Characterization of In Vivo Retinal Lesions of Diabetic Retinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy
Sonja KarstJan LammerSalma RadwanHanna KwakPaolo S. SilvaStephen A. BurnsLloyd Paul AielloJennifer K. Sun
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Abstract:
To characterize hallmark diabetic retinopathy (DR) lesions utilizing adaptive optics scanning laser ophthalmoscopy (AOSLO) and to compare AOSLO findings with those on standard imaging techniques.Cross-sectional study including 35 eyes of 34 study participants. AOSLO confocal and multiply scattered light (MSL) imaging were performed in eyes with DR. Color fundus photographs (CF), infrared images of the macula (Spectralis, Heidelberg), and Spectralis spectral domain optical coherence tomography SDOCT B-scans of each lesion were obtained and registered to corresponding AOSLO images.Individual lesion characterization by AOSLO imaging. AOSLO appearance was compared with CF and SDOCT imaging.Characterized lesions encompassed 52 microaneurysms (MA), 20 intraretinal microvascular abnormalities (IRMA), 7 neovascularization (NV), 11 hard exudates (HE), 5 dot/blot hemorrhages (HEM), 4 cotton wool spots (CWS), and 14 intraretinal cysts. AOSLO allowed assessment of perfusion in vascular lesions and enabled the identification of vascular lesions that could not be visualized on CF or SDOCT.AOSLO imaging provides detailed, noninvasive in vivo visualization of DR lesions enhancing the assessment of morphological characteristics. These unique AOSLO attributes may enable new insights into the pathological changes of DR in response to disease onset, development, regression, and response to therapy.Keywords:
Scanning laser ophthalmoscopy
Wavefront Sensorless Adaptive Optics combined with Optical Coherence Tomography and fluorescence confocal Scanning Laser Ophthalmoscopy for structural and functional imaging of the mouse retina in-vivo using a MEMS deformable mirror and a novel adaptive lens.
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We developed a clinically deployable adaptive optics (AO) scanning laser ophthalmoscope (AOSLO) using a micro-electro-mechanical (MEMS) deformable mirror and low coherent light sources. We investigated retina microstructure in retinal degeneration patients with high resolution.
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To evaluate cone spacing using adaptive optics scanning laser ophthalmoscopy (AOSLO) in eyes with nonneovascular AMD, and to correlate progression of AOSLO-derived cone measures with standard measures of macular structure.Adaptive optics scanning laser ophthalmoscopy images were obtained over 12 to 21 months from seven patients with AMD including four eyes with geographic atrophy (GA) and four eyes with drusen. Adaptive optics scanning laser ophthalmoscopy images were overlaid with color, infrared, and autofluorescence fundus photographs and spectral domain optical coherence tomography (SD-OCT) images to allow direct correlation of cone parameters with macular structure. Cone spacing was measured for each visit in selected regions including areas over drusen (n = 29), at GA margins (n = 14), and regions without drusen or GA (n = 13) and compared with normal, age-similar values.Adaptive optics scanning laser ophthalmoscopy imaging revealed continuous cone mosaics up to the GA edge and overlying drusen, although reduced cone reflectivity often resulted in hyporeflective AOSLO signals at these locations. Baseline cone spacing measures were normal in 13/13 unaffected regions, 26/28 drusen regions, and 12/14 GA margin regions. Although standard clinical measures showed progression of GA in all study eyes, cone spacing remained within normal ranges in most drusen regions and all GA margin regions.Adaptive optics scanning laser ophthalmoscopy provides adequate resolution for quantitative measurement of cone spacing at the margin of GA and over drusen in eyes with AMD. Although cone spacing was often normal at baseline and remained normal over time, these regions showed focal areas of decreased cone reflectivity. These findings may provide insight into the pathophysiology of AMD progression. (ClinicalTrials.gov number, NCT00254605).
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Ultra-widefield scanning laser ophthalmoscopy is an imaging technique that can take the 200-degree wide field of fundus image with non-mydriatic,which has been widely used in ophthalmology.Studies have shown that the ultra-widefield scanning laser ophthalmoscopy is sensitive in the screening of diabetic retinopathy and has the superiority to detect the peripheral retinal lesions compare to the traditional 7field fundus photography.In addition,the ultra-widefield scanning laser ophthalmoscopy has great significance for the screening,diagnosis and follow-up of other peripheral chorioretinopathy.
Key words:
Ultra-widefield scanning laser ophthalmoscopy; diabetic retinopathy; screening; peripheral chorioretinopathy
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Adaptive optics has been applied to retinal imaging in order to resolve the cellular features. We are investigating wavefront sensorless adaptive optics (WSAO) for Optical Coherence Tomography and Scanning Laser Ophthalmoscopy, using the image quality to guide the aberration correction. In this report we investigate characterizations of the open loop performance.
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With the development of the optic coherent tomography technology the scanning laser ophthalmoscopy, though almost always present in every such device, as well as in fluorescent angiography laser systems, is not used efficiently enough. The possibility to use the scanning laser ophthalmoscopy for screening of the optic nerve pathology is analyzed.
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To investigate longitudinal changes in the retinal nerve fiber bundle in eyes with primary open angle glaucoma using adaptive optics scanning laser ophthalmoscopy.A prospective observational case series. Fourteen eyes from 12 patients with primary open angle glaucoma that exhibited retinal nerve fiber layer defects on fundus photography were imaged with adaptive optics scanning laser ophthalmoscopy over time.The expansion of retinal nerve fiber bundle narrowing was observed on adaptive optics scanning laser ophthalmoscopy in 8 eyes (57.1%) over a period of 1.44 ± 0.42 years. Retinal nerve fiber bundle narrowing expanded horizontally in 2 eyes and vertically in 6 eyes. In 3 eyes, changes in the retinal nerve fiber layer were only detectable on adaptive optics scanning laser ophthalmoscopy images.The expansion of retinal nerve fiber bundle narrowing was observed using adaptive optics scanning laser ophthalmoscopy. Accordingly, this tool may be a useful tool for detecting glaucoma-related changes in retinal nerve fibers in a short time.
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Optical coherence tomography (OCT) and other imaging modalities, such as scanning laser ophthalmoscopy (SLO), fail to provide sufficiently detailed images of the photoreceptor microstructure, primarily due to aberrations in ocular optics. These aberrations can be compensated for by using imaging systems that incorporate adaptive optics (AO), including a wavefront sensor to measure the ocular aberrations and a deformable mirror or spatial light modulator to compensate for these ocular aberrations.
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Optical coherence tomography (OCT) and scanning laser ophthalmoscopy (SLO) are complementary imaging modalities, the combination of which can provide clinicians with a wealth of information to detect retinal diseases, monitor disease progression, or assess new therapies. Adaptive optics (AO) is a tool that enables correction of wavefront distortions from ocular aberrations. We have developed a multimodal adaptive optics system (MAOS) for high-resolution multifunctional use in a variety of research and clinical applications. The system integrates both OCT and SLO imaging channels into an AO beam path. The optics and hardware were designed with specific features for simultaneous SLO/OCT output, for high-fidelity AO correction, for use in humans, primates, and small animals, and for efficient location and orientation of retinal regions of interest. The MAOS system was tested on human subjects and rodents. The design, performance characterization, and initial representative results from the human and animal studies are presented and discussed.
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