Optical Coherence Tomography Images Research Articles

The Surviving, Not Thriving, Photoreceptors in Patients with ABCA4 Stargardt Disease.

Stargardt disease (STGD1), associated with biallelic variants in the ABCA4 gene, is the most common heritable macular dystrophy and is currently untreatable. To identify potential treatment targets, we characterized surviving STGD1 photoreceptors. We used clinical data to identify macular regions with surviving STGD1 photoreceptors. We compared the hyperreflective bands in the optical coherence tomographic (OCT) images that correspond to structures in the STGD1 photoreceptor inner segments to those in controls. We used adaptive optics scanning light ophthalmoscopy (AO-SLO) to study the distribution of cones and AO-OCT to evaluate the interface of photoreceptors and retinal pigment epithelium (RPE). We found that the profile of the hyperreflective bands differed dramatically between patients with STGD1 and controls. AO-SLOs showed patches in which cone densities were similar to those in healthy retinas and others in which the cone population was sparse. In regions replete with cones, there was no debris at the photoreceptor-RPE interface. In regions with sparse cones, there was abundant debris. Our results raise the possibility that pharmaceutical means may protect surviving photoreceptors and so mitigate vision loss in patients with STGD1.

High-resolution optical coherence tomography using a multi-level diffractive lens

We present a high-resolution optical coherence tomography (OCT) imaging system that utilizes a multi-level diffractive lens (MDL) to enhance lateral resolution. The system utilizes a polygon-based swept laser source with a center wavelength of 1,000 nm to achieve an axial resolution of 5.6 µm and an imaging depth of 1.4 mm using the bidirectional configuration of a semiconductor optical amplifier. The MDL significantly enhances the lateral resolution of the system, providing an extended depth of focus of 550 µm with an average lateral resolution of 8.5 µm. The effectiveness of this setup is validated through imaging of phantom and onion samples, demonstrating the system's capability for high-resolution deep tissue imaging. These findings underscore the potential of compact MDLs to significantly enhance the performance of OCT systems, offering a promising direction for advanced high-resolution imaging applications.

A case of prolonged corneal sulfur foreign bodies and review of literature

BackgroundThis case mainly describes a relatively rare case of an old mineral-like corneal foreign body that existed for up to 20 years, and did not significantly affect the visual quality of the patient.Case presentationA 56-year-old male miner complained of right eye vision loss for 3 years, swollen and painful for 4 months. Admission examination: Best corrected visual acuity was no light perception in the right eye and 20/20 in the left eye. Anterior segment examination: A large number of spot-like grayish-brown mineral foreign bodies in the conjunctiva of the nasal conjunctiva, emulsified silicone oil floating in the anterior chamber, Corneal foreign bodies in the right eye were widely distributed in the upper cortex and the proelastic layer. There were fewer foreign bodies in the left cornea. Previous medical history, 20 years ago due to forging and burning sulphur mine explosion, resulting in a large number of ore foreign bodies in the conjunctiva of both eyes. As these corneal foreign bodies did not affect the visual quality of the patient, we adopted a conservative treatment plan, did not remove these foreign bodies, and only carried out symptomatic treatment for the patient’s secondary ocular hypertension. The patient was followed up normally in the outpatient department, and no cornea-related complications occurred up to now.ConclusionsFirst of all, it is necessary to understand the source and nature of the foreign body in patients with corneal and conjunctival foreign body injuries. In the second, for the old corneal metal foreign body, when the patient’s visual acuity is stable and there are no symptoms of corneal irritation and inflammatory reaction, it can be Conservative treatment or outpatient follow-up observation. In the end, corneal Optical coherence tomography imaging should not be ignored, which is very important for determining the depth of embedding and the location of the corneal foreign body.

Discriminative atoms embedding relation dual network for classification of choroidal neovascularization in OCT images

Choroidal neovascularization (CNV) is an eye disease that can cause vision loss. Automatic CNV classification in OCT images is crucial in the treatment of CNV. However, two problems arise for CNV classification in OCT images. The subtle visual differences between different CNV types render classification difficult. Additionally, it is difficult to obtain sufficient labeled data, which results in performance degradation. In order to solve these two problems, a discriminative atom-embedding relation dual network is proposed in this paper. Considering that semi-supervised learning (SSL) is an effective machine learning framework to make full use of limited labeled data and a large amount of unlabeled data, the proposed network is developed within an SSL framework. To capture the visual differences, novel discriminative atoms are first introduced to mine discriminative information between different CNV types. Subsequently, a relation module is incorporated to embed the learned discriminative atom information into the features. This makes the learned features capable of distinguishing between different CNV types. Moreover, a novel relation consistency loss is proposed to further improve the robustness of the learned features. Experimental results on private and public datasets demonstrate the effectiveness of the proposed method.

Initial Factors Associated with Resistance to Intravitreal Aflibercept Injection in Polypoidal Choroidal Vasculopathy

Purpose: To identify initial factors contributing to the resistance against intravitreal aflibercept treatment in polypoidal choroidal vasculopathy (PCV) patients.Methods: This study included PCV patients initially treated with aflibercept. Resistance was defined when treatment did not reduce subretinal fluid (SRF) or intraretinal fluid (IRF) by 100 μm or more after three consecutive 4-week intervals, and the treatment interval could not be extended beyond 8 weeks. To identify initial factors associated with resistance to aflibercept treatment, we examined visual acuity and central choroidal thickness before initial treatment and after three treatments. Choroidal thickness was divided into the thickness of the large choroidal vessel layer and the layer that includes choriocapillaris and medium choroidal vessel thickness (termed medium choroidal vessel/choriocapillaris layer thickness, MCCT). Additionally, the volume of SRF, IRF, subretinal hyperreflective material, and pigment epithelial detachment in optical coherence tomography (OCT) images was investigated. The statistical significance of each factor was assessed through logistic regression analysis.Results: The study included 39 eyes showing no resistance to aflibercept and 37 eyes that exhibited resistance. Multiple logistic regression analysis, adjusted for age and sex, indicated that a lower initial ratio of MCCT to choroidal thickness at the fovea was associated with resistance to aflibercept.Conclusions: In patients with PCV treated with aflibercept, early OCT anatomical structures, such as the initial MCCT-choroidal thickness ratio at the fovea, may predict response to treatment injections.

Evaluation of cerebral microcirculation in a mouse model of systemic inflammation.

Perturbations in the microcirculatory system have been observed in neurological conditions, such as Alzheimer's disease or systemic inflammation. However, changes occurring at the level of the capillary are difficult to translate to biomarkers that could be measured macroscopically. We aim to evaluate whether transit time changes reflect capillary stalling and to what degree. We employ a combined spectral optical coherence tomography (OCT) and fluorescence optical imaging (FOI) system to investigate the relation between capillary stalling and transit time in a mouse model of systemic inflammation induced by intraperitoneal injection of lipopolysaccharide. Angiograms are obtained using OCT, and fluorescence signal images are acquired by the FOI system upon intravenous injection of fluorescein isothiocyanate via a catheter inserted into the tail vein. Our findings reveal that lipopolysaccharide (LPS) administration significantly increases both the percentage and duration of capillary stalling compared to mice receiving a 0.9% saline injection. Moreover, LPS-induced mice exhibit significantly prolonged arteriovenous transit time compared to control mice. These observations suggest that capillary stalling, induced by inflammation, modulates cerebral mean transit time, a measure that has translational potential.

Digital histology of retinal microaneurysms as provided by dense B-scan (DART) OCTA: characteristics and clinical relevance in diabetic retinopathy.

Retinal microaneurysms (MAs) are among the earliest signs of diabetic retinopathy (DR) and can be classified in several subtypes by non-invasive multimodal retinal imaging. The main aim of the present study is to characterize retinal MAs perfusion properties and their blood flow network connectivity by means of Dense Automatic-RealTime (DART) OCTA technology, checking the relationship with the multimodal retinal imaging classification and testing the clinical impact of DART. A cross-sectional, observational study setting was chosen. Multimodal retinal imaging included confocal multicolour, OCT, OCTA and DART OCTA. We classified retinal MAs accordingly with the recently proposed multimodal retinal imaging classification and we tested the role of DART OCTA for detecting retinal MAs blood flow network connectivity. We also tested the relationship with clinical parameters. We included 206 retinal MAs of 36 DR eyes. We categorized retinal MAs as red (70; 34%), mixed (106; 51%) and green (30; 15%), corresponding to precise characteristics on structural OCT and both (regular) enface and DART OCTA images. The agreement between en-face and DART OCTA techniques for detecting MAs perfusion was very high (overall ICC 0.98; p < 0.01). However, DART OCTA provided clearer visualization than enface OCTA for detecting the blood flow network connectivity of retinal MAs, especially looking at the afferent and efferent MAs capillaries. Multimodal retinal imaging classification of retinal MAs provided significant correlations with DR duration, DR stage, and macular capillary non-perfusion. DART OCTA provided several new insights on retinal MAs characteristics and their blood flow network connectivity.

Effectiveness of low-level red light for controlling progression of Myopia in children and adolescents

ObjectiveTo evaluate the effectiveness of low-level red light (LRL) in controlling the progression of myopia in children and adolescents. MethodsA randomized controlled trial was conducted from March 2022 to June 2022 at the Xuzhou First People's Hospital. A total of 73 children and adolescents with myopia, between the ages of 6 and 14, and meeting the inclusion criteria, were randomly divided into two groups. The experimental group wore single vision spectacles with LRL intervention, while the control group wore single vision spectacles alone. Spherical equivalent refraction (SER), axial length (AL), subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) were measured for the participants. Data analysis was performed using chi-square test, independent samples t-test, and Mann-Whitney U test. To compare the changes in SER and AL between groups, we utilized the Generalized Estimating Equations (GEE) model. ResultsThe experimental group was composed of 36 individuals, while the control group had 37. The mean age of the participants was 8.9 ± 2.0 years. No statistically significant distinctions in SER, AL and SFCT were observed between the two groups at baseline (P > 0.05). After 6 months of intervention, the experimental group's increase in SER (-0.01D; 95 % CI: -0.09, 0.06) was higher than that of the control group (-0.41D; 95 % CI: -0.51, -0.32), with a significance level of P < 0.001. Furthermore, the changes over time revealed significant differences between the two groups (Wald χ2group×time: 31.576, P < 0.001). The experimental group's AL increase (-0.02 mm; 95 % CI: -0.07, 0.03) was less than the control group's (0.22 mm; 95 % CI: 0.19, 0.25) (P < 0.001), with a significant difference over time between them (wald χ2group×time: 62.305, P < 0.001). SFCT change after 6 months in the experimental group was significantly greater (29.19 μm; 95 % CI: 18.48, 39.91) compared to that of the control group (-6.59 μm; 95 % CI: -14.28, 1.09) (P < 0.001). No adverse events were observed, and there was no evidence of fundus structural damage on OCT imaging. ConclusionsThe findings suggest that low-level red light can effectively control myopia progression in children and adolescents within 6 months. No adverse reactions were observed.

Enhancing OCT patch-based segmentation with improved GAN data augmentation and semi-supervised learning

For optimum performance, deep learning methods, such as those applied for retinal and choroidal layer segmentation in optical coherence tomography (OCT) images, require sufficiently large and diverse labelled datasets for training. However, the acquisition and labelling of such data can be difficult or infeasible due to privacy reasons (particularly in the medical domain), accessing patient images such as those with specific pathologies, and the cost and time investment to annotate large volumes of data by clinical experts. Data augmentation is one solution to address this issue, either using simple variations and transformations of the images (e.g. flips, brightness) or using synthetic data from sophisticated generative methods such as generative adversarial networks (GANs). Semi-supervised learning (SSL) is another technique which aims to utilise unlabelled data to enhance the performance of deep learning methods and is beneficial where significant amounts of data may be available but are not labelled. In this study, we aim to enhance patch-based OCT retinal and choroidal layer segmentation with both GAN-based data augmentation and SSL. In particular, we employ a conditional StyleGAN2 to generate synthetic patches for data augmentation and a similar unconditional GAN for pre-training the patch classifier to perform SSL. In doing so, we propose a new patch classifier architecture based on the discriminator architecture to improve performance, in addition to the SSL benefit. Compared to previous methods, the proposed data augmentation approach provides an improved data augmentation performance for patch classification with its effectiveness widespread, particularly in the case of low data, across three different OCT datasets encompassing a range of scanning parameters, noise levels, pathology and participant variability. The method provides some subsequent improvements in boundary delineation which is of high importance from a clinical perspective. Additionally, the proposed SSL approach boosts classification performance and boundary delineation performance in some cases which provides further usefulness in the case of low data. The proposed methods can be utilised to enhance OCT segmentation methods, which may be of considerable benefit for both clinicians and researchers.

Robust Ultrafast Projection Pipeline for Structural and Angiography Imaging of Fourier-Domain Optical Coherence Tomography.

The current methods to generate projections for structural and angiography imaging of Fourier-Domain optical coherence tomography (FD-OCT) are significantly slow for prediagnosis improvement, prognosis, real-time surgery guidance, treatments, and lesion boundary definition. This study introduced a robust ultrafast projection pipeline (RUPP) and aimed to develop and evaluate the efficacy of RUPP. RUPP processes raw interference signals to generate structural projections without the need for Fourier Transform. Various angiography reconstruction algorithms were utilized for efficient projections. Traditional methods were compared to RUPP using PSNR, SSIM, and processing time as evaluation metrics. The study used 22 datasets (hand skin: 9; labial mucosa: 13) from 8 volunteers, acquired with a swept-source optical coherence tomography system. RUPP significantly outperformed traditional methods in processing time, requiring only 0.040 s for structural projections, which is 27 times faster than traditional summation projections. For angiography projections, the best RUPP variation took 0.15 s, making it 7518 times faster than the windowed eigen decomposition method. However, PSNR decreased by 41-45% and SSIM saw reductions of 25-74%. RUPP demonstrated remarkable speed improvements over traditional methods, indicating its potential for real-time structural and angiography projections in FD-OCT, thereby enhancing clinical prediagnosis, prognosis, surgery guidance, and treatment efficacy.

Generative adversarial networks synthetic optical coherence tomography images as an education tool for image diagnosis of macular diseases: a randomized trial.

This study aimed to evaluate the effectiveness of generative adversarial networks (GANs) in creating synthetic OCT images as an educational tool for teaching image diagnosis of macular diseases to medical students and ophthalmic residents. In this randomized trial, 20 fifth-year medical students and 20 ophthalmic residents were enrolled and randomly assigned (1:1 allocation) into Group real OCT and Group GANs OCT. All participants had a pretest to assess their educational background, followed by a 30-min smartphone-based education program using GANs or real OCT images for macular disease recognition training. Two additional tests were scheduled: one 5 min after the training to assess short-term performance, and another 1 week later to assess long-term performance. Scores and time consumption were recorded and compared. After all the tests, participants completed an anonymous subjective questionnaire. Group GANs OCT scores increased from 80.0 (46.0 to 85.5) to 92.0 (81.0 to 95.5) 5 min after training (p < 0.001) and 92.30 ± 5.36 1 week after training (p < 0.001). Similarly, Group real OCT scores increased from 66.00 ± 19.52 to 92.90 ± 5.71 (p < 0.001), respectively. When compared between two groups, no statistically significant difference was found in test scores, score improvements, or time consumption. After training, medical students had a significantly higher score improvement than residents (p < 0.001). The education tool using synthetic OCT images had a similar educational ability compared to that using real OCT images, which improved the interpretation ability of ophthalmic residents and medical students in both short-term and long-term performances. The smartphone-based educational tool could be widely promoted for educational applications.Clinical trial registration: https://www.chictr.org.cn, Chinese Clinical Trial Registry [No. ChiCTR 2100053195].

The wavenumber linearisation without calibration device for spectral-domain optical coherence tomography.

The wavenumber nonlinearity leads to blurred reconstructed images in spectral-domain optical coherence tomography (SDOCT). In this work, a wavenumber-linearisation method without calibration devices is presented, based on the fact that the difference between the phases of adjacent peak and valley points is equal to . The theoretical model is derived, and the efficacy of the method was proven by acquiring SDOCT data from TiO2 phantom and zebrafish. The results exhibit the superior performance of our method. Compared with the linear phase-based method, the resolution could be improved at least a factor of 2. Compared with the polynomial fitting method, the resolution could also be improved by nearly half.

The impact of novel scoring balloon and cutting balloon after orbital atherectomy on severely calcified coronary lesion as assessed by optical coherence tomography.

Debulking devices are often followed by a scoring or cutting balloon in percutaneous coronary intervention (PCI) for severely calcified lesions. However, there are limited data on balloon preparation after orbital atherectomy (OA) assessed using optical coherence tomography (OCT). We aimed to compare the effects of a novel scoring and cutting balloon on calcified coronary lesions with OCT. We retrospectively examined 38 patients (38 lesions) who underwent PCI with a scoring or a cutting balloon after OA. All patients underwent pre-PCI, preballooning, postballooning, and post-PCI OCT imaging. We divided the patients into novel scoring-balloon (group A: n = 22) and cutting-balloon (group B: n = 16) groups and compared the OCT findings, including minimum lumen area (MLA) and expansion ratio (MLA divided by mean reference lumen area). The mean patient age was 76.1 ± 8.7 years; 71.5% were male. There were no significant differences in patient background between both groups. Regarding procedural characteristics, the maximum balloon pressure was significantly higher in group A (median 23 atm, interquartile range [IQR] 18-24 vs. 12 atm [IQR: 10-12], p < 0.01). Although a calcium score of 4 was more frequently observed in group A (86.4% vs. 62.5%, p = 0.12), post-PCI MLA was comparable between both groups (3.95 mm2 [IQR: 3.27-4.41] vs. 3.43 mm2 [IQR: 2.90-4.82], p = 0.63). Furthermore, the expansion ratio was significantly greater in group A (0.83 ± 0.20 vs. 0.68 ± 0.14, p < 0.01). Despite a higher calcium score, a larger expansion ratio was achieved in patients with a novel scoring balloon than in those with a cutting balloon after OA.

A hybrid model for the detection of retinal disorders using artificial intelligence techniques

The prevalence of vision impairment is increasing at an alarming rate. The goal of the study was to create an automated method that uses optical coherence tomography (OCT) to classify retinal disorders into four categories: choroidal neovascularization, diabetic macular edema, drusen, and normal cases. This study proposed a new framework that combines machine learning and deep learning-based techniques. The utilized classifiers were support vector machine (SVM), K-nearest neighbor (K-NN), decision tree (DT), and ensemble model (EM). A feature extractor, the InceptionV3 convolutional neural network, was also employed. The performance of the models was evaluated against nine criteria using a dataset of 18000 OCT images. For the SVM, K-NN, DT, and EM classifiers, the analysis exhibited state-of-the-art performance, with classification accuracies of 99.43%, 99.54%, 97.98%, and 99.31%, respectively. A promising methodology has been introduced for the automatic identification and classification of retinal disorders, leading to reduced human error and saved time.

Wide-Field Optical Coherence Tomography Imaging Improves Rate of Change Detection in Progressing Glaucomatous Eyes Compared With Standard-Field Imaging.

To compare rates of retinal nerve fiber layer change over time in healthy, eyes with nonprogressing glaucoma and eyes with progressing glaucoma using single wide-field (SWF) and optic nerve head (ONH) cube scan optical coherence tomography (OCT) images. Forty-five eyes of 25 healthy individuals and 263 eyes of 161 glaucoma patients from the Diagnostic Innovations in Glaucoma Study were included. All eyes underwent 24-2 visual field testing and OCT (Spectralis SD-OCT) ONH and macular imaging. SWF images (up to 43° × 28°) were created by stitching together ONH cube scans centered on the optic disc and macular cube scans centered on the fovea. Visual field progression was defined as guided progression analysis likely progression and/or a significant (P < 0.01) mean deviation slope of less than -1.0dB/year. Mixed effects models were used to compare rates of change. Highly myopic eyes were included. Thirty glaucomatous eyes were classified as progressing. In eyes with glaucoma, mean global rate of change was -1.22 µm/year (P < 0.001) using SWF images and -0.83 µm/year (P = 0.003) using ONH cube scans. Rate of change was significantly greater in eyes with progressing glaucoma compared with eyes with nonprogressing glaucoma (-1.51 µm/year vs. -1.24 µm/year; P = 0.002) using SWF images and was similar using ONH cube scans (P = 0.27). In this cohort that includes eyes with and without high axial myopia, the mean rate of retinal nerve fiber layer thinning measured using SWF images was faster in eyes with progressing glaucoma than in eyes with nonprogressing glaucoma. Wide-field OCT images including the ONH and macula can be effective for monitoring glaucomatous progression in patients with and without high myopia.

Automatic segmentation and quantification of OCT images before and after cataract surgery using deep learning

Obtaining quantitative geometry of the anterior segment of the eye, generally from optical coherence tomography (OCT) images, is important to construct 3D computer eye models, used to understand the optical quality of the normal and pathological eye and to improve treatment (for example, selecting the intraocular lens to be implanted in cataract surgery or guiding refractive surgery). An important step to quantify OCT images is segmentation (i.e., finding and labeling the surfaces of interest in the images), which, for the purpose of feeding optical models, needs to be automatic, accurate, robust, and fast. In this work, we designed a segmentation algorithm based on deep learning, which we applied to OCT images from pre- and post-cataract surgery eyes obtained using anterior segment OCT commercial systems. We proposed a feature pyramid network architecture with a pre-trained encoder and trained, validated, and tested the algorithm using 1640 OCT images. We showed that the proposed method outperformed a classical image-processing-based approach in terms of accuracy (from 91.4% to 93.2% accuracy), robustness (decreasing the standard deviation of accuracy across images by a factor of 1.7), and processing time (from 0.48 to 0.34 s/image). We also described a method for the 3D models’ construction and their quantification from the segmented images and applied the proposed segmentation/quantification algorithms to quantify 136 new eye measurements (780 images) obtained from OCT commercial systems.

Combined Rotating Ultra-High-Resolution Spectral Domain OCT and Scheimpflug Imaging for In Vivo Corneal Optical Biopsy.

This article introduces the Pentacam® Cornea OCT (optical coherence tomography). This advanced corneal imaging system combines rotating ultra-high-resolution spectral domain OCT with sub- 2-micron axial resolution and Scheimpflug photography. The purpose of this study is to present the first experience with the instrument and its potential for corneal diagnostics, including optical biopsy. In this prospective study, the Pentacam® Cornea OCT was used to image the corneas of seven patients. The novel wide-angle pericentric scan system enables optimal OCT imaging performance for the corneal layer structure over the entire width of the cornea, including the limbal regions. A detailed analysis of the resulting images assessed the synergism between the OCT and Scheimpflug photography. The Pentacam® Cornea OCT demonstrated significantly improved image resolution and ability to individualize corneal layers with high quality. There is a synergism between the OCT high-definition signal to individualize details on the cornea and Scheimpflug photography to detect and quantify corneal scattering. The noncontact exam was proven safe, user-friendly, and effective for enabling optical biopsy. Pentacam® Cornea OCT is an advancement in corneal imaging technology. The ultra-high-resolution spectral domain OCT and Scheimpflug photography provide unprecedented detail and resolution, enabling optical biopsy and improving the understanding of corneal pathology. Further studies are necessary to compare and analyze the tomographic reconstructions of the cornea with the different wavelengths, which may provide helpful information for diagnosing and managing corneal diseases.

Posterior Eye Shape in Myopia

PurposeTo explore prevalence and associated factors of abnormalities of the posterior eye shape in dependence of axial length. DesignPopulation-based study. ParticipantsOut of the participants (n=3468) of the Beijing Eye Study, we included all eyes with an axial length of ≥25 mm, and a randomized sample of eyes with an axial length of <25 mm. MethodsUsing 30°-wide, serial horizontal, and fovea-centered radial, optical coherence tomographic (OCT) images, we examined location and depth of the most posterior point of the retinal pigment epithelium/Bruch´s membrane line (PP-RPE/BML). Main Outcome ParametersPrevalence and depth of an extrafoveal PP-RPE/BML. ResultsThe study included 366 eyes (314 individuals;age:63.7±9.7 years). On the radial OCT scans, the PP-RPE/BML was located in the foveola in 190 (51.9%;95%CI:46.9,56.9) eyes, in 121 (33.1%;95%CI:28.1,38.1) eyes in the 6 o´clock part of the vertical meridian at a mean distance of 1.73±0.70mm from the foveola, and in 54 (14.8%;95%CI:11.1,18.4) eyes in the 12 o´clock part of the vertical meridian at a distance of 2.01±0.66mm from the foveola. Deeper PP-RPE/BML depth increased with longer axial length (beta:0.28;B:12.3;95%CI:7.5,17.1;P<0.001), female sex (beta:0.17;B:30.2;95%CI:10.7,49.6;P=0.002), and higher corneal astigmatism (beta:0.12;B:13.9;95%CI:1.50,26.3;P=0.03). On the horizontal OCT scans, the PP-RPE/BML was located in the foveola in 304 (83.1%;95%CI:79.2,86.9) eyes, between the foveola and the optic disc in 36 (9.8%;95%CI:6.8,12.9) eyes (mean depth: 119±142μm; mean distance:1.59±0.76mm from the foveola), and temporal to the foveola in 26 (7.1%;95%CI:4.5,9.8) eyes (depth:71±46μm; distance:1.20±0.60mm). Higher prevalence of an extrafoveal PP-RPE/BML correlated with longer axial length (OR:1.55;95%CI:1.28,1.89;P<0.001), higher corneal astigmatism (OR:1.78;95%CI:1.14,2.79;P=0.01) and female sex (OR:2.74;95%CI:1.30,5.77;P=0.008). The curvature of the RPE/BM line at the posterior pole was similar to the RPE/BM line curvature outside of the posterior pole in 309 (84.4%;95%CI:80.7,88.2) eyes, and it was steeper (i.e., smaller curvature radius) in 57 (15.6%;95%CI:12.1,19.1) eyes. In these eyes, axial length was longer (24.41±1.78mm versus 27.74±1.88mm;P<0.001). ConclusionsWith longer axial length, the foveola is more often located outside of the geometrical posterior pole. It may be of importance for biometric axial length measurements. An extrafoveal location of the PP-RPE/BML may be due to an axial elongation-associated, meridionally asymmetric enlargement of Bruch´s membrane in the fundus midperiphery.

Non-mydriatic ultra-widefield diffraction-limited retinal imaging.

We demonstrate a new non-mydriatic ultra-widefield optical coherence tomography retinal imaging system, designed with custom optics to improve the imaging field of view, lateral resolution, and patient comfort. The key motivation is to address the challenge with conventional systems that require pupillary dilation, adding time, expense, discomfort, and medical risk to the examination of the retina. Our system provides an ultrawide 100° field of view (beam scanning angle at the scanning pivot point) and maintains a lateral resolution of 20 µm on the center. It also allows a generous working distance of 16 mm, 2-3 times longer than existing ultra-widefield OCT imaging systems. This advanced system was able to avoid iris vignetting artifacts without pharmacological dilation and ensure diffraction-limited ultra-widefield imaging under a generalized eye model. This enables a comprehensive evaluation of retina diseases, especially those affecting the peripheral regions.

In vivo identification of the retinal layer containing photopigments in OCT images through correlation with two-photon psychophysics

Two-photon vision enables near-infrared light perception in humans. We investigate the possibility to utilize this phenomenon as an indicator of the location of the outer segments of photoreceptor cells in the OCT images. Since two-photon vision is independent on OCT imaging, it could provide external to OCT reference relative to which positions of retinal layers visible in OCT imaging could be measured. We show coincidence between OCT imaging of outer retinal layers and two-photon light perception. The experiment utilizes an intrinsic nonlinear process in the retina, two-photon absorption of light by visual photopigments, which triggers perception of near-infrared light. By shifting the focus of the imaging/stimulus beam, we link the peak efficiency of two-photon vision with the visibility of outer segments of photoreceptor cells, which can be seen as in vivo identification of a retinal layer containing visual photopigments in OCT images. Determination of the in-focus retinal layer is achieved by analysis of en face OCT image contrast. We discuss experimental methods and experimental factors that may influence two-photon light perception and the accuracy of the results. The limits of resolution are discussed in analysis of the one-photon and two-photon point spread functions.