Ryan P. McNabb

Robotic Optical Coherence Tomography Retinal Imaging for Emergency Department Patients: A Pilot Study for Emergency Physicians’ Diagnostic Performance

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Study objective To evaluate the diagnostic performance of emergency physicians’ interpretation of robotically acquired retinal optical coherence tomography images for detecting posterior eye abnormalities in patients seen in the emergency department. Methods Adult patients presenting to Duke University Hospital emergency department from November 2020 through October 2021 with acute visual changes, headache, or focal neurologic deficit(s) who received an ophthalmology consultation were enrolled in this pilot study. Emergency physicians provided standard clinical care, including direct ophthalmoscopy, at their discretion. Retinal optical coherence tomography images of these patients were obtained with a robotic, semi-autonomous optical coherence tomography system. We compared the detection of abnormalities in optical coherence tomography images by emergency physicians with a reference standard, a combination of ophthalmology consultation diagnosis and retina specialist optical cohe...

Optical coherence tomography refraction and optical path length correction for image-guided corneal surgery

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Optical coherence tomography (OCT) may be useful for guidance of ocular microsurgeries such as deep anterior lamellar keratoplasty (DALK), a form of corneal transplantation that requires delicate insertion of a needle into the stroma to approximately 90% of the corneal thickness. However, visualization of the true shape of the cornea and the surgical tool during surgery is impaired in raw OCT volumes due to both light refraction at the corneal boundaries, as well as geometrical optical path length distortion due to the group velocity of broadband OCT light in tissue. Therefore, uncorrected B-scans or volumes may not provide an accurate visualization suitable for reliable surgical guidance. In this article, we introduce a method to correct for both refraction and optical path length distortion in 3D in order to reconstruct corrected OCT B-scans in both natural corneas and corneas deformed by needle insertion. We delineate the separate roles of phase and group index in OCT image disto...

Computational 3D microscopy with optical coherence refraction tomography

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Optical coherence tomography (OCT) has seen widespread success as an in vivo clinical diagnostic 3D imaging modality, impacting areas including ophthalmology, cardiology, and gastroenterology. Despite its many advantages, such as high sensitivity, speed, and depth penetration, OCT suffers from several shortcomings that ultimately limit its utility as a 3D microscopy tool, such as its pervasive coherent speckle noise and poor lateral resolution required to maintain millimeter-scale imaging depths. Here, we present 3D optical coherence refraction tomography (OCRT), a computational extension of OCT that synthesizes an incoherent contrast mechanism by combining multiple OCT volumes, acquired across two rotation axes, to form a resolution-enhanced, speckle-reduced, refraction-corrected 3D reconstruction. Our label-free computational 3D microscope features a novel optical design incorporating a parabolic mirror to enable the capture of 5D plenoptic datasets, consisting of millimetric 3D f...

Nonlinear distortion correction for posterior eye segment optical coherence tomography with application to tree shrews

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We propose an empirical distortion correction approach for optical coherence tomography (OCT) devices that use a fan-scanning pattern to image the posterior eye segment. Two types of reference markers were used to empirically estimate the distortion correction approach in tree shrew eyes: retinal curvature from MRI images and implanted glass beads of known diameter. Performance was tested by correcting distorted images of the optic nerve head. In small animal eyes, our purposed method effectively reduced nonlinear distortions compared to a linear scaling method. No commercial posterior segment OCT provides anatomically correct images, which may bias the 3D interpretation of these scans. Our method can effectively reduce such bias. ( Read Full Article )

Robotically aligned optical coherence tomography with 5 degree of freedom eye tracking for subject motion and gaze compensation

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Optical coherence tomography (OCT) has revolutionized diagnostics in ophthalmology. However, OCT requires a trained operator and patient cooperation to carefully align a scanner with the subject’s eye and orient it in such a way that it images a desired region of interest at the retina. With the goal of automating this process of orienting and aligning the scanner, we developed a robot-mounted OCT scanner that automatically aligned with the pupil while matching its optical axis with the target region of interest at the retina. The system used two 3D cameras for face tracking and three high-resolution 2D cameras for pupil and gaze tracking. The tracking software identified 5 degrees of freedom for robot alignment and ray aiming through the ocular pupil: 3 degrees of translation (x, y, z) and 2 degrees of orientation ( yaw , pitch ). We evaluated the accuracy, precision, and range of our tracking system and demonstrated imaging performance on free-standing human subjects. Our re...

Ultrawide field, distortion-corrected ocular shape estimation with MHz optical coherence tomography (OCT)

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Ocular deformation may be associated with biomechanical alterations in the structures of the eye, especially the cornea and sclera in conditions such as keratoconus, congenital glaucoma, and pathological myopia. Here, we propose a method to estimate ocular shape using an ultra-wide field MHz swept-source optical coherence tomography (SS-OCT) with a Fourier Domain Mode-Locked (FDML) laser and distortion correction of the images. The ocular biometrics for distortion correction was collected by an IOLMaster 700, and localized Gaussian curvature was proposed to quantify the ocular curvature covering a field-of-view up to 65°×62°. We achieved repeatable curvature shape measurements (intraclass coefficient = 0.88 ± 0.06) and demonstrated its applicability in a pilot study with individuals (N = 11) with various degrees of myopia. ( Read Full Article )

In Vivo Quantitative Analysis of Anterior Chamber White Blood Cell Mixture Composition Using Spectroscopic Optical Coherence Tomography

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Anterior uveitis is the most common form of intraocular inflammation, and one of its main signs is the presence of white blood cells (WBCs) in the anterior chamber (AC). Clinically, the true composition of cells can currently only be obtained using AC paracentesis, an invasive procedure to obtain AC fluid requiring needle insertion into the AC. We previously developed a spectroscopic optical coherence tomography (SOCT) analysis method to differentiate between populations of RBCs and subtypes of WBCs, including granulocytes, lymphocytes and monocytes, both in vitro and in ACs of excised porcine eyes. We have shown that different types of WBCs have distinct characteristic size distributions, extracted from the backscattered reflectance spectrum of individual cells using Mie theory. Here, we further develop our method to estimate the composition of blood cell mixtures, both in vitro and in vivo. To do so, we estimate the size distribution of unknown cell mixtures by fitting the distrib...

Quantitative topographic curvature maps of the posterior eye utilizing optical coherence tomography

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Purpose: Deformations of the retina such as staphylomas in myopia or scleral flattening in high intracranial pressure can be challenging to quantify with en face imaging. We describe an OCT based method for the generation of quantitative posterior eye topography maps in normal and pathologic eyes. Methods: Utilizing “ whole eye ” OCT we corrected for subjects’ optical distortions to generate spatially accurate posterior eye OCT volumes and created local curvature ( K M , mm -1 ) topography maps for each consented subject. We imaged nine subjects, three normal, two with myopic degeneration (MD), and four with papilledema including one that was imaged longitudinally. Results: Normal subjects mean temporal K M was 0.0923 mm -1 , nasal K M was 0.0927 mm -1 , and K M local variability was 0.0162 mm -1 . In MD subjects K M local variability was higher at 0.0836 mm -1 . In papilledema subjects nasal K M was flatter compared to temporal K M (0.0709 mm -1 vs. 0.0885 mm -1 )...

Topography and pachymetry maps for mouse corneas using optical coherence tomography

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

Ocular anterior chamber blood cell population differentiation using spectroscopic optical coherence tomography

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There is potential clinical significance in identifying cellular responses in the anterior chamber (AC) of the eye, which can indicate hyphema (an accumulation of red blood cells [RBCs]) or aberrant intraocular inflammation (an accumulation of white blood cells [WBCs]). In this work, we developed a spectroscopic OCT analysis method to differentiate between populations of RBCs and subtypes of WBCs, including granulocytes, lymphocytes and monocytes, both in vitro and in ACs of porcine eyes. We developed an algorithm to track single cells within OCT data sets, and extracted the backscatter reflectance spectrum of each single cell from the detected interferograms using the short-time Fourier transform (STFT). A look-up table of Mie back-scattering spectra was generated and used to correlate the backscatter spectral features of single cells to their characteristic sizes. The extracted size distributions based on the best Mie spectra fit were significantly different between each cell type...

Advances in Whole-Eye Optical Coherence Tomography Imaging

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Contemporary anterior segment and retinal optical coherence tomography (OCT) systems only image their particular designated region of the eye and cannot image both areas of the eye at once. This separation is due to the differences in optical system design needed to properly image the front or back of the eye and also due to limitations in the imaging depth of current commercial OCT systems. More recently, research and commercial OCT systems capable of "whole-eye" imaging have been described. These whole-eye OCT systems enable applications such as ocular biometry for cataract surgery, ocular shape analysis for myopia, and others. Further, these whole-eye OCT systems allow us to image the eye as an integrated whole rather than as separate, independent divisions. ( Read Full Article )

Volumetric Measurement of Subretinal Blebs Using Microscope-Integrated Optical Coherence Tomography

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Purpose : We advance studies of subretinal treatments by developing a microscope-integrated optical coherence tomography (MIOCT) image-based method for measuring the volume of therapeutics delivered into the subretinal space. Methods : A MIOCT image-based volume measurement method was developed and assessed for accuracy and reproducibility by imaging an object of known size in model eyes. This method then was applied to subretinal blebs created by injection of diluted triamcinolone. Bleb volumes obtained from MIOCT were compared to the intended injection volume and the surgeon's estimation of leakage. Results : Validation of the image-based volume measurement method showed accuracy to ±1.0 μL (6.0% of measured volume) with no statistically significant variation under different imaging settings. When this method was applied to subretinal blebs, four of 11 blebs without surgeon-observed leakage yielded a mean volume of 32 ± 12.5 μL, in contrast to the intended 50 &...

Anterior chamber blood cell differentiation using spectroscopic optical coherence tomography

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There is great clinical importance in identifying cellular responses in the anterior chamber (AC) which can indicate signs of hyphema (an accumulation of red blood cells (RBCs)) or aberrant intraocular inflammation (an accumulation of white blood cells (WBCs)). These responses are difficult to diagnose and require specialized equipment such as ophthalmic microscopes and specialists trained in examining the eye. In this work, we applied spectroscopic OCT to differentiate between RBCs and subtypes of WBCs, including neutrophils, lymphocytes and monocytes, both in vitro and in ACs of porcine eyes. We located and tracked single cells in OCT volumetric images, and extracted the spectroscopic data of each cell from the detected interferograms using short-time Fourier Transform (STFT). A look-up table of Mie spectra was generated and used to correlate the spectroscopic data of single cells to their characteristic sizes. The accuracy of the method was first validated on 10um polystyrene mic...

Retinal imaging in human autopsy eyes using a custom optical coherence tomography periscope

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Age-related macular degeneration (AMD) is a major cause of vision loss in the elderly. To better study the pathobiology of AMD, postmortem eyes offer an excellent opportunity to correlate optical coherence tomography (OCT) imaging characteristics with histopathology. However, postmortem eyes from autopsy present challenges to standard OCT imaging including opaque anterior segment structures and standard of care autopsy processing resulting in oblique views to the macula. To overcome these challenges, we report a custom periscope attached by a standard mount to an OCT sample arm and demonstrate high quality macular OCT acquisitions in autopsy-processed eyes. ( Read Full Article )

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