shows the results from Group A (no MIOCT
guidance) and Group B (MIOCT guidance). Residents operating
with direct MI OCT feedback demonstrated enhanced performance
in depth-based anterior segment maneuvers compared to the control
group (p<0.0001). Residents trained with MI OCT continued to
outperform the controls when operating without direct MI OCT
feedback (p<0.0001) (Fig 1A). Surgical performance of residents
who were trained and tested without MI OCT improved to equivalent
performance when given MI OCT feedback. Resident surgeons
rated subjective experience of using MI OCT very favorably and on
average are “more likely” to use it in their future practice (Fig 1B).
Conclusions: Real-time MI OCT guidance improved depth based
surgical maneuvers. MI OCT may be a useful adjunct in surgical
education of ophthalmology residents.
Figure 1. Surgical performance (A) and subjective feedback (B) of
ophthalmology residents with and without MI OCT feedback.
Commercial Relationships: Bozho -. Todorich, None; Christine
Shieh, None; Philip DeSouza, None; Oscar Carrasco-Zevallos,
None; David Cunefare, None; Joseph A. Izatt, Bioptigen
(I), Bioptigen (P), Bioptigen (S); Sina Farsiu, None; Prithvi
Mruthyunjaya, None; Anthony N. Kuo, Bioptigen (P); Cynthia A.
Toth, Alcon (P), Bioptigen (F), Genentech (F)
Support: R01-EY02039 (Toth/Izatt) and Research to Prevent
Blindness grant (DeSouza)
Program Number: 4087 Poster Board Number: B0009
Presentation Time: 8:30 AM–10:15 AM
Macroarchitectural Intraoperative Retinal Alterations Following
Membrane Peeling Visualized with Intraoperative OCT in the
PIONEER Study
Jaehong Han1, 2, Sunil K. Srivastava2, Peter K. Kaiser2, Rishi P.
Singh2, Justis P. Ehlers2. 1Case Western Reserve University School
of Medicine, Cleveland Heights, OH; 2Ophthalmic Imaging Center,
Cole Eye Institute of Cleveland Clinic, Cleveland, OH.
Purpose: To assess the retinal macroarchitectural alterations that
occur during membrane peeling for vitreomacular interface (VMI)
disorders utilizing intraoperative OCT (iOCT)
Methods: The PIONEER study is a prospective study examining
iOCT in ophthalmic surgery. Eyes undergoing membrane peeling
were evaluated with video/iOCT correlation. Clinical variables
assessed included membrane peeling technique (e.g., diamond-dusted
membrane scraper [DDMS], forceps). iOCT images were reviewed
for macroarchitectural changes (e.g., inner and full-thickness retinal
changes). A microscope mounted portable SD-OCT probe (Bioptigen,
Research Triangle Park, NC) was used to obtain preincision and
post-peel iOCT images. Postoperative OCT images were analyzed at
1 week and 1 month.
Results: Of the total 163 eyes, post-peel retinal changes were noted
by iOCT in 45 eyes (28%). Inner retinal elevations were noted in 38
eyes (23%), and 8 eyes (5%) had full-thickness retinal elevations.
Based on video/iOCT correlation, 95% of the retinal changes
correlated with instrument utilization. Direct peel initiation resulted
in 47% of the changes and indirect pulling during completion of
peel resulted in 48% of the changes. The retinal elevations occurred
in 33% of the eyes when using forceps-only and in 23% of the eyes
when using both forceps and a DDMS (p= 0.16, chi square). At
1-week post-op, 19% of the retinal changes persisted as focal inner
retinal thickening or thinning. No full-thickness retinal changes
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
persisted. At 1-month post-op, 60% of inner retinal thickening had
resolved, while all focal retinal thinning persisted.
Conclusions: Significant subclinical macroarchitectural changes
occur during membrane peeling for VMI conditions that are
directly related to instrument manipulations. iOCT technology is
able to identify these changes. There was a trend towards increased
alterations with forceps-only technique compared to using a DDMS
for peel initiation. Inner retinal changes persisted in many eyes at
1 month postoperatively. Further research is needed on the visual
effects of these changes and how to minimize these changes during
surgery.
A: preincision iOCT image; B: post-peel iOCT image; C: iOCTgenerated fundus map; D: correlated surgery video
Program Number: 4088 Poster Board Number: B0010
Presentation Time: 8:30 AM–10:15 AM
Evaluation of a Surgical Microscope Interfaced SD-OCT system
for Anterior Segment Surgery
Marco Ruggeri1, Florence Cabot1, Sonia H. Yoo1, Jean-Marie A.
Parel1, 2. 1Ophthalmology, Bascom Palmer Eye Inst, Univ of Miami,
Miami, FL; 2Vision Cooperative Research Centre, Brien Holden
Vision Institute, UNSW, Sydney, NSW, Australia.
Purpose: To evaluate the use of an intraoperative SD-OCT system
that attaches to an ophthalmic operating microscope (OPMI) for ondemand OCT guided anterior segment (AS) surgery.
Methods: We used a commercial prototype (Bioptigen, Inc.)
that consists of a compact OCT delivery console connected to a
transportable cart that houses an SD-OCT engine, a computer for
image acquisition and processing and a monitor for image display.
The system provides near 9mm axial resolution over an imaging
depth of 15.4 mm in air. The scanning console can attach to several
commercial OPMI models and includes a proprietary microscope
objective with a focal length of 175 mm, a two axes OCT scanning
mechanism and the optics to combine the OCT scanning beam with
the illumination and viewing paths of the host OPMI. The delivery
console is setup by removing the original microscope objective lens
from the host OPMI and by securing the scanning head enclosure to
the dovetail connection of the host OPMI. Prior to surgery, the OCT
delivery unit was attached to the OPMI and the cart was deployed
near the bedside so that intraoperative OCT images of the surgical
site could be displayed in real-time to the surgeon using the computer
monitor.
Results: Under an IRB approved protocol, 4 patients who underwent
AS surgical procedures including cataract and DSAEK surgeries
were imaged intraoperatively. Surgeries were uneventful. The system
enabled displaying the images to the surgeon without interrupting
the surgical maneuvers or blocking the OPMI view. The distance
of 167 mm between the microscope objective and the patient eye
provided enough room for the surgeon to operate comfortably. The
compact surgical OCT interface did not interfere with the sterile field
and the standard operations performed by the surgical staff. Preoperatively, the system enabled to confirm that the AS did not show
any abnormality. Throughout DSAEK surgeries, the long imaging
depth and the volumetric capability of the SD-OCT system enabled
to verify optimal adhesion of the entire graft to the host cornea in 3D.
Throughout cataract surgery the system enabled to verify the integrity
of the capsule and the final position of the intraocular lens.
Conclusions: The intraoperative SD-OCT system can be easily
and safely used to assist the surgeon for AS surgeries. This tool
has potential to improve the outcome of DSAEK and help with
challenging cases of cataract surgery.
A, B: preoperative OCT-generated fundus map and OCT image; C,
D: postoperative OCT-generated fundus map and OCT image
Commercial Relationships: Jaehong Han, None; Sunil K.
Srivastava, Allergan (R), Baucsh and Lomb (C), Baucsh and Lomb
(R), Bioptigen (P), Carl Zeiss Meditec (C), Leica (C), Synergetics
(P); Peter K. Kaiser, Alcon (C), Bausch and Lomb (C), Bayer (C),
Carl Zeiss Meditec (C), Genentech (C), Novartis (C), Ophthotech
(C), Oraya (C), Regeneron (C), Topcon (C); Rishi P. Singh, Carl
Zeiss Meditec (C); Justis P. Ehlers, Alcon (C), Bioptigen (C),
Bioptigen (F), Bioptigen (P), Genentech (F), Leica (C), Leica (F),
Synergetics (P), Thrombogenics (C), Thrombogenics (F), Zeiss (C),
Zeiss (F)
Support: NIH/NEI K23-EY022947-01A1 (JPE); Ohio Department
of Development TECH-13-059 (JPE); Thrombogenics research grant:
THROM1403JE
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Conclusions: Integrating automated lateral and depth tracking with
iOCT will allow real-time imaging of surgical dynamics. Improved
understanding of tissue-instrument interactions during conventional
ophthalmic surgical maneuvers may elucidate mechanisms of tissue
repair, be predictive of clinical outcomes, and lead to novel iOCTguided surgical techniques.
Commercial Relationships: Marco Ruggeri, Bioptigen Inc. (F);
Florence Cabot, None; Sonia H. Yoo, None; Jean-Marie A. Parel,
Bioptigen Inc. (F)
Support: Bioptigen Inc; NIH P30EY14801 (Center Grant); Florida
Lions Eye Bank; Drs KR Olsen and ME Hildebrandt, Research to
Prevent Blindness; The Henri and Flore Lesieur Foundation (JMP).
Program Number: 4089 Poster Board Number: B0011
Presentation Time: 8:30 AM–10:15 AM
Real-time dynamic depth tracking for arbitrarily long range
OCT imaging and surgical instrument tracking using a Fourier
domain optical delay line
Mohamed El-Haddad, Yuankai Tao. Ophthalmic Research, Cleveland
Clinic Foundation, Shaker Heights, OH.
Purpose: Intraoperative optical coherence tomography (iOCT)
allows visualization of tissue microstructure, and provides real-time
feedback for clinical decision making during ophthalmic surgery.
However, the potential for iOCT-guided surgical maneuvers has
been limited both by imaging speed, which can only display single
cross-sectional images at video-rates, and imaging range, which is
on the order of 2 mm for SDOCT and 8 mm for SSOCT. Last year,
we presented novel lateral tracking technology that automatically
centered the iOCT scan field on the tip of ophthalmic surgical
instruments. Here, we demonstrate a digitally controlled optical
delay that allows real-time depth tracking. Integration of automated
lateral and depth tracking with iOCT will allow for dynamic threedimensional field-of-view imaging of ophthalmic surgical dynamics.
Methods: A reference arm based on a Fourier domain optical delay
line (FDODL), was designed to provide a digitally controlled optical
delay for iOCT. A free-space optical delay on a motorized stage was
added to the FDODL path to further extend the available tracking
range. A control algorithm handles the actuation hand-off between the
stage and the FDODL to allow for fast scanning over a short range,
and slower scanning over a long range (Fig. 1). The FDODL allowed
inter-line depth tracking over >16 mm depth range with a 100 ms
small-angle step response (Fig. 1, δz) while the motorized stage
allowed for inter-frame scanning over a 100 mm range at speeds up
to 100 mm/s (Fig. 1, Δz).
Results: As a demonstration, we imaged a metal surface placed at
~62 deg. to the horizontal (Fig. 1). Without tracking, small part of the
surface was visible (Fig. 1b, blue). The FDODL was then scanned by
a saw-tooth function, effectively compensating for the tilt (Fig. 1b,
red). The A-Scans in the latter represent different depths, in linear
proportion to the applied voltage (3.7 mm/volt), which was corrected
for in post-processing to reflect the true image over the entire range
of the FDODL.
Commercial Relationships: Mohamed El-Haddad, None; Yuankai
Tao, None
Program Number: 4090 Poster Board Number: B0012
Presentation Time: 8:30 AM–10:15 AM
Utility of the intraoperative OCT during posterior segment
surgery
Michele Coppola, Federico Solignani. Ophthalmology, Azienda
Ospedaliera di Desio e Vimercate (MB), Milano, Italy.
Purpose: Intraoperative OCT is a new surgical tool helping surgeons,
improving intraoperative safety and allowing a real-time feedback
from all ocular structures: epiretinal membranes, internal limiting
membrane, outer retinal layers.
Our purpose is showing, directly through videos, the easy use of
iOCT and its add-on, like checking the closure of macular holes
during surgery ( high myopic macular hole closure by external
indentation), the complete removal of ERM and ILM even without
using dyes twice.
Methods: ZEISS RESCAN Lumera 700 (Carl Zeiss Meditec, Dublin,
Calif., USA) - with integrated intra-operative OCT technology and
Callisto eye software (Carl Zeiss Meditec, Dublin, Calif., USA)
can be used during all surgical procedures performed on anterior
segment, glaucoma, and retina. The wavelength of spectral domain
iOCT is 840 nm, the scanning speed is 27000 A-scans per second
with an A-scan depth of 2.0 mm, an axial resolution of 5.5 μm in
tissue. Scan length is adjustable from 3 to 16 mm, and scan rotation
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
is adjustable over 360°. Image acquisition is possible by recording
movies or taking pictures.
Results: The new machinery, iOCT, improves the safety and the
surgeon’ self confidence during every surgical procedure.
Starting new era that opens other surgical scenarios: surgeons can
work with anatomical guide. iOCT shows anatomical reperies
of the eye directly in surgical field overlaying the main image.
It is controlled by the foot switch, allowing the surgeon to move
indipendently from other members of the surgical staff thus
enhancing the theatre safety.
Conclusions: In conclusion, the importance of our video is related
to the use of a new technique that allows the use of OCT during
surgery and in selected cases of diagnosis as well. Further studies are
certainly necessary for a better comprehension of uses and limitations
of iOCT, but our videos for the first time demonstrate possible new
applications.
iOCT showing epiretinal membrane interrruption and its retraction
after sharp needle scraping.
Commercial Relationships: Michele Coppola, None; Federico
Solignani, None
Program Number: 4091 Poster Board Number: B0013
Presentation Time: 8:30 AM–10:15 AM
Intraoperative Optical Coherence Tomography (iOCT) In
Newborn And Infant Children With Anterior Segment Anomalies
Sebastian E. Siebelmann, Philipp Steven, Manuel Hermann, Thomas
Dietlein, Claus Cursiefen. Department of Ophthalmology, University
of Cologne, Cologne, Germany.
Purpose: Examination of newborn or infant children with anterior
segment anomalies is often challenging due to limited compliance, so
that an examination under general anesthesia is preferred. However,
intraoperative imaging tools are so far limited. Therefore we
evaluated intraoperative Optical Coherence Tomography (iOCT) as
a tool for intraoperative imaging, diagnostics and surgery monitoring
in newborn and infants with anterior segment anomalies and corneal
opacities.
Methods: Retrospective case series of four newborn and infants
with anterior segment anomalies (2 children with congenital corneal
opacities, 1 child with congenital cataract and one with iridocorneal
synechiae), who underwent examinations under general anesthesia,
using a commercially available 840nm OCT, mounted to an operating
microscope (iOCT; OptoMedical Technologies, Luebeck, Germany).
Mean age was 6 years (range: 6 month – 14 years).
Results: Anterior segments could be completely visualized in the
intraoperative set up using iOCT under general anesthesia including
cornea, anterior chamber angle, iris and lens despite presence of
corneal opacities. iOCT was a helpful tool to detect corneal, iridal
and lens-anomalies in these newborn and infants, who were not
accessible to normal OCT-diagnostics without general anesthesia.
Moreover iOCT enabled intraoperative decision making to perform
anterior segment surgery (e.g. phototherapeutic keratectomy or
lamellar keratectomy) in patients with corneal opacities. Furthermore,
depth of tissue ablation could precisely be monitored during anterior
lamellar keratectomy.
Conclusions: Intraoperative Optical Coherence Tomography (iOCT)
closes the gap of imaging diagnostics observed in newborns and
infants, who have to be examined under general anesthesia and are
not accessible to “routine” advanced imaging techniques so far.
Furthermore iOCT proved to be a helpful tool for online monitoring
of anterior segment surgery in newborn and infant children.
Commercial Relationships: Sebastian E. Siebelmann, None;
Philipp Steven, None; Manuel Hermann, None; Thomas Dietlein,
None; Claus Cursiefen, None
Program Number: 4092 Poster Board Number: B0014
Presentation Time: 8:30 AM–10:15 AM
Structural and functional retinal imaging with MHz Line-field
parallel swept source imaging (LPSI)
Daniel Fechtig1, 2, Tilman Schmoll3, Cedric Blatter1, Rainer A.
Leitgeb1, 2. 1Center for Med. Phys. and Biom. Eng., Medical
University Vienna, Vienna, Austria; 2Center for Med. Phys. and
Biom. Eng., Christian Doppler Society, Vienna, Austria; 33Carl Zeiss
Meditec, Inc., Dublin, CA.
Purpose: MHz OCT allows mitigating undesired influence of motion
artifacts during retinal assessment, but comes in state-of-the-art
point scanning OCT at the price of increased system complexity.
By changing the paradigm from scanning to parallel OCT for in
vivo retinal imaging the three-dimensional (3D) acquisition time
is reduced without a trade-off between speed, sensitivity and
technological requirements.
Methods: Line field parallel interferometric imaging (LPSI) is
utilizing a commercially available swept source, a single-axis
galvo-scanner and a line scan camera for recording 3D data with
up to 1MHz A-scan rate. Besides line-focus illumination and
parallel detection, we mitigate the necessity for high-speed sensor
and laser technology by holographic full-range imaging, which
allows for increasing the imaging speed by low sampling of the
optical spectrum. High B-scan rates up to 1kHz further allow
for implementation of lable-free optical angiography in 3D by
calculating the inter B-scan speckle variance.
Results: We achieve a detection sensitivity of 93.5 (96.5) dB at
an equivalent A-scan rate of 1 (0.6) MHz. Fig. 1(a) was obtained
by stitching 7 slightly overlapping non-averaged tomograms. The
sensitivity and resolution are high enough to visualize the external
limiting membrane (ELM), and to contrast the various layers of the
inner retina. Despite the loss of confocality in one lateral dimension
and the shorter center wavelength of 840nm, the signal intensity
from the choroid is remarkably strong maintaining structural details.
In Fig. 1(b) we feature a enface projection of micro-angiographic
information. One single 3D stack corresponds to a lateral FOV of
approx. 5-6° and is acquired in just 2.5 s.
Conclusions: Our results demonstrate for the first time competitive
imaging sensitivity, resolution and speed with a parallel OCT
modality. LPSI is in fact currently the fastest OCT device applied to
retinal imaging and operating at a central wavelength window around
800 nm with a detection sensitivity of higher than 93.5 dB.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Fig. 1(a) and 1(b)
Commercial Relationships: Daniel Fechtig, None; Tilman
Schmoll, None; Cedric Blatter, None; Rainer A. Leitgeb, None
Support: Christian Doppler Society
Program Number: 4093 Poster Board Number: B0015
Presentation Time: 8:30 AM–10:15 AM
Investigation of the microscopic retina with MHz AO-OCT
Omer P. Kocaoglu, Tim L. Turner, Zhuolin Liu, Donald T. Miller.
School of Optometry, Indiana University, Bloomington, IN.
Purpose: Optical coherence tomography (OCT) has undergone
considerable technological advances over the last two decades, yet
image acquisition speed remains a major limiting factor for its use
in retinal imaging. Increased speed enables imaging of larger fields
of view at finer spatial and temporal sampling, while also reducing
the effects of eye motion. Reduction of eye motion is particularly
attractive with adaptive optics OCT (AO-OCT) because the cellularlevel lateral resolution afforded by AO makes the system more
susceptible to eye motion. In this study we employ a research-grade
AO-OCT system that acquires images 25 times faster than clinical
OCT and use it to investigate the microscopic retina in the living
human eye.
Methods: The Indiana MHz AO-OCT system is based on spectral
domain technology. It employs a high-speed 1×4 optical switch in
its novel, quad-spectrometer detection channel to achieve 1 million
A-lines/s acquisition speed. The design also makes efficient use of the
light available for detection. A superluminescent diode (λc=790nm,
Δλ=42nm) illuminates the retina providing 5.3 μm axial resolution.
The sample channel contains the AO system that dynamically
corrects for ocular aberrations across a 6.7 mm pupil to provide
diffraction-limited lateral resolution (1.7 μm confocal) and improved
signal-to-noise ratio of retinal images. Volumes videos were acquired
with the MHz AO-OCT system of all major retinal layers from
the retinal pigment epithelium layer to retinal nerve fiber layer at
6 superior to the fovea. Volumes were 1.1 ×1.3 or 0.5 ×0.7 in size
(containing 320 B-scans × 400 A-lines) and acquired at real time rates
of 7.8 Hz and in 30 volume sequences (3.84 s).
Results: MHz AO-OCT volumes were successfully acquired on three
normal subjects. Retinal images were typically of ~30 dB dynamic
range, without averaging, and revealed substantially reduced image
blur and distortion due to eye motion compared to earlier generation
AO-OCT systems developed at Indiana. The 30 dB dynamic range is
comparable to that of clinical OCT and permitted visualization of all
major retinal layers. The 7.8 Hz volume rate also captured the flow
dynamics of retinal capillaries at different depths in the inner retina.
Conclusions: MHz AO-OCT provides sufficient 3D resolution and
sensitivity to image at the microscopic level any major layer of the
retina.
Representative MHz AO-OCT volumetric image displayed on a
linear-scale. Scale bars: 25μm.
Commercial Relationships: Omer P. Kocaoglu, None; Tim L.
Turner, None; Zhuolin Liu, None; Donald T. Miller, #7,364,296
(P)
Support: NEI grants R01-EY018339 and P30- EY019008
Program Number: 4094 Poster Board Number: B0016
Presentation Time: 8:30 AM–10:15 AM
Long Working Distance Swept Source Optical Coherence
Tomography for Pediatric Imaging
Ruobing Qian1, Oscar Carrasco-Zevallos1, Lejla Vajzovic2, Cynthia
A. Toth2, 1, Joseph A. Izatt1, 2. 1Biomedical Engineering, Duke
University, Durham, NC; 2Ophthalmology, Duke University Medical
Center, Durham, NC.
Purpose: Optical coherence tomography (OCT) has become the
standard of care for diagnosis of many retinal pathologies. However,
current commercial OCT systems require cooperative patients to
maintain fixation for several seconds in a chinrest. Handheld OCT
systems have also been demonstrated for successful imaging of
supine patients, as well as pre-term infants and neonates up to ~1 year
old. However, no technology yet exists for OCT in young children
due to their lack of attention and cooperation, as well as inherent fear
of large objects close to their face. Therefore, we designed and built a
novel OCT system with a very long working distance (distance of the
last optical component of the system to the subject’s eye) to facilitate
imaging of young children.
Methods: A novel scanning configuration OCT system was designed
to achieve a working distance of 36 cm (Fig. 1) to situate young
children at a comfortable distance away during imaging. A 2f
scanning configuration, instead of the conventional 4f scheme, was
implemented to reduce the footprint and weight of the sample arm.
To optimize optical performance at the retinal plane, the 2f system
employed two custom-designed lenses (Zemax, Inc; Redmon, WA).
A dichroic mirror after the objective enabled co-alignment of a LCD
display used for fixation. The monitor displayed videos and targets to
aid fixation during imaging.The swept-source OCT system employed
a 1060 nm frequency-swept laser (Axsun Tech; Billerica, MA) and a
Mach-Zender interferometer. The interferometric signal was detected
with a dual-balanced receiver (Thorlabs, Inc.; Newton, NJ) and
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
digitized at 800 MS/s (Alazar Tech Inc; QC, Canada). Custom GPUbased software enabled real-time volumetric imaging at 100,000
A-line/second.
Results: The axial resolution across the 6 mm imaging depth range
was measured to be 8.4um and the lateral resolution was measured
to be 11-12 um. The peak sensitivity was 99.4 dB with a 3.5 mm
-6dB falloff. To prove the feasibility of the system, consented adult
subjects were imaged. A representative volumetric and an averaged
B-scan image are shown in Fig 2. The subject was situated on a
chinrest 36 cm away from the system. The LCD monitor facilitated
fixation during imaging.
Conclusions: A novel long working distance OCT system along with
the fixation system were designed, built and tested on adult subjects.
The future implication is to image the retina of young children.
Commercial Relationships: Ruobing Qian, None; Oscar
Carrasco-Zevallos, None; Lejla Vajzovic, None; Cynthia A. Toth,
Alcon (P), Bioptigen (F), Duke University (P), Genetech (F); Joseph
A. Izatt, Bioptigen (I), Bioptigen (P), Bioptigen (S)
Support: The Hartwell Foundation
Program Number: 4095 Poster Board Number: B0017
Presentation Time: 8:30 AM–10:15 AM
Birefringence analysis of retinal nerve fiber bundles in the human
eye
Christoph K. Hitzenberger1, Mitsuro Sugita1, 2, Michael Pircher1,
Bernhard Baumann1, Philipp K. Roberts3, Stephan Holzer3, Tomoyuki
Makihira2, Nobuhiro Tomatsu2, Makoto Sato2, Clemens Vass3. 1Center
F Med Physics & Biomed Eng, Medical University of Vienna,
Vienna, Austria; 2Canon Inc., Tokyo, Japan; 3Ophthalmology and
Optometry, Medical University of Vienna, Vienna, Austria.
Purpose: To analyze birefringence, retardation, and thickness of the
retinal nerve fiber layer (RNFL) along traces of retinal nerve fiber
bundles in the human eye in vivo.
Methods: A polarization sensitive (PS) OCT system with an
integrated retinal tracker was used to record 3D data sets in healthy
human eyes in vivo. En face maps of RNFL thickness, retardation,
axis orientation, and birefringence were generated from the PSOCT data sets. Based on the axis orientation and thickness maps,
traces of nerve fiber bundles were extracted. A new type of graphic
data representation was developed: a 2D false color map that plots
birefringence, retardation, and thickness along the nerve fiber bundle
(y-direction) as a function of azimuthal angle (x-direction) around the
optic nerve head (ONH). Based on these plots, a quantitative analysis
of the variations of parameters along the nerve fiber bundle is made.
Results: We analyzed the variations of retardation, thickness, and
birefringence along superior and inferior nerve fiber bundles in 4
healthy eyes. If measured from the ONH outward, retardation and
thickness showed a pronounced decrease along fiber traces near the
ONH of > 8°/mm and > 50 mm/mm, respectively, while birefringence
was rather constant, with a change of < 0.05°/mm/mm.
Conclusions: In healthy eyes, RNFL birefringence is rather constant
along the nerve fiber bundle length. Deviations from this pattern
might be indicative of diseases like glaucoma.
Nerve fiber analysis of healthy human retina from PS-OCT data set.
Left: unfolded retardation map: retardation (color) is plotted along
nerve fiber bundle length (y-axis) as a function of origin on azimuthal
circle around ONH (x-axis). Right: unfolded birefringence map.
Commercial Relationships: Christoph K. Hitzenberger, Canon
Inc. (F), Canon Inc. (P); Mitsuro Sugita, Canon Inc. (E), Canon Inc.
(P); Michael Pircher, Canon Inc. (F), Canon Inc. (P); Bernhard
Baumann, None; Philipp K. Roberts, Canon Inc. (F); Stephan
Holzer, None; Tomoyuki Makihira, Canon Inc. (E); Nobuhiro
Tomatsu, Canon Inc. (E), Canon Inc. (P); Makoto Sato, Canon Inc.
(E), Canon Inc. (P); Clemens Vass, Canon Inc. (P)
Program Number: 4096 Poster Board Number: B0018
Presentation Time: 8:30 AM–10:15 AM
Wavefront sensorless adaptive optics OCT with real time axial
tracking for imaging human retina
Yifan Jian1, Kevin S. Wong1, Michelle Cua1, Stefano Bonora2, Robert
J. Zawadzki3, 4, Marinko V. Sarunic1. 1Engineering Science, Simon
Fraser University, Burnaby, BC, Canada; 2CNR-Institute of Photonics
and Nanotechnology, Padova, Italy; 3Department of Cell Biology
and Human Anatomy, University of California Davis, Davis, CA;
4
Department of Ophthalmology & Vision Science, University of
California Davis, Sacramento, CA.
Purpose: We describe our wavefront sensorless adaptive optics
optical coherence tomography (WSAO-OCT) system for imaging
the human photoreceptor mosaic in vivo. Real time segmentation of
the retinal OCT B-scan permitted axial tracking and extraction of en
face images. We validated our system performance by imaging the
retina at several eccentricities, and demonstrated the improvement in
photoreceptor visibility with WSAO aberration correction.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Methods: A human WSAO-OCT system was constructed using
lenses (instead of mirrors), delivering a 5.5mm (diameter) at the
subject’s pupil. The OCT engine acquired A-scans at a rate of 200
kHz, and volumes of 1024x200x80 voxels were acquired in ~0.1
s. A custom written GPU program tracked the layer of interest
initially selected by the operator using a simple retinal segmentation
algorithm, and then extracted the corresponding en face projection
image. The modal WSAO algorithm optimized Zernike radial
orders 2 to 4 in order to maintain a balance between optimization
time and effective aberration correction. For each Zernike mode,
the optimization was performed by acquiring an OCT volume
and extracting an en face image for each of 5 different coefficient
values. The coefficient that produced the brightest en face image
was selected as the optimized value. The entire optimization process
required 6~12 seconds, depending on the amount of the aberrations in
the subject’s eye.
Results: We present en face images acquired at three different retinal
eccentricities before and after WSAO optimization in Figure 1. In
the unoptimized images, the cones are mostly indistinguishable from
speckle pattern. After optimization, the image contrast increased, and
the cone mosaic can be resolved.
Conclusions: We demonstrated a lens-based approach for WSAOOCT that is capable of resolving the cone mosaic in the human eye
at small angles of eccentricity with non-mydriatic pupils even with a
small-stroke DM. The reduced complexity of the lens-based WSAO
design can facilitate a robust and compact imaging system that is
highly suitable for clinical applications in ophthalmology.
As such, correct interpretation of clinical OCT images is of great
importance. Interpretation of these images, though, is clouded
by optical properties of the eye, the complexity of light-tissue
interactions, and image post-processing. We have designed and built
a custom OCT system equipped with adaptive optics that provides
greatly improved 3D resolution and permits precise instrument
calibration and characterization. We investigated the OCT outer
retinal band 3, thought to originate from either the cone outer
segment tips or zone of interdigitation between cone outer segments
(OS) and apical processes of the RPE.
Methods: Five subjects were imaged between 1.5 and 4.25°. Cones
were segmented and aligned by their band 3 peaks. The resulting
aligned B-scan was averaged and the thickness of band 3 was
measured. Next, after bulk motion correction, the phase of the band
3 reflection was extracted and variance of this phase, which is a
measure of the surface’s roughness, was computed.
Results: After subtracting measured axial blur, average thickness
of band 3, measured in single cones, was 2.1 μm. Typical variance
of bulk-motion-corrected phase measurements was 0.09 rad, which
corresponds to a surface roughness of 4 nm RMS.
Conclusions: Cellular measurements of band 3 suggest strongly that
the reflection comes from a thin, optically smooth origin, such as a
reflective surface, and not from an axially extended zone of scattering
material. This surface must be located distal to the cone OS lumen
and proximal to the RPE body. The most likely origin is the distal
plasma membrane of the cone outer segment.
Figure 1: En face images of the human photoreceptor layer acquired
at several angles of eccentricity from the fovea.
Commercial Relationships: Yifan Jian, (); Kevin S. Wong, None;
Michelle Cua, None; Stefano Bonora, None; Robert J. Zawadzki,
None; Marinko V. Sarunic, None
Support: CIHR, NSERC, Michael Smith Foundation for Health
Research, and Simon Fraser University Vice President of Research.
NEI (R01 EY024239), UC Davis RISE Grant, NSF I/UCRC CBSS
Grant. NVIDIA hardware donation program.
Program Number: 4097 Poster Board Number: B0019
Presentation Time: 8:30 AM–10:15 AM
Cellular morphometry of the outer retina using adaptive optics
OCT
Ravi S. Jonnal, Justin Migacz, Iwona Gorczynska, Robert J.
Zawadzki, John S. Werner. Ophthalmology, UC Davis, Sacramento,
CA.
Purpose: Diseases and disorders which impact the outer retina, such
as AMD, diabetic retinopathy, macular hole, and retinal detachment
are routinely evaluated using optical coherence tomography (OCT).
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
AO-OCT B-scan taken at 1.5° temporal to the fovea. In (a), band 3
reflections from single cones are marked. Axial shifts of reflections
are evident. In (b), the cones are shown without axial alignment. In
(c), the cones are aligned by band 3.
(a) Bulk-corrected phase of band 3 of the cones in Fig. 1. Average
longitudinal reflectance profiles of the (b) unaligned cones and (c)
the band 3-aligned cones. Unaligned band 3 FWHM is 10.8 μm and
aligned FWHM is 4.1 μm, which includes the 2.8 μm (measured)
axial PSF. This suggests that the bulk of band 3’s thickness in
commercial OCT images is due to axial displacements of the
reflections.
Commercial Relationships: Ravi S. Jonnal, US Patent No.
7,364,296; unlicensed; (P); Justin Migacz, None; Iwona
Gorczynska, None; Robert J. Zawadzki, None; John S. Werner,
None
Support: NEI Grant R01 EY024239; unrestricted grant from
Research to Prevent Blindness, Incorporated
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 4098 Poster Board Number: B0020
Presentation Time: 8:30 AM–10:15 AM
Visualization of Multiple Retinal Capillary Beds using Offset
Pinhole Adaptive Optics Scanning Light Ophthalmoscopy
Richard B. Rosen1, 2, Nadim Choudury1, 2, Nikhil Menon1, 2, Alexander
Pinhas1, 2, Rishard Weitz1, Joseph Carroll3, Alfredo Dubra3,
Toco Chui1, 2. 1New York Eye and Ear Infirmary, New York, NY;
2
Ophthalmology, Ican School of Medicine at Mount Sinai, New York,
NY; 3Ophthalmology, Medical College of Wisconsin, Milwaukee, WI.
Purpose: To image retinal capillary beds at different retinal layers in
healthy and diseased retinas using an offset pinhole adaptive optics
scanning light ophthalmoscope (AOSLO).
Methods: Retinal capillary plexuses at different depths were imaged
at various retinal locations in 2 healthy controls and 3 patients (PDR,
HRVO, BRVO) using an offset pinhole AOSLO with an imaging
wavelength centered at 790nm. Imaging locations on the healthy
controls were located at 5° temporal, nasal, and superior to the fovea.
Region of interests with vasculopathic structures were pre-identified
on fundus pictures on the patients. Image sequences were acquired
using 1° or 1.5° field of view at a frame rate of 15Hz. After sinusoidal
distortion and eye motion were removed, averaged images and
motion contrast perfusion maps were generated at different retinal
depths.
Results: Multiple retinal capillary beds were clearly visualized
in both controls and patients using offset pinhole AOSLO. Three
distinct capillary beds were resolved at all retinal locations imaged
in the controls. From the 3 patients with retinopathies, vasculopathic
structures such as microaneurysms and tortuous blood vessels
were observed at different retinal depths. Fig 1 demonstrates a
fusiform microaneurysm located in the outer retina in a patient with
HRVO. This technique enabled precise depth location of normal
and pathologic structures with high lateral resolution that is often a
limiting factor when attempting similar stratification using optical
cohernece tomography
Conclusions: Offset pinhole AOSLO provides noninvasive and direct
visualization of multiple retinal capillary beds at different depths,
as well as the ability to isolate retinal vasculopathic structures at
different retinal capillary beds. This imaging technique provides a
better understanding of normal and pathological retinal vasculature
development.
Program Number: 4099 Poster Board Number: B0021
Presentation Time: 8:30 AM–10:15 AM
Non-invasive adaptive optics imaging of the ground squirrel
retina
Benjamin S. Sajdak2, Christopher S. Langlo2, Yusufu N. Sulai1, Robert
F. Cooper3, Dana K. Merriman5, Joseph Carroll2, 1, Alfredo Dubra1,
4 1
. Opthalmology, Medical College of Wisconsin- Eye Institute,
Milwaukee, WI; 2Cell Biology, Neurobiology, & Anatomy, Medical
College of Wisconsin, Milwaukee, WI; 3Biomedical Engineering,
Marquette University, Milwaukee, WI; 4Biophysics, Medical College
of Wisconsin, Milwaukee, WI; 5Biology, University of Wisconsin
Oshkosh, Oshkosh, WI.
Purpose: Ground squirrels are an important model for studying
visual processing, retinal circuitry, and cone photoreceptor function.
Using a custom adaptive optics scanning light ophthalmoscope
(AOSLO), we sought to noninvasively image the microscopic
structure of the ground squirrel retina.
Methods: Four 13-lined ground squirrels (Ictidomys
tridecemlineatus) were anesthetized with isoflurane (5% induction,
2-3% maintenance) and placed on a heated stage. Pupils were
dilated with one drop of 2.5% phenylephrine and one drop of 1%
tropicamide. Saline drops were applied as needed to maintain
corneal hydration. Reflectance, confocal and split-detection AOSLO
imaging through a 4 mm diameter pupil was performed with near
infrared light (790 nm). The pixel size in microns was calculated
using a Ronchi ruling placed in the back focal plane of a 19 mm focal
length model eye, and then scaled according to the axial length of
each animal, measured with an ultrasound A-scan (OTI-Scan 1000).
Photoreceptor density and Voronoi geometry were calculated at
known retinal locations using cell coordinates obtained by a semiautomated cell counting algorithm.
Results: High-resolution images of the photoreceptor mosaic, nerve
fiber layer, and retinal vasculature (Fig.1) were obtained with a high
success rate (100%, n = 4). No lens opacities were observed during
any of the imaging sessions, which lasted up to 1 hour. Photoreceptor
density values are consistent with previously published histological
data of a congener species (Long and Fisher, J Comp Neurol., 1983;
Kryger et al., Vis Neurosci., 1998), ranging from 25,600–78,400
cells/mm2. The mosaic displayed a fairly triangular packing geometry,
with 42-56% of the cells having six-sided Voronoi domains around
the horizontal streak, and 59-69% in more peripheral locations.
Conclusions: The photoreceptor mosaic, retinal capillaries and
microscopic detail on the nerve fiber layer inner surface of the ground
squirrel were visualized with AOSLO. The image quality and success
rate appears to be better than current AOSLO efforts on mice and
rats. Thus, when combined with the non-invasive high resolution
imaging afforded through AOSLO, the ground squirrel could serve as
a useful model to aid drug discovery and testing through longitudinal
imaging on the cellular scale.
Fig 1 demonstrates a fusiform microaneurysm located in the outer
retina capillary layer in a patient with HRVO. The thru focus
technique is able to distinguish the precise level of the lesion
Commercial Relationships: Richard B. Rosen, Advanced Cellulat
Technologies (C), Allergan (C), Carl Zeiss Meditech (C), Clarity (C),
OD-OS (C), Opticology (I), Optovue (C); Nadim Choudury, None;
Nikhil Menon, None; Alexander Pinhas, None; Rishard Weitz,
None; Joseph Carroll, ImagineEyes (C); Alfredo Dubra, University
of Rochester (P); Toco Chui, None
Support: Marrus Foundation, Wise Foundation
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Ground squirrel cone photoreceptors using confocal (A) and split
detector (B) AOSLO. Nerve fiber layer (C) and retinal capilaries (D).
Scale bars 50mm
Commercial Relationships: Benjamin S. Sajdak, None;
Christopher S. Langlo, None; Yusufu N. Sulai, None; Robert F.
Cooper, None; Dana K. Merriman, None; Joseph Carroll, None;
Alfredo Dubra, None
Support: P30 EY001931, T32-GM080202
Program Number: 4100 Poster Board Number: B0022
Presentation Time: 8:30 AM–10:15 AM
Spectral domain optical coherence tomography analysis
of the retina in a rat model: a comparison of transgenic
immunodeficient retinal degenerate rat (SD-Foxn1
Tg(S334ter)3Lav) and rats with normal retina
Alexander De Guzman1, 2, Bibo Khatib2, Robert Lin1, 2, Bryce
T. McLelland2, Anuradha Mathur2, Robert B. Aramant2, Brian
Cummings1, 2, Magdalene J. Seiler1, 2. 1Physical Medicine &
Rehabilitation, University of California, Irvine, Irvine, CA; 2Stem
Cell Research Center, University of California, Irvine, Irvine, CA.
Purpose: Retinal degeneration (RD) affects millions of people
worldwide, and in vivo monitoring of the progression of this disorder
is needed to aid the development of treatments for it, such as retinal
sheet transplants. The goal of this study is twofold: to show that
retinal degeneration worsens with age, and to demonstrate that
Spectral Domain Optical Coherence Tomography (SD-OCT) can
track the progression of this condition in a new immunodeficient RD
rat model.
Methods: Retinal cross-section SD-OCT scans (Bioptigen Envisu
R2200 Spectral Domain Ophthalmic Imaging System) were obtained
from male and female rats (n=40) aged between P17-P77, using a
group of transgenic SD-Foxn1 Tg(S334ter)3Lav rats (=RD rats) as a
model for retinal degeneration, and a normal retinal control group of
rats expressing human placental alkaline phosphatase (hPAP). Data
analysis was done using the Bioptigen post-scan analysis software
InVivoVue Diver Release 2.0 (Bioptigen, Research Triangle Park,
NC). Changes in the thickness of the total retina (TR), the outer retina
(OR), and the inner nuclear layer (INL) were determined with respect
to age. Using SigmaPlot 11.0 (Systat Software, Inc., San Jose, CA;
Fisher-corrected multiple comparison tests), layer thicknesses were
compared with age group and with rat strain.
Results: P17 was the earliest age in which retinas could be imaged.
At this age, there was already a noticeable difference in total retinal
(TR) and outer retinal (OR) thickness between hPAP rats and RD
rats. In normal rats, TR was decreasing with eye growth between
the ages of P17 and P77 by 10.4% (from 260μm to 233μm) whereas
TR of RD rats decreased by 32.6% (from 133μm to 95μm). OR
was decreasing with eye growth between the ages of P17-P77 by
6.5% (from 141μm to 132μm) whereas OR of RD rats decreased
by 28.8% (from 26μm to 20μm). The INL was decreasing with eye
growth between the ages of P17-P77 by 32.6% (from 38μm to 25μm)
whereas the INL of RD rats decreased by 38.8% (from 34μm to
21μm).
Conclusions: This study has demonstrated that SD-OCT is a
viable method of detecting and analyzing retinal degeneration; and
consequently, the status of the retina and any occurring changes can
be monitored and analyzed over time in vivo. SD-OCT may be useful
in the evaluation of treatments for retinal degeneration.
Commercial Relationships: Alexander De Guzman, None;
Bibo Khatib, None; Robert Lin, None; Bryce T. McLelland,
None; Anuradha Mathur, None; Robert B. Aramant, Ocular
Transplantation LLC (E), Ocular Transplantation LLC (P); Brian
Cummings, None; Magdalene J. Seiler, Ocular Transplantation
LLC (C), Ocular Transplantation LLC (P)
Support: CIRM Grant TR4-06648; Summer Undergraduate Student
Research Program, UC Irvine
Program Number: 4101 Poster Board Number: B0023
Presentation Time: 8:30 AM–10:15 AM
Google Cardboard anterior and posterior segment imaging: a
valuable tool for limited-resource settings
Simon Ghofrani, Mahsa Rezaei, Aaron Wang, Allen O. Eghrari,
Christopher J. Brady. Wilmer Eye Institute, Johns Hopkins,
Baltimore, MD.
Purpose: In limited-resource settings such as developing countries,
significant obstacles to ocular imaging include cost and local
availability of required instruments. Smartphone photography
leverages the ubiquity of mobile handsets to image the posterior pole,
but typically requires the use of both hands to hold the device and
a lens, which generally must be purchased separately at significant
expense. Here, we describe the use of modified, open-source Google
Cardboard technology to image the anterior and posterior segment
using a head-mounted device composed of materials available
globally and at minimal cost.
Methods: A single Google Cardboard device, composed of cardboard
and acrylic lenses, was modified with a strap to mount to the
viewer’s head. Of the two lenses, each of which has a focal point of
4.5cm (22.2D) the right one was removed from the device and the
examiner’s smartphone placed within the device to be centered in
front of the left eye. A white LED light and coin cell battery were
affixed to the Cardboard to maximize smartphone battery life, and
installed superior to the mobile phone camera in order to provide
maneuverability comparable to an indirect ophthalmoscope.
Results: This device, plans for which are open source and
freely available online, allows the viewer to conduct indirect
ophthalmoscopy through a smartphone embedded in the headset,
while recording the examination from the perspective of the
examiner. The examination is facilitated with a 20D lens, but can
also be demonstrated using the detached right 22.2D acrylic lens
that is associated with the product, thereby allowing the examiner to
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
perform indirect ophthalmoscopy without costly equipment. Video
and clinical photographs of the technique are demonstrated.
Conclusions: Using only a smartphone, cardboard and acrylic,
products available in most regions of the world, indirect
ophthalmoscopy can be conducted through a headset and images
recorded for clinical or research use.
capture human fundus images. GoPro software was then used for
image processing.
Results: The GoPro camera was able to capture images with both the
simple eye model and the healthy human eye. Images from the study
included healthy optic nerve, retinal vessel, and macular anatomy
(Figure).
Conclusions: The GoPro camera is capable of capturing fundus
images of the human eye; however, the clinical utility of the images
still needs to be demonstrated. The quality of the images rivals that
of smartphone ophthalmic photography and head-to-head testing
could be an area of future exploration. Additionally, while there was
success with the GoPro/LED combination for coaxial camera and
light source, improvements in the construct could potentially yield
higher image quality. High-quality ophthalmic images obtained
with relatively inexpensive and portable devices, such as the GoPro
camera, will likely continue to have a growing impact on the field of
ophthalmology.
Still photo of indirect opthalmoscopy from video acquired through
Google Cardboard. Video to be demonstrated at time of presentation
reveals ease of use.
Commercial Relationships: Simon Ghofrani, None; Mahsa
Rezaei, None; Aaron Wang, None; Allen O. Eghrari, None;
Christopher J. Brady, None
Figure 1. Fundus photo of the right eye using GoPro camera device.
Commercial Relationships: R Joel Welch, None; Quan Dong
Nguyen, None
Program Number: 4102 Poster Board Number: B0024
Presentation Time: 8:30 AM–10:15 AM
A novel approach to ophthalmic photography using a portable
and versatile camera device
R Joel Welch, Quan Dong Nguyen. Ophthalmology, UNMC, Omaha,
NE.
Purpose: Smartphone fundus photography has grown in popularity
over recent years. The ability to use a portable device, such as a
smartphone, to capture high-resolution and clinically relevant fundus
photographs has had a significant impact on patient care and interphysician communication. While the cameras of modern smartphones
are growing increasingly robust, limitations do exist. To date, the
GoPro camera (GoPro Inc., San Mateo, CA, USA), considered as one
of the most powerful and versatile portable camera devices, has not
been used in ophthalmic photography. The purpose of this study is
to determine whether the GoPro camera can be used for ophthalmic
fundus photography.
Methods: A GoPro HERO4 Silver camera (GoPro Inc., San Mateo,
CA, USA ) and a 20D lens (Volk Optical Inc., Mentor, OH, USA)
were used for this study. Additionally, a battery-powered five
millimeter white LED (NTE Electronics, Inc., Bloomfield, NJ, USA)
was used as the coxial light source and attached to the camera using
Transpore medical tape (3 M, St. Paul, MN, USA). A simple and
inexpensive model of the human eye was constructed to aide the
author in learning image capture technique before approaching a
human volunteer. Once the technique was mastered using the model,
the right eye of one human volunteer was dilated in order to safely
Program Number: 4103 Poster Board Number: B0025
Presentation Time: 8:30 AM–10:15 AM
Slitlamp-mounted smartphone adapters using reverse
engineering with 3D scanning and 3D printing
Charline Boente1, Ethan Tu2, Rony Sayegh1. 1Ophthalmology,
University Hospitals Case Medical Center, Cleveland, OH;
2
Biomedical Engineering, Case Western Reserve University,
Cleveland, OH.
Purpose: Slitlamp smartphone adapters have become widely
available, however, only a limited number of phone models are
supported. We describe a process using 3D scanning and 3D printing
to build customizable adapters that fit virtually any smartphone to any
slitlamp.
Methods: With the selected smartphone, we obtained precise
dimensions of the phone using 3D scanning (NextEngine 3D Scanner,
Santa Monica, CA), which outputs a stereolithography (STL) file
that can be manipulated in a variety of design software programs.
We used AutoCAD software (AutoDesk, Inc. San Rafael, CA) to
design a custom adapter from the dimensions obtained from the
scanned phone using reverse engineering principles. A prototype of
the custom adapter was then produced using 3D printing (Stratasys
Fortus 400mc, Eden Prairie, MN). Each customized model was tested
on our clinics’ slitlamps and verified for fit and ease of obtaining
photographic images of the anterior segment.
Results: Slitlamp-mounted adapters for a variety of iPhone (Apple,
Cupertino, CA) models as well as the Samsung Galaxy S4 (Samsung
Electronics Co. Ltd., Ridgefield Park, NJ) were built using this
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
method. Precise measurements were obtainable using 3D scanning
which were used to build accurate and custom adapters using
AutoCAD followed by 3D printing.
Conclusions: 3D scanning provides easy data acquisition of the
phone dimensions that improves the accuracy of the 3D printed
adapters and allows a wider range of phone models to be used for
slitlamp photography.
Commercial Relationships: Charline Boente, None; Ethan Tu,
None; Rony Sayegh, None
Program Number: 4104 Poster Board Number: B0026
Presentation Time: 8:30 AM–10:15 AM
Smartphone fundus photography, in vivo retinal fluorescent
photography and fluorescein angiography in mouse eyes
Cynthia X. Qian1, Eiichi Hasegawa1, Luis Haddock2, David M.
Wu1, 3, Shizuo Mukai1. 1Ophthalmology, Massachusetts Eye and Ear
Infirmary, Boston, MA; 2Bascom Palmer Eye Institute, Palm Beach
Gardens, FL; 3Genetics, Harvard Medical School, Boston, MA.
Purpose: To describe a technique of fundus photography, in vivo
fluorescent retinal photography and fluorescein angiography in mouse
eyes using a smartphone
Methods: Wild-type mice with normal fundi and with retinal
detachment and retinas expressing Green Fluorescent Protein
(GFP) or Discosoma Red Fluorescent Protein (DsRed) secondary
to adeno-associated virus (AAV) infection or electroporation. After
pharmacologic mydriasis, the mice were gently held in hand without
anesthesia. Using a modification of our techniques previously
described for human and rabbit eyes (Haddock et al. J Ophthalmol
2013, Article ID 518479) fundus photography was carried out using
an iPhone 5s® or iPhone 6® and a 78D lens (as compared to 20D
and 28D lenses for human and rabbit eyes respectively). For in vivo
fluorescent photography of retinas transduced with GFP or DsRed,
an excitation filter (but no barrier) for fluorescein angiography from
an old fundus camera was placed in front of the LED light source
but not the camera lens of the iPhone®. For fluorescein angiography,
an excitation filter was place in front of the LED and a barrier filter
was placed in front of the camera lens, and images were taken after
intraperitoneal injection of fluorescein.
Results: Using this system we were able to consistently take
high-quality video clips and fundus photographs in the eyes of
awake mice. The use of an excitation filter allowed for fluorescent
photography of the patches of subretinal GFP and DsRed transgene
expression. Using a combination of excitation and barrier filters we
were able to perform fluorescein angiography in wild-type mice.
Conclusions: We demonstrated that with a modification of a
previously described system for human and rabbit eyes, fundus
photography, in vivo retinal fluorescent photography and fluorescein
angiography can be performed using the iPhone®. This technique is
relatively inexpensive, readily available, and very portable.
Fluorescein angiography imaging highlighting normal vasculature in
a mouse retina
Fluorescent photography highlighting patch of DsRed staining in a
rd1 mouse retina
Commercial Relationships: Cynthia X. Qian, None; Eiichi
Hasegawa, None; Luis Haddock, None; David M. Wu, None;
Shizuo Mukai, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 4105 Poster Board Number: B0027
Presentation Time: 8:30 AM–10:15 AM
Comparison of Smartphone Ophthalmoscopy with Slit-lamp
Biomicroscopy for Undilated Glaucoma Screening
Andrea Russo1, Francesco Morescalchi1, Luisa Delcassi1, Ciro
Costagliola2, Francesco Semeraro1. 1Univ degli Studi di Brescia Italy, Brescia, Italy; 2Eye Clinic, University of Molise, Campobasso,
Italy.
Purpose: Smartphone ophthalmoscopy is a recent and promising
technique to screen the community. The purpose of this study is to
evaluate the agreement of smartphone ophthalmoscope and slitlamp biomicroscopy to discriminate eyes with glaucoma from those
without.
Methods: One hundred glaucoma patients and 100 healthy control
subjects were included. All of them underwent visual field test and
undilated smartphone ophthalmoscopy with D-Eye device (Si14
S.p.A., Padova, Italy) followed by dilated optic nerve head (ONH)
slit-lamp examination. The following parameters were evaluated:
cup/disc ratio; neuroretinal rim pallor (4-step scale); peripapillary
chorioretinal atrophy; and optic disc hemorrhages.
Results: All included eyes completed the study. Cup/disc ratio exact
agreement between the two methods was observed in 186 (93%)
of 200 eyes (simple κ = 0.91; 95% CI 0.87–0.95) and agreement
within one step was observed in 200 eyes (100%). Rim pallor exact
agreement was observed in 179 eyes (89.5%; simple κ = 0.85; 95%
CI 0.79–0.91) and agreement within one step was observed in 197
eyes (98.5%). An almost perfect agreement was observed for both
peripapillary chorioretinal atrophy and optic disc hemorrhages.
Conclusions: Undilated smartphone ophthalmoscopy showed a very
good agreement with dilated biomicroscopy for ONH assessment.
Smartphone ophthalmoscopy can accurately detect ONH parameters
and might be used as a screening tool for glaucoma.
Representative retinal images of optic nerve head taken with D-Eye.
(A) Cup/disc ratio evaluated as 0.6 in a 76-year-old male patient
with nuclear cataract. (B) Healthy optic nerve head in a 23-year-old
female. (C) Depiction of the D-Eye prototype magnetically attached
to the smartphone.
Commercial Relationships: Andrea Russo, None; Francesco
Morescalchi, None; Luisa Delcassi, None; Ciro Costagliola, None;
Francesco Semeraro, None
Program Number: 4106 Poster Board Number: B0028
Presentation Time: 8:30 AM–10:15 AM
Smart phone retinal photography: Uses and experiences with the
novel retinal imaging technique
Luis Leon, Jonathan I. Huz, Arkadiy Yadgarov, Marco A. Zarbin,
Neelakshi Bhagat. Ophthalmology, Rutgers New Jersey Medical
School, South Orange, NJ.
Purpose: Retinal imaging is an essential component in the
practice of ophthalmology; its use is limited to the availability
of necessary imaging equipment. We reviewed fundus photos
taken using a recently described technique of fundus photography
using a smartphone, and its utility in a large hospital with a busy
ophthalmology training program. This study describes and evaluates
the use of this technique in a setting when fundus cameras are not
available.
Methods: We performed a retrospective review of all fundus
photographs of retinal pathology taken using smart phone cameras
in the inpatient or emergency room settings. Fundus images were
captured with an iPhone 4, 5 or 6 and a 20D lens. Using the coaxial
light source from the phone and its included video software,the phone
functions as an indirect ophthalmoscope, high-definition videos of
the fundus can be recorded for subsequent still image extraction. The
pictures were evaluated by ophthalmologists to asses its quality and
clinical utility.
Results: We obtained fundus photos of patients with retinal
pathology incluiding retinal detachment, pre-retinal membranes,
proliferative diabetic retinopathy with pre-retinal and vitreous
hemorrhage, macular pucker, commotio and retinal hemorrhages
of shaken baby syndrome . Retina specialists the residents
easily identified the pathology that was photographed using this
technique. Pictures were of very good quality even when taken by
ophthalmology residents that were inexperienced with the technique.
The resolution and details observed in the photos was sufficient to
recognize important retinal details and to establish a diagnosis. The
pictures were also noted to be an excellent resource to compare
disease progression and changes of retinal anatomy in subsequent
examinations.
Conclusions: In our review, we noted that the technique to obtain
retinal pictures with smartphones is an excellent resource, especially
in the emergency room and inpatient setting. With this technique eye
doctors can assess and follow up retinal pathology effectively, high
quality fundus photos can be obtained by relatively inexperienced
personnel. This technique should be introduced to all eye care
specialists in order to effectively document retinal findings when
there are no retinal cameras available; this technique could also
be introduced to emergency room personnel in order to evaluate a
patient’s retina with minimal equipment cost.
Commercial Relationships: Luis Leon, None; Jonathan I.
Huz, None; Arkadiy Yadgarov, None; Marco A. Zarbin, None;
Neelakshi Bhagat, None
Program Number: 4107 Poster Board Number: B0029
Presentation Time: 8:30 AM–10:15 AM
The Potential Positives of Smartphone Photography Using
Negative Images
David L. Nash, Eric Crouch, Shannon McCole. Ophthalmology,
Eastern Virginia Medical School, Norfolk, VA.
Purpose: Smartphone photography has become increasingly popular
and has several applications. We retrospectively reviewed and
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
compared standard color photographs with the negative photographic
image of several retinal findings photographed with a handheld
smartphone to identify any utility in the use of negative retinal
images with smartphone photography.
Methods: Using an iPhone 4S (Apple Inc., Cupertino, CA, USA)
and a handheld 20 or 28 diopter lens to capture retinal images of
4 separate patients with a variety of retinal conditions seen by a
single resident at a metropolitan based, residency program, color
photographs were compared to the negative images. The negative
images were created with the application Negative Me (Fuen Mao ©
2010-2013 1 stfancy Studio). The negative images were compared
retrospectively to their color counterparts. Photographs were cropped
to remove patient identifying information. All patients signed hospital
consent forms to be photographed.
Results: Smartphone negative retinal images, when compared to
their color image, best highlight hypopigmented lesions (such as
Cytomegalovirus (CMV) scarring), lightly colored structures on the
retina such as the optic disc, and areas or retinal pigment epithelium
loss. Examination of negative images taken three weeks apart of a
patient with CMV retinitis may highlight areas of retinal scarring.
Conclusions: Smartphone fundoscopy has many applications.
Negative images are simple to create using smartphone technology.
Certain conditions, most notably those involving hypopigmentation
of the retina, may benefit from the use of negative imagery. There
may also be utility in evaluating cup to disc ratios with negative
imaging. This study acts as a pilot study. Further study is needed to
validate the utility of negative imagery and its clinical application in
disease management.
Image 1: a: Color photograph taken with a 20 diopter lens. b: Color
photograph taken with a 28 diopter lens. c: Negative image of 1a. d:
Negative image of 1b. All images are inverted.
Image 2: a: Color photograph taken with a 20 diopter lens. b: color
photograph taken 3-4 weeks later of the same eye with a 20 diopter
lens. c: Negative image of 3a. d: Negative image of 3b. All images
are inverted.
Commercial Relationships: David L. Nash, None; Eric Crouch,
None; Shannon McCole, None
Program Number: 4108 Poster Board Number: B0030
Presentation Time: 8:30 AM–10:15 AM
Wide-Field Bedside Imaging of the Human Retina Using a
Smartphone Adapter
Lianna Valdes, Dov B. Sebrow, Tongalp H. Tezel. Edward S. Harkness
Eye Institute, Department of Ophthalmology, Columbia University
College of Physicians and Surgeons, New York, NY.
Purpose: To develop and evaluate the clinical utility of a
smartphone-based portable fundus camera that can be used for widefield imaging and recording of fundus pathologies at bedside.
Methods: A polyurethane mount was designed and constructed
to keep the camera module of a smartphone (iPhone 4S) aligned
with the assistant mirror of an indirect ophthalmoscope (Keeler
Inc., Broomall, PA). Pretesting was performed to determine the
optimal lighting and focusing conditions for video and single-shot
photography of the human fundus. Next, macular and peripheral
images of various fundus pathologies were obtained using both
a standard fundus camera (Zeiss FF450, Dublin, CA) and the
smartphone-based camera. The clarity of the images, correct
identification of the pathologies, and ease of obtaining and storing
the fundus images were compared using 8 masked ophthalmologists.
A 3D printable model of the camera mount was created with a 3D
scanner.
Results: High-quality imaging of the posterior pole and retinal
periphery was achieved using the novel iPhone-adapted indirect
ophthalmoscope. Best results were obtained when positioning
the iPhone camera 0.5 cm from the assistant mirror and using
medium intensity illumination (~0.6 mW cm-2 sr-1) from the indirect
ophthalmoscope. When looking at the fundus images captured by
the smartphone camera, survey participants accurately described
the details of the fundus pathology 72% of the time. After viewing
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
the corresponding standard fundus photos, only 28% of respondents
changed their initial diagnosis correctly. The iPhone camera was
easy to use and was able to image far peripheral lesions that were
located beyond the capture range of the stationary fundus camera. It
allowed documentation of a peripheral retinal lesion during dynamic
depression. It also has the advantage of being considerably less
expensive and more portable than other modalities.
Conclusions: The Smartphone-adapted indirect ophthalmoscope
can provide clinically useful imaging of the posterior pole and
retinal periphery. This efficient, cost-effective, and portable imaging
modality will allow rapid acquisition, storage, and transmission of
fundus images in the pediatric population and in patients unable to
sit for standard fundus photography. We believe it will be especially
useful for documenting and monitoring the fundus changes in
retinopathy of prematurity.
Commercial Relationships: Lianna Valdes, None; Dov B. Sebrow,
None; Tongalp H. Tezel, None
Support: Columbia University College of Physicians and Surgeons Scholarly Projects Program
Program Number: 4109 Poster Board Number: B0031
Presentation Time: 8:30 AM–10:15 AM
AMD - A Metamorphopsia Detector
Daniela Claessens1, Ronald V. Krüger2. 1Augenärztliche
Gemeinschaftspraxis Lindenthal, Cologne, Germany; 2app4eyes,
Meinerzhagen, Germany.
Purpose: Purpose: We developed the computer based App AMD
-A Metamorphopsia Detector- to provide a self-control monitoring
tool to detect and control the degree and size of metamorphopsias
and scotomas. This study was performed to examine sensitivity
and specificity of AMD and its correlation with anatomical course,
functional development and quality of life.
Methods: Methods: AMD is based on the Amsler grid. The
software uses the concept of a negative image: a distorted image
can be straightened by moving the mouse. Degree and dimension of
distorted lines or scotoma are transformed into indices.
I) In a pretest sensitivity and specificity of the AMD App were
examined in 17 healthy and 5 eyes with metamorphopsias due to
macular degeneration (age 61-83).
II) In a second step 19 eyes (age 24-91) with maculopathies
performed the metamorphopsia module alone or in combination with
the scotoma module.
III) In a prospective observational clinical pilot study we examined
monocular best corrected visual acuity (BCVA), Amsler grid,
vision related quality of life (National Eye Institute Visual Function
Questionnaire NEI VFQ 25), OCT (optical coherence tomography)
and AMD in 13 eyes (age 37-91) with macular edema before and after
intravitreal injections of anti vascular endothelial growth factor. Prior
to the study all patients signed informed consent.
Results: Results: I) Pretests confirmed construct validity and
reliability. Sensitivity of AMD was 80%, specificity was 100%.
Chi2-Test lead to rejection of the zero hypothesis (c2 > 3.84; freedom
degree = 1, α = 0.05).
II) Including a wider range of pathologies, addition of the scotoma
module increased sensitivity from 0.84 to 0.94. OR to detect macular
pathologies without metamorphopsias was 3.37; 95% CI: 0.94 - 5.67
when combining both app modules.
III) a-VEGF improved OCT and AMD in all 13 eyes: average
decrease of macular thickness was 77.54 mm (median 55 mm; SD
49.99; CI 104.75; 50.33) and 6.0 (median 4.76; SD 3.5; CI 7.9; 4.1)
for metamorphopsia index. Mean gain in NEI VFQ 25 was 8.77
(median 19; SD 12.39; CI 15.51; 2.03).BCVA improved in 10 and
was stable in 3 patients. Geometric mean BCVA was 0.38 logMAR
(SD 0.28) before and 0.25 logMAR (SD 0,21) after treatment.
Conclusions: Conclusions: As a quantitative test AMD can support
conventional diagnosis, lower the threshold for diagnosis,enhance
compliance and adherence in the treatment of age related macular
degeneration and other diseases leading to macular edema.
Commercial Relationships: Daniela Claessens, None; Ronald V.
Krüger, app4eyes (I)
Program Number: 4110 Poster Board Number: B0032
Presentation Time: 8:30 AM–10:15 AM
Smart Ophthalmics: A Smart Service Platform for TeleOphthalmology
Wolfgang Fink, Mark Tarbell. Vis & Autonomous Explorat’n Sys,
University of Arizona, Tucson, AZ.
Purpose: To provide ophthalmic healthcare to people who are
geographically dispersed (e.g., rural populations), or operate/
live in austere environments (e.g., military, third world, natural
disaster), where time, cost, and possibility of travel make access to
even adequate medical care difficult. As a result, significant causes
of preventable vision loss, such as ocular trauma, glaucoma, and
macular degeneration, may be detected early and treated in time to
prevent permanent vision impairment.
Methods: Optical extension devices are attached to a smartphone to
turn it into a mobile ophthalmic examination device. A custom app
is engaged to perform an eye exam specific to the attached optical
extension. Using a wireless connection, the smartphone app submits
the collected examination data to a remote “expert system,” which
provides medical analysis. The analysis results are sent back to and
displayed on the smartphone.
Results: A server-based telediagnostic analysis capability for current
and future smartphone-based ophthalmic examination devices has
been developed. Examination data, gathered with such devices, can
now be sent via WiFi or cell signal through a smartphone app to a
server for automated analysis, the results of which are sent back to
the originating smartphone almost immediately. As a first analysis
example, the cup-to-disc ratio in fundus images is determined
to assist the early detection of glaucoma. The fundus images are
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
obtained via a commercial-off-the-shelf handheld ophthalmoscope
that is attached to a smartphone. Moreover, a smartphone-based
miniaturized pupillometer has been developed that allows for the
recording of pupillary behavior in the presence and absence of light
stimulation, i.e., pupillary light reflex and dark reaction. The pupillary
diameter as a function of time is displayed in addition to parameters
such as latency, constriction, and dilation times.
Conclusions: Smartphone-based mobile ophthalmic examination
devices combined with server-based smart telediagnosis
capabilities pave the way towards smart ophthalmics, i.e., smart
tele-ophthalmology. This paradigm may greatly improve remote
patient screening and triage. It may help ensure that patients with
undiagnosed eye diseases are detected early and treated in time to
prevent permanent vision impairment. Establishing this paradigm
has the potential to change the very economy of extending quality
healthcare to many while reducing cost.
Commercial Relationships: Wolfgang Fink, California Institute of
Technology (P), University of Arizona (P); Mark Tarbell, University
of Arizona (P)
Support: NSF Award #IIP-1430062
Program Number: 4111 Poster Board Number: B0033
Presentation Time: 8:30 AM–10:15 AM
Mobile application software (App) for Prediction of Advanced
Age-related Macular Degeneration
Min-Lee Chang1, Yu-Hsuan Chiu3, Chung-Jung Chiu1, 2, Luca
Avoni4. 1USDA Human Nutrition Research Center on Aging, Tufts
University, Boston, MA; 2Department of Ophthalmology School of
Medicine, Tufts University, Boston, MA; 3Concord-Carlisle High
School, Concord, MA; 4Department of Ophthalmology, Bologna
Hospital Ospedale Maggiore, Bologna, Italy.
Purpose: To develop a state-of-the-art mobile application software
(App) for the macular risk scoring system (MRSS).
Methods: The MRSS algorithm uses information from a patient’s
age, sex, race, education level, smoking status, macular pigmentation
(normal vs. abnormal), maximal drusen size, and drusen texture (hard
vs. soft) to calculate a risk score for progression to advance agerelated macular degeneration (AMD). Based on a one-page prototype
of the MRSS App for the Age-Related Eye Disease Study (AREDS)
that have been developed and published along with the MRSS paper
(Chiu et al., Ophthalmology 2014;121:1421-1427.), we wrote a userfriendly App for iOS devices (iPhones/iPads) and Android devices
and submitted the App to the Apple App Store and the Google Play,
respectively.
Results: The App consists of 12 pages, including a cover page,
a welcome page, a credit page, 8 question pages for the eight
predictors, and a result page that automatically presents the result
from the MRSS. Before submitted for download, the App was tested
to ensure consistent results with both of the prototype of the App and
manual calculation from the MRSS algorithm. The App is free for
download at https://itunes.apple.com/us/app/macular-degenerationtest/id944048670?l=it&ls=1&mt=8 for iOS devices and at https://
play.google.com/store/apps/details?id=com.arscolor.app.mrss&hl=it
for Android devices.
Conclusions: We have refined the AREDS MRSS App prototype and
made the App available for download via Internet. To our knowledge,
our App is the first mobile application for the prediction of advanced
AMD. Based on the results from the MRSS paper, this App can serve
as a platform for modifications to work in other populations.
Commercial Relationships: Min-Lee Chang, None; Yu-Hsuan
Chiu, None; Chung-Jung Chiu, None; Luca Avoni, None
Program Number: 4112 Poster Board Number: B0034
Presentation Time: 8:30 AM–10:15 AM
A New iPad and iPhone App to Manage Patients with Dry Eye
caterina cordella1, Edoardo Oliveri3, Massimo Sonnati3, Stefano
Barabino2. 1Farmigea SpA, Pisa, Italy; 2Clinica Oculistica,
DiNOGMI, Azienda Ospedaliera San Martino-IST, Genoa, Italy;
3
Hippocrates Sintech, Genoa, Italy.
Purpose: Dry eye syndrome (DES) is a disease of the ocular
surface and one of the most frequent pathological conditions in
ophthalmology. The aim of the project was to develop an app to offer
the possibility to use iPad and iPhone to record patients’ complete
clinical chart data with a specific section dedicated to ocular surface
tests and DES management that could be used in everyday clinical
practice and for clinical studies.
Methods: In the first phase we compared numerous clinical charts
available for PC and paper versions. Then we developed a complete
clinical chart (iEyes) to record patients’ picture, medical and
ophthalmological history, visual acuity, and clinical data for iPad.
In particular we have included a section with specific ocular surface
tests: dry eye questionnaires, Schirmer test, fluorescein and lissamine
green staining grading scales, tear break-up time, conjunctival
hyperemia score, eyelid margin redness, quality of expressed
meibum, and other specific tests used in experimental studies only.
The app was tested by 3 general ophthalmologists and 3 specialists in
ocular surface diseases. Data were recorded with standard methods
(paper) and with the new app. Recording time were measured and
compared. Data could visualized on i Phone also.
Results: A total of 300 patients were recorded, with ocular surface
tests performed in 90 patients. No problems were referred by
physicians with the use of the app on iPad. The recording time was
significantly (P<0.05) lower in the iPad group compared to the paper
group. The chance to visualize clinical chart recorded data on iPhone
obtained a significant satisfaction rate.
Conclusions: This new app provides a useful tool for clinicians and
researchers to record data that could be used in everyday practice
and for clinical studies. Future developments could be the possibility
for patients included in clinical studies to communicate data of
questionnaires from their devices and to verify treatment compliance.
Commercial Relationships: caterina cordella, Farmigea SpA
(E); Edoardo Oliveri, Hippocrates Sintech (E); Massimo Sonnati,
Hippocrates Sintech (E); Stefano Barabino, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 4113 Poster Board Number: B0035
Presentation Time: 8:30 AM–10:15 AM
Automated ocular surface staining analysis based on a teachable
algorithm: smartphone web-based applicayion for dry eye and
ocular surface disease
Felipe H. Padovani1, Paulo Borges5, Kristopher Sanford5, Luciana
Oharomari4, Eduardo M. Rocha4, Paulo Schor3, Monica Alves2.
1
Pontific Catholic University of Campinas, Jundiaí, Brazil;
2
Ophthalmolgy, University of Campinas, Campinas, Brazil;
3
Ophthalmology, Federal University of São Paulo, São Paulo,
Brazil; 4Ophthalmology, FMRP, Ribeirão Preto, Brazil; 5Electrical
Engineering, Santa Clara University, Santa Clara, CA.
Purpose: Dry Eye Disease (DED) and ocular surface disorders
diagnosis, scoring and follow up apply vital stainings. However,
interpretation is influenced by observer experience and subjectivity.
The aim of the present work is to describe a web-based application
(app) which runs an algorithm to analyzes images of fluorescein
ocular surface staining obtained with the digital camera of a
smartphone to quantify, register and provide a follow up tool.
Methods: Support Vector Machine (SVM) was applied to score
the intensity and pattern of fluorescein staining in images of ocular
surface obtained from healthy individuals and ocular surface diseases
patients using the camera of the smartphone connected to a slit lamp.
We are trying an automated approach to reduce the noise and to crop
the unwanted background, using a sequence of algorithms from the
Open Computer Vision (OpenCV) programming library. The goal is
to obtain an image that can be analysed by a standard method which
produces a numerical coefficient tha can be compared to clinical
results.
Results: The software determines the optimal hyperplane to provide
the most accurate maximum margin to separate the staining area
from not one, as seen in punctate keratitis in DED, corneal ulcers and
epithelial defects. Gauss filters are being applied to improve the final
results. Preliminary results have showed necessity to improve the
techniques in order to reduce the noise and crop the image properly
and, then, improve the statistical and clinical relevance of the
numeric coefficient.
Conclusions: The present work describes a new tool capable to
register and score corneal fluorescein staining. It will be useful for
clinical standardization and follow up measurements of DED severity
and ocular surface disorders. Regarding practical aspect this tool can
run in devices present in the daily clinical practice, the slit lamp and
the smartphone, providing a feasible and more precise method to
analyse ocular surface staining.
Normal ocular surface: fluorescein staining under cobalt filter,
smartphone and slit lamp photograph 10x magnification.
Image editing algorithm prior to staining analysis.
Commercial Relationships: Felipe H. Padovani, None; Paulo
Borges, None; Kristopher Sanford, None; Luciana Oharomari,
None; Eduardo M. Rocha, None; Paulo Schor, None; Monica
Alves, None
Program Number: 4114 Poster Board Number: B0036
Presentation Time: 8:30 AM–10:15 AM
Contribution of augmented reality in clinical practice in
ophthalmology
Mathieu Flores1, Nina Mauris2, Anne-Charlotte Level2, Julien
Magnin-Feysot2, Maher Saleh1. 1CHU Besançon, Besançon, France;
2
ISIFC, Besançon, France.
Purpose: Feasibility study of a device allowing recording,
transmission and viewing by another operator of a stereoscopic
clinical examination at the slit lamp.
Methods: Two medical cameras (CM900, Haag-Streit, Bern,
Switzerland) were mounted on a slit lamp (BQ900, Haag-Streit,
Bern, Switzerland) equipped with a beam splitter allowing to record
stereoscopic videos. The video footage associated with the patient’s
clinical data were then remotely transmitted to another examiner
located in another room via a secure server dedicated to telemedicine.
The data was then visualized through augmented reality glasses type
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Oculus Rift DK2 (Oculus VR, California) for stereoscopic viewing of
the recorded consultation.
Results: Five patients consulting for diseases of the anterior and
posterior segments were examined remotely and the diagnosis was
consistent with that of the first examiner in all cases.
Conclusions: The success of this experience of telemedicine and
augmented reality offers significant opportunities in the fields of
education and remote consultation.
Commercial Relationships: Mathieu Flores, None; Nina Mauris,
None; Anne-Charlotte Level, None; Julien Magnin-Feysot, None;
Maher Saleh, None
Program Number: 4115 Poster Board Number: B0037
Presentation Time: 8:30 AM–10:15 AM
A novel imaging technique to non-invasively track molecules in
the eye
Guillaume Normand1, Jan Penraat2, Joy Ghosh4, Kellyann Kovach2,
Mikele Simkins2, Michael Rosol1, Cynthia L. Grosskreutz3, Sudeep
Chandra1. 1BioMarker Development, Novartis Institutes for
Biomedical Research, East Hanover, NJ; 2LAS, Novartis Institutes
for Biomedical Research, East Hanover, NJ; 3Translational Medicine,
Novartis Institutes for Biomedical Research, Cambridge, MA;
4
Ophthalmology Research, Novartis Institutes for Biomedical
Research, Cambridge, MA.
Purpose: Understanding biodistribution in the eye is a critical step
in developing novel therapeutics, yet outside of small animals the
ability to visualize such distribution remains limited. A novel in vivo
imaging method was evaluated to non-invasively and longitudinally
measure the distribution of molecules after intravitreal (IVT)
injection. The goals of this study were to select the optimal dye
for in vivo use, to build a quantification method and to develop a
translatable technology.
Methods: The near-infrared probes IRDye800CW and Indocyanine
Green (ICG), as well as fluorescein, were evaluated ex vivo and in
vivo after IVT or intravenous (IV) dosing. Cynomolgus monkeys
were taken to the imaging room under anesthesia. After pupil
dilation, animals were placed in the prone position and images were
captured with a Spectralis, a confocal laser ophthalmoscope (cSLO),
using 30 degree and ultra-widefield lenses (UWF) and at different
sensitivities and diopters. Fluorescence intensity was measured at the
retina and in the vitreous using the CellProfiler software.
Results: IRDye800CW was found to be brighter both ex vivo and in
vivo and less prone to quenching at high concentrations as compared
to ICG. Moreover, IRDye800CW was shown to be cleared less
rapidly than fluorescein and ICG from the retina and blood pool
after IVT or IV injection, respectively. Based on a dose comparison
study, the minimum detectable concentration of IRDye800CW at the
retina was determined to be between 0.0349ug and 0.349ug. After
IVT injection of 3.49ug of IRDye800CW, fluorescence intensity at
the retina peaked 24h post-dose but was undetectable after 15 days
post-dose. Interestingly, IRDye8000CW was observed to accumulate
in the optic disc as well as form speckles along the retinal arteries.
The UWF lens was able to demonstrate the high variability of the
injection site and pattern by capturing a larger area of the retina.
Conclusions: Of the dyes tested, IRDye800CW was validated in
this study as the optimal dye for in vivo ocular imaging and potential
future clinical use. Distribution of the free dye was measured in
several animals in order to benchmark the passage of the free dye
as compared to other targeted probes. In contrast to other methods,
this is a non-invasive technique that combines qualitative as well as
semi-quantitative measurements of a molecule’s vitreous passage and
provides useful anatomical information, especially for the retina.
Commercial Relationships: Guillaume Normand, Novartis (E);
Jan Penraat, Novartis (E); Joy Ghosh, Novartis (E); Kellyann
Kovach, Novartis (E); Mikele Simkins, Novartis (E); Michael
Rosol, Novartis (E); Cynthia L. Grosskreutz, Novartis (E); Sudeep
Chandra, Novartis (E)
Program Number: 4116 Poster Board Number: B0038
Presentation Time: 8:30 AM–10:15 AM
In vivo low light level mouse retinal SLO imaging: limits for
backscattered intensity and autofluorescense detection
Pengfei Zhang1, Azhar Zam1, Edward Pugh1, Robert J. Zawadzki1, 2.
1
Cell Biology and Human Anatomy, University of California, Davis,
Davis, CA; 2Dept. of Ophthalmology & Vision Science, University of
California, Davis, Sacramento, CA.
Purpose: To evaluate feasibility of a custom mouse scanning light
ophthalmoscope (SLO) for low light level (below 1mW) mouse
retinal imaging. Low light imaging is desired to reduce potential
deleterious effects of light-tissue interactions, including heating
and photochemical reactions (e.g., reactive oxygen species; retinoid
byproducts from pigment bleaching).
Methods: A custom widefield (~50 deg VA) high-resolution retinal
imaging SLO with a 0 Dpt contact lens (affixed to the SLO optics)
was used to simultaneously acquire both backscattered intensity as
well as autofluorescense signal from mouse retina. Different scanning
speeds and light levels were tested to find the minimum light power
that gives good quality images. 469 nm light from a Fianium sc400
Supercontinuum laser source was used for imaging and a 503 nm
long-pass filter was used to select retinal autofluorescense. The
SLO detection system consisted of a Hamamatsu PMT (H742220) for reflected light and H7422-40 for fluorescense and Femto
preamplifiers (107 gain), and the sampling rate is 500kHz. Custom
Labview acquisition software allowed selection of the sampling
region (ROI) and frame rate. Pigmented (C57BL/6) and albino
(BALB/cJ) mice from Jackson Laboratory were used as subjects.
During imaging, mice were anesthetized with 2-3% inhalational
isoflurane anesthetic. Pupils were dilated and cyclopleged with
Tropicamide and phenylephrine.
Results: Example images of mouse retina (BALB/cJ, 13 mo)
acquired simultaneously in reflectance and fluorescence channels
during a single imaging session with different light levels are
presented (Fig. 1). The data were acquired with pixel sample time of
6 μs and sampling density of 256 x 256 pixels, resulting in frame rate
of ~2Hz. Control gain voltage of the PMTs was adjusted to match the
dynamic range of the DAQ during imaging.
Conclusions: Low light level mouse retinal imaging is essential to
allow study of physiological processes of the retina in vivo without
adversely affecting retinal structure and function by the probing beam
itself. Our data suggest that low light level SLO is feasible for mouse
retinal imaging. In particular, light levels below 1mW can be used
during mouse positioning, keeping light exposure to minimum.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Conclusions: The translation of this approach into clinical practice
would enable visualisation of immune cells in situ. This will not only
provide a greater understanding of pathogenesis, monitoring and
assessment of therapy in many human ocular diseases but also opens
the ability to image immunity live for neurodegenerative disorders,
cardiovascular disease and systemic immune mediated disorders.
Fig.1 Single frame and 50 frames summed reflectance(REFL) and
autofluorescence(AF) images with different light levels.
Commercial Relationships: Pengfei Zhang, None; Azhar Zam,
None; Edward Pugh, None; Robert J. Zawadzki, None
Support: UC Davis Research in Science & Engineering (RISE)
grant, UC Davis National Eye Institute Core facilities grant.
Program Number: 4117 Poster Board Number: B0039
Presentation Time: 8:30 AM–10:15 AM
Depot Indocyanine Green Dye for in vivo visualization of
infiltrating leukocytes
Dawn A. Sim1, 2, Colin J. Chu2, Michael B. Powner2, Senthil Selvam2,
Adnan Tufail1, 2, Catherine A. Egan1, James W. Bainbridge1, 2, Richard
W. Lee3, 1, Andrew D. Dick3, 1, Marcus Fruttiger2. 1NIHR Biomedical
Research Center, Moorfields Eye Hospital, London, United Kingdom;
2
UCL Institute of Ophthalmology, London, United Kingdom;
3
Academic unit of Ophthalmology, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom.
Purpose: To assess a novel method to label and image myeloid cells
infiltrating the mouse retina and choroid in vivo, using a single depot
injection of Indocyanine green dye (ICG).
Methods: We assess the use of depot ICG for the purpose of in
vivo cell labelling on three different ocular models of inflammation
and angiogenesis - endotoxin-induced uveitis (EIU), experimental
autoimmune uveoretinitis (EAU) and laser-induced choroidal
neovascularisation (CNV) model. A near-infrared scanning
ophthalmoscope was used for in vivo imaging of the eye and flow
cytometry was used on blood and spleen to assess the number and
phenotype of labelled cells. ICG was administered 72 hours prior
to the induction of inflammation to ensure clearance from systemic
circulation.
Results: We found that in vivo intravenous administration failed to
label any leukocytes, whereas depot injection, either intraperitoneal
or subcutaneous, was successful in labelling CD11b+ myeloid cells.
Progression of inflammation could be traced over a period of 14
days following a single depot injection of ICG. Additionally, flow
cytometric analysis revealed that the predominant population of cells
stained by ICG are circulating and splenic reservoir CD11b+ myeloid
cells.
Commercial Relationships: Dawn A. Sim, Allergan (F), UCL
Business (P); Colin J. Chu, None; Michael B. Powner, None;
Senthil Selvam, None; Adnan Tufail, UCL Business (P); Catherine
A. Egan, None; James W. Bainbridge, None; Richard W. Lee,
None; Andrew D. Dick, None; Marcus Fruttiger, UCL Business (P)
Program Number: 4118 Poster Board Number: B0040
Presentation Time: 8:30 AM–10:15 AM
Exploring photoreceptor directionality using quadrant pupil
detection
Brian Vohnsen, Salihah Qaysi, Pedro Anjos, Denise Valente. School
of Physics, University College Dublin, Dublin, Ireland.
Purpose: Photoreceptors are endowed with directional properties
that are expressed by their angular sensitivity to incident light and
directionality in retinal imaging known as the Stiles-Crawford effect
of the first kind (SCE) and the optical SCE, respectively. Individual
photoreceptor tilt can be analyzed by moving the incident light across
the pupil when capturing retinal images. The purpose of this study is
to examine with numerical analysis and fundus imaging the viability
of an alternative quadrant detection scheme in which retinal images
are captured through four equal-sized pupil sectors from which
individual cone photoreceptor tilts can be derived.
Methods: A numerical analysis has been performed for directional
light scattering from photoreceptor cones in the retinal mosaic
modeled as tri-layered structures that represent the location of
mitochondria in the ellipsoid, the inner-outer segment junction and
the posterior outer segment tip [Vohnsen, Frontiers in Optics (2014)
FW5F.5]. Each outer segment has been added random tilt of varying
amplitude. Simulated cone mosaic images are calculated through 4
equal-sized sectors in the pupil plane. The numerical predictions are
compared with experimental quadrant parafoveal fundus images for
healthy subjects.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Results: The sectored quadrant pupil allows not only determination
of total intensity images but also direct determination of local cone
photoreceptor tilts (which may differ from their psychophysically
relevant tilts) in two orthogonal directions using the sectored
backscattered light intensity. It is found that the method is highly
suited to determine tilt without requiring displacement of the incident
light in the pupil plane whereby the analysis becomes simplified
although it requires proper centration with respect to the SCE peak
location. Retinal images in the healthy subjects show only small
photoreceptor tilts in the parafoveal region but confirm the potential
of the technique.
Conclusions: The numerical analysis shows that the quadrant pupil
detection is suitable for rapid detection of individual photoreceptor
tilts in the photoreceptor mosaic of less than 1 degree. With
proper optimization this may have clinical potential for analysing
perturbations caused by drusen and retinal disease that may alter the
pointing of the photoreceptors causing a resulting deterioration of
vision.
Commercial Relationships: Brian Vohnsen, None; Salihah Qaysi,
None; Pedro Anjos, None; Denise Valente, None
Support: SFI 08/IN.1/B2053
Program Number: 4119 Poster Board Number: B0041
Presentation Time: 8:30 AM–10:15 AM
Intraocular scattering compensation in macular pigment density
measurement
Dimitrios Christaras, Harilaos Ginis, Alexandros Pennos, Pablo
Artal. Laboratorio de Optica, Universidad de Murcia, Murcia, Spain.
Purpose: Intraocular scattering reduces the contrast of fundus
images, especially in flood-illumination imaging systems. Since
macular pigment density (MPD) is often estimated from the analysis
of multispectral retinal images, this contrast reduction may affect the
results. We performed experiments to better understand the severity
of this problem and to overcome it by compensating scatter, thus
obtaining a more accurate estimate of the MPD.
Methods: A new multispectral fundus imaging system based on
the double pass principle, also capable of measuring intraocular
scattering at various wavelengths, was built. In addition, a
computational method to estimate MPD from retinal images after
compensation of light scattering was developed. The experimental
setup includes a xenon lamp filtered by band-pass filters and
homogenized by diffusers,a motorized iris conjugated to the subject’s
retina and an electron multiplying CCD camera. To avoid reflections
and backscattered light from the lens and the cornea, the imaging and
illumination arms are spatially separated by means of rectangular
apertures conjugated to the pupil plane. Intraocular scattering was
estimated using an optical integrator method by projection of uniform
disks ranging from 0.4 to 6 degrees radius (Ginis, et al (2012),
Journal of Vision, 12(3), 1–10). For the MPD calculation, a pair of
foveal images was recorded at two wavelengths, 460 and 550 nm.
These images were then corrected for the effect of scatter by using a
standard deconvolution technique and the scatter free value of MPD
was calculated according to a formula (Delori et al (2001), J. Opt.
Soc. Am. A, 18, 1212–1230).
Results: The complete procedure was successfully applied to 2 young
subjects, LH and DC, with no known eye pathology. The observed
maximum value of the MPD was 0.34 and 0.28 D.U. for DC and LH
respectively, whereas without any scatter compensation the respected
vales were 0.18 and 0.16 D.U., exhibiting an underestimation at the
order of 45% for the maximum value and 35% for the mean value of
the total MPD. The effect depends highly on the overall scattering but
also on the difference in scattering for blue and for green.
Conclusions: Initial results from two young, healthy subjects have
shown an important underestimation of the MPD when the effect of
scattering is not taken into account. This effect is expected to be more
important in elderly subjects with elevated intraocular straylight.
Commercial Relationships: Dimitrios Christaras, None; Harilaos
Ginis, None; Alexandros Pennos, None; Pablo Artal, None
Program Number: 4120 Poster Board Number: B0042
Presentation Time: 8:30 AM–10:15 AM
Methods for an Enhanced 3D Interpretation of Autoradiographic
Ocular Drug Distribution Data
Julie E. Whitcomb1, Susan S. Lee1, Michael Robinson1, Jie Shen1,
Elizabeth Spencer3, Meagan Krueger3, Harvey Pollack2, Rex Moats2,
Yang Tang2, Mayssa Attar1. 1Allergan, Irvine, CA; 2Childrens Hospital
of Los Angeles, Los Angeles, CA; 3Covance, Madison, WI.
Purpose: Understanding drug distribution in the eye following
various routes of administration is important for optimizing drug
delivery. The physiologic and anatomic barriers that affect drug
distribution to the site of action can be studied with autoradiography
(ARL), which detects radiolabeled drug compounds on two
dimensional film, but lacks anatomical landmarks for spatial
reference. Herein, we describe a method to enhance ARL images for
3D interpretation.
Methods: A model radiolabeled compound (MW: 430 g/mol)
was dosed unilaterally via daily repeated topical dose and a single
intravitreal injection (n = 2 monkeys). The frozen heads were
sectioned into 43 transverse cross sections 20 mm thick through
the eye. Sections were mounted on a lexan plate, photographically
imaged (Figure 1a), then exposed on phosphor imaging screens
(Figure 1b) with blood standards for radioactivity quantitation. A
novel algorithm was designed to align the anatomical photographic
images to the ARL slides. Radioactivity concentration as a function
of image density was generated and the individual images stacked to
render a 3D volume.
Results: The 3D reconstruction provided an anatomically accurate
and quantitative representation of the 2D phosphor images. The blood
standards were used to translate the log-linear concentration of the
radioactivity to a quantitative heat map (Figure 1c) to interpretat the
dimensional gradient. Interpolation between the individual slices was
done to visually illustrate the regional drug distribution between the
two routes of administration (Figure 2). Overall the topical dosing
resulted in localized distribution in the anterior region; whereas, the
intravitreal dose was more dispersed throughout the entire eye.
Conclusions: Traditional ARL films are generally difficult to
interpret in a 3D space and the drug distribution is difficult to
interpret without any anatomic references. Quantitative 3D renderings
of drug distribution from 2D digital autoradiographic images is a
useful tool for understanding local drug delivery in relation to the
anatomical structures and can be applied to other labeling techniques
to better understand drug distribution.
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Photographic (top), Autoradiographic (middle), and Quantitative
Heat Map (bottom) Images with Topical (left) and Intravitreal
(right) Administration
3D Rendered Images Comparing Topical (left) and Intravitreal
(right) Administration
Commercial Relationships: Julie E. Whitcomb, Allergan (E);
Susan S. Lee, Allergan (E); Michael Robinson, Allergan (E); Jie
Shen, Allergan (E); Elizabeth Spencer, Covance (E); Meagan
Krueger, Covance (E); Harvey Pollack, Allergan (C), Childrens
Hospital of Los Angeles (E); Rex Moats, Allergan (C), Childrens
Hospital of Los Angeles (E); Yang Tang, Allergan (C), Childrens
Hospital of Los Angeles (E); Mayssa Attar, Allergan (E)
Program Number: 4121 Poster Board Number: B0043
Presentation Time: 8:30 AM–10:15 AM
Microfocus computed tomography as a new method for highresolution imaging of microstructures in the eye: a pilot study
Christian Enders1, Eva Braig2, Jens U. Werner1, Gerhard K. Lang1,
Gabriele E. Lang1, Kai H. Scherer2, Franz Pfeiffer2. 1Department of
Ophthalmology, University of Ulm, Ulm, Germany; 2Department of
Pyhsics and Institute of Medical Engineering, Technische Universität
München, Munich, Germany.
Purpose: Histopathological examination requires processing and
provides a two-dimensional (2D) view on the sections of a specimen.
The aim of this study is to investigate the structural characteristics
of the eye in an ex-vivo study using high-resolution microfocus
computed tomography (micro ct) without the need of processing and
providing three-dimensional (3D) non-destructive sectional images.
Methods: The study was approved by the institutional reviewboard,
and informed consent was obtained. A total of 4 specimens were
used. Among them were 3 enucleated human bulbi and 1 exenterated
swine eye. The 3 human specimens had underwent regular
histopathological examination. Diagnoses of the human specimens
were angle closure glaucoma, retinal detachment and malignant
melanoma. The swine eye had been used for surgical training and
a CyPass micro-stent® had been implanted. All specimens were
fixated in paraffin. We obtained images with a high-resolution micro
ct system (v|tome|x by GE®) for 3D computed tomography and 2D
non-destructive X-ray inspection. The maximum resolution is 2-20
micrometers depending on the sample size.
Results: The obtained images showed good correlation with
histopathologic findings. The maximum resolution in our specimens
is 20 micrometers. In the 2D-images retinal, choroidal, uveal,
corneal and lental tissues can be distinguished among others. The
configuration of the anatomical structures e.g. the chamber-angle
can be assessed without damaging the integrity of the specimen.
The exact position of a surgically applicated device like the CyPass
micro-stent® can be assessed faster and more accurate than with
standard histological examination. The 3D-images give a helpful
overview of the anatomical structures but cannot distinguish between
tissues as good as the 2D-images.
Conclusions: The results of this study indicate that ex-vivo micro ct
is a helpful research tool in the examination of enucleated bulbi with
excellent correlation to histo-pathologic findings. Although at present
not applicable in vivo because of the radiation load and sample size,
micro ct is a valuable complimentary tool in ex-vivo diagnostics
and in the development of new surgical techniques and ophthalmic
devices.
3D rendering of a swine eye with a micro-stent
orthogonal 2D slice of a a swine eye with a micro-stent
Commercial Relationships: Christian Enders, None; Eva Braig,
None; Jens U. Werner, None; Gerhard K. Lang, None; Gabriele
E. Lang, None; Kai H. Scherer, None; Franz Pfeiffer, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
Program Number: 4122 Poster Board Number: B0044
Presentation Time: 8:30 AM–10:15 AM
Two-photon Signals From Label-free Human Epiretinal
Membranes
Juan M. Bueno1, Xavier Valldeperas2, Francisco J. Avila1, Raquel
Palacios1, Pablo Artal1. 1Laboratorio de Optica, Universidad de
Murcia, Murcia, Spain; 2Hospital Universitari Germans Trias,
Badalona, Spain.
Purpose: Epiretinal membranes (ERMs) are composed of neural
elements and different cellular and extracellular matrix (ECM)
components usually visualized using multi-labeling methods. We
have used two-photon microscopy to image non-stained human
ERMs to analyze the sources of two-photon excitation fluorescence
(TPEF) and second harmonic generation signal (SHG). This would
help to better understand the organization and structure of ERMs.
Methods: A custom-developed multiphoton microscope equipped
with adaptive optics (Bueno et al., J. Biomed. Opt. 2010) was used
to record pairs of TPEF-SHG images originated from the ERM
structures in a backward configuration. Specimens from ten patients
were successfully removed during vitrectomy and ERM peeling,
without the use of ophthalmic dyes. Immediately after surgery,
ERMs were fixated with a paraformaldehyde solution overnight and
flatmounted for two-photon microscopy imaging. Series of images
across the specimen and 3D stacks as a function of depth were
acquired for the different samples.
Results: Both TPEF and SHG signals were obtained from the ERM’s
samples, revealing different structures. SHG signals confirmed the
presence of filamentous structures corresponding to collagen fibers
and covering the specimen. TPEF signal was significantly higher
probably due to the presence of numerous types of cells (Muller,
glial…). This cellular autofluorescence is originated from the
mitochondrial reduced pyridine nucleotides NAD(P)H and flavin
compounds. Moreover, the elastin of the ECM might also contribute
to TPEF images.
Conclusions: Two-photon microscopy provides a non-invasive tool
to image unstained isolated ERMs. TPEF/SHG signal combination
revealed detailed information on the ERM morphology not available
with classical imaging techniques. Since staining procedures are not
required, the sample manipulation is reduced. Non-linear imaging
techniques are useful in the visualization and analysis of healthy
and pathological retinal and epiretinal tissues. Farther studies should
investigate the dependence between TPEF/SHG signals and ERM
etiology (idiopathic, diabetic or inflammatory).
Commercial Relationships: Juan M. Bueno, None; Xavier
Valldeperas, None; Francisco J. Avila, None; Raquel Palacios,
None; Pablo Artal, None
Support: Ministerio de Economía y Competitividad, Spain (grant
FIS2013-41237-R)
Program Number: 4123 Poster Board Number: B0045
Presentation Time: 8:30 AM–10:15 AM
Noninvasive functional retinal imaging disrupted by
pharmacologic manipulation of neurovascular coupling pathways
Daniel Y. Tso1, 2, Momotaz Begum1, 2. 1Depts of Neurosurgery and
Ophthalmology, SUNY Upstate Medical Univ, Syracuse, NY; 2SUNY
Eye Institute, Syracuse, NY.
Purpose: Intrinsic signal optical imaging studies have shown the
existence of stimulus-evoked signals in the retina that are likely to be
of outer retinal origin. Additional studies have also shown that such
reflectance change signals are dominated by hemodynamics. The
linkage between this stimulus-driven retinal activity and the resulting
hemodynamic basis of the measured reflectance changes is a form of
neurovascular coupling. However the precise chain of mechanisms
in the retina whereby photoreceptor activation leads to a vascular
response is unknown. Most previous studies of neurovascular
coupling in the retina have been in vitro. In the present study, we
sought to dissect the role of several prospective signaling pathways
in the observed stimulus-evoked neurovascular responses in vivo
through intravitreal injections of selected agonists, antagonists and
blockers, while imaging these retinal intrinsic signals.
Methods: Animals and Preparation. Adult cats were anesthetized,
paralyzed and positioned in a stereotaxic. Using a modified fundus
camera, the retina was stimulated with visible (550nm) patterned
stimuli and illuminated in the near-infrared (700-900nm), while
intrinsic optical signals were recorded with a CCD camera.
Drug-injections. Intravitreal injections included suramin (purinergic
antagonist), HET0016 (20-HETE inhibitor), PPOH (EET inhibitor)
and NECA (adenosine agonist).
Results: Previous retinal imaging studies using intravitreal injections
of blockers of inner retinal function (e.g. TTX, PDA, APB) yielded
little impact on the retinal imaging signals. However in the present
study, each drug selected to interfere with a particular neurovascular
coupling pathway had profound impact on the observed retinal
imaging signals. In some cases, the sign of the observed retinal
imaging signal changed from negative to positive.
Conclusions: This novel functional retinal imaging technique
is shown to reveal outer retinal function through its impact on
hemodynamics via the neurovascular coupling pathways. These
studies help establish the chain of retinal events from light absorption
to observed changes in retinal reflectance in vivo. It is anticipated that
an understanding of the underlying neural, biophysical and signaling
mechanisms will help determine the utility of this method for studies
of retinal function, health and related clinical applications.
Commercial Relationships: Daniel Y. Tso, None; Momotaz
Begum, None
Program Number: 4124 Poster Board Number: B0046
Presentation Time: 8:30 AM–10:15 AM
RetinAsk: A Queryable Atlas of the Retina
Jessica Taibl, Samir I. Sayegh. The EYE Center, Champaign, IL.
Purpose: To present the improved version of The Queryable Atlas
of the Retina that allows for queries based on partial information,
including retinal images, of an unknown retinal condition.
Methods: Since the original presentation of the Queryable Atlas
of the Retina (Sayegh et al, AAO 2000) a number of events have
occurred that led to a fundamental redesign and improvement of
the Atlas. 1) OCT has become a major tool of diagnosis of retinal
disease, 2) the speed and memory capacity of computers, as well
as speed of implementation of search algorithms, have continued
to rise exponentially and 3) new treatments paradigm and novel
surgical techniques have profoundly transformed retinal therapeutics.
These three aspects have been utilized to redesign the Atlas while
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
maintaining its fundamental queryable nature which clearly
distinguishes it from other more traditional approaches.
Results: The new design allows for rapid queries to be resolved
based on limited characterization or partial information. The search
“by field” and “by image” features have been vastly improved.
Conclusions: The Queryable Atlas of the Retina can be used as a
powerful diagnostic support tool as well as a valuable teaching tool in
residency and retinal fellowship programs.
Commercial Relationships: Jessica Taibl, None; Samir I. Sayegh,
None
Program Number: 4125 Poster Board Number: B0047
Presentation Time: 8:30 AM–10:15 AM
Physical and Optical Properties of Rigid Gas Permeable Contact
Lenses Measured with Optical Coherence Tomography
Dean A. VanNasdale, Gang Huang, Nicky Lai, Marisa Ciamacca,
Amanda Eilerman, Aaron Zimmerman, Alex Nixon, Molly Smith.
Optometry, Ohio State Univ College of Optometry, Columbus, OH.
Purpose: To calibrate the axial and lateral dimensions of spectral
domain optical coherence tomography (SDOCT) images using rigid
gas permeable (RGP) contact lenses. To quantify the physical and
optical characteristics of RGP lenses using cross sectional OCT
imaging.
Methods: The parameters of 5 spherical RGP lenses of the same
design, index of refraction = 1.433, were manually verified. The
posterior side of each lens was mounted on a flat surface and imaged
using the Heidelberg Spectralis SDOCT system with Anterior
Segment Module (Heidelberg Engineering, Carlsbad, CA). The 30
deg image included the entire cross section of the central lens and
extended beyond the lens boundaries to included locations of the
mounting platform only, which was used as an axial reference. The
lateral and axial pixel dimensions were calculated and divided by
the known diameter of the contact lens and center thickness. The
index of refraction of the lens material was used to compensate
for the thickness changes induced in the cross sectional imaging.
Optical path length differences created by the thickness and index of
refraction change of the lenses were confirmed by measuring by the
displacement of the flat mounting surface under the lens, relative to
the undeviated surface imaged outside of the lens boundaries.
Results: Lateral and axial characteristics of the OCT images could
be successfully calibrated using the known parameters of the RGP
lenses. The coefficient of variation for distance conversions of the 5
lenses was less than 1% for each of the axial and lateral dimensions.
The displacement of the flat surface caused by the optical path length
difference induced by the contact lens was linearly proportional to the
thickness of the contact lens (r2 = 0.9736).
Conclusions: RGP lenses can be used to calibrate cross sectional
OCT images in both the lateral and axial dimensions. Physical
characteristics of RGP lenses can be extracted from cross sectional
OCT data. Optical properties of RGP lens can be assessed using
optical path length differences induced by the RGP thickness and
index of refraction changes.
Commercial Relationships: Dean A. VanNasdale, None; Gang
Huang, None; Nicky Lai, None; Marisa Ciamacca, None; Amanda
Eilerman, None; Aaron Zimmerman, None; Alex Nixon, None;
Molly Smith, None
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].