Duke University

Intrasession Repeatability of Optical Coherence Tomography Angiography Parameters in Neurodegenerative Disease

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Purpose To assess the intrasession repeatability of macular optical coherence tomography angiography (OCTA) parameters in Alzheimer disease (AD), mild cognitive impairment (MCI), Parkinson disease (PD), and normal cognition (NC). Design Cross sectional study. Subjects, Participants, and/or Controls Patients with a clinical diagnosis of AD, PD, MCI, or normal cognition were imaged. Images with poor quality and of those with diabetes mellitus, glaucoma or vitreoretinal disease were excluded from analysis. Methods, Intervention or Testing All participants were imaged using the Zeiss Cirrus HD-5000 with AngioPlex (Carl Zeiss Meditec, Dublin, CA, Software Version 11.0.0.29946) and repeat OCTA images were obtained for both eyes. Perfusion density (PFD), vessel density (VD), and FAZ area (FAZ) were measured from 3x3mm and 6x6mm OCTA images centered on the fovea using an ETDRS (Early Treatment Diabetic Retinopathy Study) grid overlay. Main Outcome Measures Intraclass correlation co...

Contactless, autonomous robotic alignment of optical coherence tomography for in vivo evaluation of diseased retinas

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During the COVID-19 pandemic, an emphasis was placed on contactless, physical distancing and improved telehealth; contrariwise, standard-of-care ophthalmic imaging of patients required present, trained personnel. Here, we introduce contactless, autonomous robotic alignment of optical coherence tomography (RAOCT) for in vivo imaging of retinal disease and compare measured retinal thickness and diagnostic readability to technician operated clinical OCT. In a powered study, we found no statistically significant difference in retinal thickness in both healthy and diseased retinas (p > 0.7) or across a variety of demographics (gender, race, and age) between RAOCT and clinical OCT. In a secondary study, a retina specialist labeled a given volume as normal/abnormal. Compared to the clinical diagnostic label, sensitivity/specificity for RAOCT were equal or improved over clinical OCT. Contactless, autonomous RAOCT, that improves upon current clinical OCT, could play a role in both ophthal...

Quantitative measurements of intraocular structures and microinjection bleb volumes using intraoperative optical coherence tomography

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Intraoperative optical coherence tomography (OCT) systems provide high-resolution, real-time visualization and/or guidance of microsurgical procedures. While the use of intraoperative OCT in ophthalmology has significantly improved qualitative visualization of surgical procedures inside the eye, new surgical techniques to deliver therapeutics have highlighted the lack of quantitative information available with current-generation intraoperative systems. Indirect viewing systems used for retinal surgeries introduce distortions into the resulting OCT images, making it particularly challenging to make calibrated quantitative measurements. Using an intraoperative OCT system based in part on the Leica Enfocus surgical microscope interface, we have devised novel measurement procedures, which allowed us to build optical and mathematical models to perform validation of quantitative measurements of intraocular structures for intraoperative OCT. These procedures optimize a complete optical mod...

Deep learning-enabled volumetric cone photoreceptor segmentation in adaptive optics optical coherence tomography images of normal and diseased eyes

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Deep learning-enabled volumetric cone photoreceptor segmentation in adaptive optics optical coherence tomography images of normal and diseased eyes Objective quantification of photoreceptor cell morphology, such as cell diameter and outer segment length, is crucial for early, accurate, and sensitive diagnosis and prognosis of retinal neurodegenerative diseases. Adaptive optics optical coherence tomography (AO-OCT) provides three-dimensional (3-D) visualization of photoreceptor cells in the living human eye. The current gold standard for extracting cell morphology from AO-OCT images involves the tedious process of 2-D manual marking. To automate this process and extend to 3-D analysis of the volumetric data, we propose a comprehensive deep learning framework to segment individual cone cells in AO-OCT scans. Our automated method achieved human-level performance in assessing cone photoreceptors of healthy and diseased participants captured with three different AO-OCT systems representing two different types of point scanning OCT: spectral domain and swept source.

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...

Retinal injury identified by overhead-mounted optical coherence tomography in two young children with infantile-onset glaucoma

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Purpose To report and characterize unexpected retinal findings identified by imaging with overhead-mounted optical coherence tomography (OCT) in 2 young children with infantile-onset glaucoma. Methods Children with glaucoma were imaged during clinically indicated examinations under anesthesia using overhead-mounted HRA+OCT Spectralis with Flex module (Flex-OCT, Heidelberg, Germany) from February 2017 through February 2022. Imagers prioritized scans of the peripapillary retinal nerve fiber layer (pRNFL), optic nerve head, and macula. Children imaged before age 2 years with images adequate for evaluation were included. Age at glaucoma diagnosis, glaucoma type, highest intraocular pressure (IOP), corneal diameter (CD), and axial length (AL) were recorded. Results A total of 41 children (71 eyes with glaucoma) were imaged before age 2 years. Macular imaging identified both inner and outer retinal thinning in 3 eyes of 2 young children (both eyes of a child with newborn primary congenita...

Wide Field Optical Coherence Tomography and Optical Coherence Tomography Angiography in Uveitis

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Background: We review the current literature on the use of wide-field optical coherence tomography (OCT) and wide-field optical coherence tomography angiography (OCTA) in different uveitic phenotypes as well as various sequelae of uveitis and discuss the limitations of this evolving technology. Main body: Current consensus guidelines on nomenclature in wide-field OCT and OCTA are described. The specific utility of wide-field OCT and OCTA in assessment of the retina and choroid using different en-face and cross-sectional slabs in various inflammatory diseases is reviewed. Furthermore, we discuss widefield OCT and OCTA in assessment of retinal ischemia and its limitations in assessing retinal vascular leakage. Conclusion: Wide-field OCT and OCTA deliver more sensitive measures of inflammation. With continued advancement in both hardware technology and software processing, these modalities will allow for more accurate assessment of uveitis, better understanding of disease mechanisms, a...

Deep Learning Assisted Detection of Glaucoma Progression in Spectral-Domain Optical Coherence Tomography

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Purpose: To develop and validate a deep learning (DL) model for detection of glaucoma progression using spectral-domain optical coherence tomography (SDOCT) measurements of retinal nerve fiber layer (RNFL) thickness. Design: Retrospective cohort study. Participants: A total of 14,034 SDOCT scans from 816 eyes from 462 individuals. Methods: A DL convolutional neural network was trained to assess SDOCT RNFL thickness measurements of two visits (a baseline and a follow-up) along with time between visits to predict the probability of glaucoma progression. The ground truth was defined by consensus from subjective grading by glaucoma specialists. Diagnostic performance was summarized by the area under the receiver operator characteristic curve (AUC), sensitivity, and specificity, and was compared to conventional trend-based analyses of change. Interval likelihood ratios were calculated to determine the impact of DL model results in changing the post-test probability of progression. Main o...

An Engineer at Heart: Cynthia Toth’s 25 years of revolutionizing eye care and surgery

As Cynthia Toth , MD, prepares to "dive" inside the eye, she practices a relaxed mind. "Slow breath, focus, concentrate," she tells herself. In 30 years as a retinal surgeon, she has trained to make her left hand as proficient as her right, so she can smoothly reach the part of the retina she needs to. Toth is rewarded with immersion in an ocean of color. "When you use the operating microscope, it's like you're a deep-sea diver," she said. "The whole world in there is glowing orange. It's just fun and beautiful." Toth's love of exploring the retina has led to her revolutionizing retinal imaging for both adult and pediatric ophthalmology. The Joseph A.C. Wadsworth Distinguished Professor of Ophthalmology, she is a world expert in a high-resolution, three-dimensional imaging technology called optical coherence tomography, and she has pioneered its use during surgery and in very young children. Her research in this and other areas has led to better ways to diagnose and predict the cour...

Izatt Named Chair of Biomedical Engineering at Duke

Joseph A. Izatt has been appointed chair of Duke’s Department of Biomedical Engineering. An internationally recognized expert in medical imaging innovation, respected student mentor and advisor, and faculty leader, Izatt has served as interim chair since July and will now lead Duke BME until June 2025. “After seeing the energy and dedication he brings to the position, even in a temporary capacity, I quickly concluded that Joe would be an excellent choice for chair,” said Jerome P. Lynch, Vinik Dean of Engineering at Duke. “His first-hand experience in translation of innovation from lab to clinic makes Joe a fantastic resource to lead Duke BME into its next phase of growth, which will emphasize deepening its positive impact on society.” Izatt, the Michael J. Fitzpatrick Distinguished Professor of Engineering, has been a member of the Duke BME faculty since 2001. He is a pioneering researcher and inventor who played a foundational role in optical coherenc...

Distinguishing Healthy From Glaucomatous Eyes With Optical Coherence Tomography Global Circumpapillary Retinal Nerve Fiber Thickness in the Bottom 5th Percentile

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Précis: Two novel, quantitative metrics, and 1 traditional metric were able to distinguish between many, but not all healthy and glaucomatous eyes in the bottom 5th percentile of global circumpapillary retinal nerve fiber layer ( cpRNFL ) thickness. Purpose: To test the hypothesis that objective optical coherence tomography measures can distinguish between a healthy control with global cpRNFL thickness within the lower 5% of normal and a glaucoma patient with an equivalent cpRNFL thickness. Patients and Methods: A total of 37 healthy eyes from over 700 normative eyes fell within the bottom 5th percentile in global cpRNFL thickness. The global cpRNFL thickness of 35 glaucomatous eyes from 188 patients fell within the same range. For the traditional methods, the global cpRNFL thickness percentile and the global ganglion cell layer (GCL) thickness percentile for the central ±8 degrees, were calculated for all 72 eyes. For the novel cpRNFL method, the normalized root mean ...

Optical coherence tomography versus angiography and intravascular ultrasound to guide coronary stent implantation: A systematic review and meta-analysis

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Background: Optical coherence tomography (OCT) is an adjunct to angiography-guided coronary stent placement. However, in the absence of dedicated, appropriately powered randomized controlled trials, the impact of OCT on clinical outcomes is unclear. Objective: To conduct a systematic review and meta-analysis of all available studies comparing OCT-guided versus angiography-guided and intravascular ultrasound (IVUS)-guided coronary stent implantation. Methods: MEDLINE and Cochrane Central were queried from their inception through July 2022 for all studies that sought to compare OCT-guided percutaneous coronary intervention (PCI) to angiography-guided and IVUS-guided PCI. The primary endpoint was minimal stent area (MSA) compared between modalities. Clinical endpoints of interest were all-cause and cardiovascular mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thro...

Duke University Receives NIH Grant for Robotic Point-of-Care OCT

Duke University Received a 2022 NIH Grant for $97,825 for Robotic Point-of-Care OCT. The principal investigator is Mark Draelos. Below is a summary of the proposed study. The PI was previously funded by the F30 mechanism while completing the Duke Medical Scientist Training Program. He has since completed medical school and internship and now returns for a full-time research career. This career development proposal is an effective continuation of the PI’s prior mentored training and research experience and seeks to develop him into an independent investigator. The proposed project concerns the role of optical coherence tomography (OCT) in retinal disease screening. Preventable retinal blindness affects tens of millions of Americans and hundreds of millions worldwide. Its top three causes are chronic, progressive conditions that yield irreversible vision loss after an initial asymptomatic period. Annual screening is therefore essential to detect and treat these diseases before s...

Duke University Receives NIH Grant for $504,051 for Secondary Data Analysis for Neonates with Retinal OCT Imaging

Duke University Received a 2022 NIH Grant for $257,350 for Secondary Data Analysis for Neonates with Retinal OCT Imaging. The principal investigator is Cynthia Toth. Below is a summary of the proposed study. The Secondary Data Analysis for Neonates with Retinal OCT Imaging includes data from 330 infant participants previously enrolled into prospective observational studies which included use of investigational OCT devices for imaging at the bedside. These data have been divided into two groups: the Retinopathy of Prematurity (ROP) Group and the Healthy Term Infant Group. The ROP Group consists of data from 239 preterm infants evaluated for ROP from the following studies: The Hartwell Foundation funded Spectral Domain Optical Coherence Tomography Imaging of Infant Eyes: A Practical Diagnostic Tool and Methodology, the Research to Prevent Blindness funded Association of Inflammatory Markers and Cystoid Macular Edema in Very Preterm Infants, a pilot National Center for Research Resourc...

Biphasic change in retinal nerve fibre layer thickness from 30 to 60 weeks postmenstrual age in preterm infants

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Background/Aims The optic nerve development during the critical postnatal weeks of preterm infants is unclear. We aimed to investigate the change of retinal nerve fibre layer (RNFL) in preterm infants. Methods We used an investigational handheld optical coherence tomography (OCT) system to serially image awake preterm infants between 30 and 60 weeks postmenstrual age (PMA) at the bedside. We assessed RNFL thickness in the papillomacular bundle and nasal macular ganglion cell layer+inner plexiform layer (GCL+IPL) thickness. We applied a segmented mixed model to analyse the change in the thickness of RNFL and GCL+IPL as a function of PMA. Results From 631 OCT imaging sessions of 101 infants (201 eyes), RNFL thickness followed a biphasic model between 30 and 60 weeks, with an estimated transition at 37.8 weeks PMA (95% CI: 37.0 to 38.6). RNFL thickness increased at 1.8 μm/week (95% CI: 1.6 to 2.1) before 37.8 weeks and decreased at −0.3 μm/week (95% CI: &minus...

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