Optical coherence tomography: an emerging technology for biomedical imaging and optical biopsy

Automatic identification and characterization of the epiretinal membrane in OCT images

Optical coherence tomography (OCT) is a medical image modality that is used to capture, non-invasively, high-resolution cross-sectional images of the retinal tissue. These images constitute a suitable scenario for the diagnosis of relevant eye diseases like the vitreomacular traction or the diabetic retinopathy. The identification of the epiretinal membrane (ERM) is a relevant issue as its presence constitutes a symptom of diseases like the macular edema, deteriorating the vision quality of the patients. This work presents an automatic methodology for the identification of the ERM presence in OCT scans. Initially, a complete and heterogeneous set of features was defined to capture the properties of the ERM in the OCT scans. Selected features went through a feature selection process to further improve the method efficiency. Additionally, representative classifiers were trained and tested to measure the suitability of the proposed approach. The method was tested with a dataset of 285 OCT scans labeled by a specialist. In particular, 3,600 samples were equally extracted from the dataset, representing zones with and without ERM presence. Different experiments were conducted to reach the most suitable approach. Finally, selected classifiers were trained and compared using different metrics, providing in the best configuration an accuracy of 89.35%.

AI-Assisted In Situ Detection of Human Glioma Infiltration Using a Novel Computational Method for Optical Coherence Tomography

PURPOSE

In glioma surgery, it is critical to maximize tumor resection without compromising adjacent noncancerous brain tissue. Optical coherence tomography (OCT) is a noninvasive, label-free, real-time, high-resolution imaging modality that has been explored for glioma infiltration detection. Here, we report a novel artificial intelligence (AI)-assisted method for automated, real-time, in situ detection of glioma infiltration at high spatial resolution.Experimental Design: Volumetric OCT datasets were intraoperatively obtained from resected brain tissue specimens of 21 patients with glioma tumors of different stages and labeled as either noncancerous or glioma-infiltrated on the basis of histopathology evaluation of the tissue specimens (gold standard). Labeled OCT images from 12 patients were used as the training dataset to develop the AI-assisted OCT-based method for automated detection of glioma-infiltrated brain tissue. Unlabeled OCT images from the other 9 patients were used as the validation dataset to quantify the method detection performance.

RESULTS

Our method achieved excellent levels of sensitivity (∼100%) and specificity (∼85%) for detecting glioma-infiltrated tissue with high spatial resolution (16 μm laterally) and processing speed (∼100,020 OCT A-lines/second).

CONCLUSIONS

Previous methods for OCT-based detection of glioma-infiltrated brain tissue rely on estimating the tissue optical attenuation coefficient from the OCT signal, which requires sacrificing spatial resolution to increase signal quality, and performing systematic calibration procedures using tissue phantoms. By overcoming these major challenges, our AI-assisted method will enable implementing practical OCT-guided surgical tools for continuous, real-time, and accurate intraoperative detection of glioma-infiltrated brain tissue, facilitating maximal glioma resection and superior surgical outcomes for patients with glioma.

Chromatic Properties of Blood During Coagulation

This paper proposes a method of detecting blood clots by analyzing the chromatic properties of blood. Measurements are performed with a Basler camera on blood during coagulation to determine the changes in red, green, and blue (RGB) values. Results show that there is a significant change in the red value that can be exploited for real-time, early detection of blood clots.

Organic Nanotheranostics for Photoacoustic Imaging-Guided Phototherapy

Phototherapies including photothermal therapy (PTT) and photodynamic therapy (PDT) have emerged as one of the avant-garde strategies for cancer treatment. Photoacoustic (PA) imaging is a new hybrid imaging modality that shows great promise for real-time in vivo monitoring of biological processes with deep tissue penetration and high spatial resolution. To enhance therapeutic efficacy, reduce side effects and minimize the probability of over-medication, it is necessary to use imaging and diagnostic methods to identify the ideal therapeutic window and track the therapeutic outcome. With this regard, nanotheranostics with the ability to conduct PA imaging and PTT/PDT are emerging. This review summarizes the recent progress of organic nanomaterials including nearinfrared (NIR) dyes and semiconducting polymer nanoparticles (SPNs) in PA imaging guided cancer phototherapy, and also addresses their present challenges and potential in clinical applications.

Ultrasound multiple scattering with microbubbles can differentiate between tumor and healthy tissue in vivo

Most solid tumors are characterized by highly dense, isotropic vessel networks. Characterization of such features has shown promise for early cancer diagnosis. Ultrasound diffusion has been used to characterize the micro-architecture of complex media, such as bone and the lungs. In this work, we examine a non-invasive diffusion-based ultrasound technique to assess neo-vascularization. Because the diffusion constant reflects the density of scatterers in heterogeneous media, we hypothesize that by injecting microbubbles into the vasculature, ultrasound diffusivity can reflect vascular density (VD), thus differentiating the microvascular patterns between tumors and healthy tissue. The diffusion constant and its anisotropy are shown to be significantly different between fibrosarcoma tumors (n  =  16) and control tissue (n  =  18) in a rat animal model in vivo. The diffusion constant values for control and tumor were found to be 1.38  ±  0.51 mm2 µs-1 and 0.65  ±  0.27 mm2 µs-1, respectively. These results are corroborated with VD from acoustic angiography (AA) data, confirming increased vessel density in tumors compared to controls. The diffusion constant offers a promising way to quantitatively assess vascular networks when combined with contrast agents, which may allow early tumor detection and characterization.

Laser brain cancer surgery in a xenograft model guided by optical coherence tomography

Higher precision surgical devices are needed for tumor resections near critical brain structures. The goal of this study is to demonstrate feasibility of a system capable of precise and bloodless tumor ablation. An image-guided laser surgical system is presented for excision of brain tumors in vivo in a murine xenograft model. The system combines optical coherence tomography (OCT) guidance with surgical lasers for high-precision tumor ablation (Er:YAG) and microcirculation coagulation (Thulium (Tm) fiber laser).

Methods: A fluorescent human glioblastoma cell line was injected into mice and allowed to grow four weeks. Craniotomies were performed and tumors were imaged with confocal fluorescence microscopy. The mice were subsequently OCT imaged prior, during and after laser coagulation and/or ablation. The prior OCT images were used to compute three-dimensional tumor margin and angiography images, which guided the coagulation and ablation steps. Histology of the treated regions was then compared to post-treatment OCT images.

Results: Tumor sizing based on OCT margin detection matched histology to within experimental error. Although fluorescence microscopy imaging showed the tumors were collocated with OCT imaging, margin assessment using confocal microscopy failed to see the extent of the tumor beyond ~ 250 µm in depth, as verified by OCT and histology. The two-laser approach to surgery utilizing Tm wavelength for coagulation and Er:YAG for ablation yielded bloodless resection of tumor regions with minimal residual damage as seen in histology.

Conclusion: Precise and bloodless tumor resection under OCT image guidance is demonstrated in the murine xenograft brain cancer model. Tumor margins and vasculature are accurately made visible without need for exogenous contrast agents.

Raman Sensing and Its Multimodal Combination with Optoacoustics and OCT for Applications in the Life Sciences

Currently, many optical modalities are being investigated, applied, and further developed for non-invasive analysis and sensing in the life sciences. To befit the complexity of the study objects and questions in this field, the combination of two or more modalities is attempted. We review our work on multimodal sensing concepts for applications ranging from non-invasive quantification of biomolecules in the living organism to supporting medical diagnosis showing the combined capabilities of Raman spectroscopy, optical coherence tomography, and optoacoustics.

Stigmatic Microscopy Enables Low-Cost, 3D, Microscale Particle Imaging Velocimetry in Rehydrating Aqueous Two-Phase Systems

This paper describes the construction of a novel stigmatic microscope and image analysis algorithm to simultaneously analyze convective mixing both inside and outside of rehydrating μL-scale aqueous two-phase system (ATPS) droplets. Stigmatic microscopy is inexpensive and advantageous because it modifies the point-spread function of fluorescent particles to enable measurement of their 3D positions from single 2D images, without needing to take slices. In one application of the technique, the convection patterns captured clarify how different ATPS formulations succeed or fail to exclude cells for patterning. Particle flow traces reveal speed and directionality of circulation, indicating temporary eddies at the outer edge of the rehydrating droplet. In another application, the speed of circulation during rehydration was analyzed for different ATPS formulations and the results used to develop a new fast ELISA procedure. While this paper focuses on ATPS rehydration, the microscope and algorithm should be applicable to a broad range of microfluidic flows where microscale 3D convection is important.

Optical coherence tomography imaging of cardiac substrates

Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Knowledge of a patient's heart structure will help to plan procedures, potentially identifying arrhythmia substrates, critical structures to avoid, detect transplant rejection, and reduce ambiguity when interpreting electrograms and functional measurements. Similarly, basic research of numerous cardiac diseases would greatly benefit from structural imaging at cellular scale. For both applications imaging on the scale of a myocyte is needed, which is approximately 100 µm × 10 µm. The use of optical coherence tomography (OCT) as a tool for characterizing cardiac tissue structure and function has been growing in the past two decades. We briefly review OCT principles and highlight important considerations when imaging cardiac muscle. In particular, image penetration, tissue birefringence, and light absorption by blood during in vivo imaging are important factors when imaging the heart with OCT. Within the article, we highlight applications of cardiac OCT imaging including imaging heart tissue structure in small animal models, quantification of myofiber organization, monitoring of radiofrequency ablation (RFA) lesion formation, structure-function analysis enabled by functional extensions of OCT and multimodal analysis and characterizing important substrates within the human heart. The review concludes with a summary and future outlook of OCT imaging the heart, which is promising with progress in optical catheter development, functional extensions of OCT, and real time image processing to enable dynamic imaging and real time tracking during therapeutic procedures.

Anterior Segment Optical Coherence Tomography: Applications for Clinical Care and Scientific Research

Anterior segment optical coherence tomography (AS-OCT) is a non-contact imaging technique that produces high-resolution images and quantitative measurements of the anterior segment and its anatomical structures. There has been rapid development of OCT technology over the past 2 decades, with the transition from time-domain to Fourier-domain OCT devices. By integrating these advancements in OCT technology, AS-OCT devices have evolved into versatile clinical and research tools for studies of the anterior segment and ocular surface. The primary purpose of this article was to review OCT technology and AS-OCT devices as well as applications of AS-OCT for clinical practice and scientific research. We first describe the different types of OCT technology, how they have been adapted for AS-OCT imaging, and differences between various AS-OCT devices. We then review the applications of AS-OCT for characterizing the anatomical structures of the anterior segment and aqueous outflow pathways, including the anterior chamber angle, trabecular meshwork, and Schlemm canal. We also describe glaucoma-related applications of AS-OCT imaging, which include evaluating patients for static and dynamic biometric risk factors of primary angle closure disease and assessing the efficacy of glaucoma interventions, such as laser peripheral iridotomy and glaucoma surgery. Finally, we review other clinical applications of AS-OCT imaging for detection and management of diseases of the ocular surface, cornea, and lens.

Reflectance and Thickness Analysis of Retinal Layers in Patients with Epiretinal Membranes Using Spectral-Domain OCT before and after Vitrectomy with Membrane Peeling

PURPOSE

To compare thickness and reflectance of retinal layer findings in patients with idiopathic epiretinal membranes (ERMs) before and after surgery with those of normal controls.

DESIGN

Retrospective study.

PARTICIPANTS

Patients with ERMs before and after surgery and healthy controls.

METHODS

Spectral-domain (SD) OCT imaging of eyes with ERMs before and after surgery and of healthy eyes were analyzed for morphologic appearance and using a customized algorithm to measure retinal layer reflectance and thickness. Findings were correlated with visual acuity outcomes.

MAIN OUTCOME MEASURES

Retinal layer thickness and reflectance.

RESULTS

Thirty-four ERM and 12 healthy eyes were identified. Mean preoperative best-corrected visual acuity (BCVA) improved from 0.53±0.31 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/68) to 0.41±0.25 logMAR (Snellen equivalent, 20/51) after surgery (P = 0.030). Differences in reflectance and thickness of retinal layers were identified among the preoperative ERM, postoperative ERM, and healthy eyes. High preoperative reflectance of the internal limiting membrane (ILM) to outer plexiform layer (OPL) was correlated with better postoperative BCVA (r = -0.451; P = 0.007). A larger improvement in BCVA was correlated with preoperative thick measurements of the outer nuclear layer (r = 0.514; P = 0.002), high reflectance of the group of layers from the ILM to the OPL (r = 0.426; P = 0.012), and low reflectance of the photoreceptor layer (r = -0.453; P = 0.007). Using linear regression analysis, better postoperative BCVA was associated with better preoperative vision (standardized regression coefficient, 0.553; P = 0.001) and high reflectance of the group of layers from the ILM to OPL (standardized regression coefficient, -0.526; P = 0.001). A larger improvement in BCVA was associated with worse preoperative BCVA (standardized regression coefficient, -0.539; P < 0.001) and high reflectance of the group of layers from the ILM to OPL (standardized regression coefficient, -0.428; P = 0.001).

CONCLUSIONS

Quantitative differences in reflectance and thickness among preoperative, postoperative, and normal SD OCT imaging allow assessment of retina layer changes secondary to ERMs. High reflectance of the ILM to OPL correlated with and was associated with better postoperative BCVA and improvement in BCVA.

Visualizing flow in an intact CSF network using optical coherence tomography: implications for human congenital hydrocephalus

Cerebrospinal fluid (CSF) flow in the brain ventricles is critical for brain development. Altered CSF flow dynamics have been implicated in congenital hydrocephalus (CH) characterized by the potentially lethal expansion of cerebral ventricles if not treated. CH is the most common neurosurgical indication in children effecting 1 per 1000 infants. Current treatment modalities are limited to antiquated brain surgery techniques, mostly because of our poor understanding of the CH pathophysiology. We lack model systems where the interplay between ependymal cilia, embryonic CSF flow dynamics and brain development can be analyzed in depth. This is in part due to the poor accessibility of the vertebrate ventricular system to in vivo investigation. Here, we show that the genetically tractable frog Xenopus tropicalis, paired with optical coherence tomography imaging, provides new insights into CSF flow dynamics and role of ciliary dysfunction in hydrocephalus pathogenesis. We can visualize CSF flow within the multi-chambered ventricular system and detect multiple distinct polarized CSF flow fields. Using CRISPR/Cas9 gene editing, we modeled human L1CAM and CRB2 mediated aqueductal stenosis. We propose that our high-throughput platform can prove invaluable for testing candidate human CH genes to understand CH pathophysiology.

First in vivo visualization of the human subarachnoid space and brain cortex via optical coherence tomography

The present work explores optical coherence tomography (OCT) as a suitable in vivo neuroimaging modality of the subarachnoid space (SAS). Patients (n = 26) with frontolateral craniotomy were recruited. The temporal and frontal arachnoid mater and adjacent anatomical structures were scanned using microscope-integrated three-dimensional OCT, (iOCT). Analysis revealed a detailed depiction of the SAS (76.9%) with delineation of the internal microanatomical structures such as the arachnoid barrier cell membrane (ABCM; 96.2%), trabecular system (50.2%), internal blood vessels (96.2%), pia mater (26.9%) and the brain cortex (96.2%). Orthogonal distance measuring was possible. The SAS showed a mean depth of 570 µm frontotemporal. The ABCM showed a mean depth of 74 µm frontotemporal. These results indicate that OCT provides a dynamic, non-invasive tool for real-time imaging of the SAS and adjacent anatomical structures at micrometer spatial resolution. Further studies are necessary to evaluate the value of OCT during microsurgical procedures.

Super-achromatic optical coherence tomography capsule for ultrahigh-resolution imaging of esophagus

Endoscopic optical coherence tomography (OCT) is a noninvasive technology allowing for imaging of tissue microanatomies of luminal organs in real time. Conventional endoscopic OCT operates at 1300 nm wavelength region with a suboptimal axial resolution limited to 8-20 μm. In this paper, we present the first ultrahigh-resolution tethered OCT capsule operating at 800 nm and offering about 3- to 4-fold improvement of axial resolution (plus enhanced imaging contrast). The capsule uses diffractive optics to manage chromatic aberration over a full ~200 nm spectral bandwidth centering around 830 nm, enabling to achieve super-achromaticity and an axial resolution of ~2.6 μm in air. The performance of the OCT capsule is demonstrated by volumetric imaging of swine esophagus ex vivo and sheep esophagus in vivo, where fine anatomic structures including the sub-epithelial layers are clearly identified. The ultrahigh resolution and excellent imaging contrast at 800 nm of the tethered capsule suggest the potential of the technology as an enabling tool for surveillance of early esophageal diseases on awake patients without the need for sedation.

Mapping the human pulmonary venoatrial junction with optical coherence tomography

Imaging guidance provided by optical coherence tomography (OCT) could improve the outcomes of atrial fibrillation (AF) ablation by providing detailed structural information of the pulmonary veins, which are critical targets during ablation. In this study, stitched volumetric OCT images of venoatrial junctions from post-mortem human hearts were acquired and compared to histology. Image features corresponding to venous media and myocardial sleeves, as well as fiber orientation and fibrosis, were identified and found to vary between veins. Imaging of detailed tissue architecture could improve understanding of the AF structural substrate within the pulmonary veins and assist the guidance of ablation procedures.

MEMS Actuators for Optical Microendoscopy

Growing demands for affordable, portable, and reliable optical microendoscopic imaging devices are attracting research institutes and industries to find new manufacturing methods. However, the integration of microscopic components into these subsystems is one of today's challenges in manufacturing and packaging. Together with this kind of miniaturization more and more functional parts have to be accommodated in ever smaller spaces. Therefore, solving this challenge with the use of microelectromechanical systems (MEMS) fabrication technology has opened the promising opportunities in enabling a wide variety of novel optical microendoscopy to be miniaturized. MEMS fabrication technology enables abilities to apply batch fabrication methods with high-precision and to include a wide variety of optical functionalities to the optical components. As a result, MEMS technology has enabled greater accessibility to advance optical microendoscopy technology to provide high-resolution and high-performance imaging matching with traditional table-top microscopy. In this review the latest advancements of MEMS actuators for optical microendoscopy will be discussed in detail.

Light-responsive nanomedicine for biophotonic imaging and targeted therapy

Nanoparticles (NPs) play a key role in nanomedicine in multimodal imaging, drug delivery and targeted therapy of human diseases. Consequently, due to the attractive properties of NPs including high stability, high payload, multifunctionality, design flexibility, and efficient delivery to target tissues, nanomedicine employs various types of NPs to enhance targeting and treatment efficacy. In this review, we primarily focus on light-responsive materials, such as fluorophores, photosensitizers, semiconducting polymers, carbon structures, gold particles, quantum dots, and upconversion crystals, for their biomedical applications. Armed with these nanomaterials, NPs represent a growing potential in biophotonic imaging (luminescence, photoacoustic, surface enhanced Raman scattering, and optical coherence tomography) as well as targeted therapy (photodynamic therapy, photothermal therapy, and light-responsive drug release).

Emerging imaging technologies in dermatology: Part I: Basic principles

Dermatologists rely primarily on clinical examination in combination with histopathology to diagnose conditions; however, clinical examination alone might not be sufficient for accurate diagnosis and skin biopsies have associated morbidity. With continued technological advancement, there are emerging ancillary imaging technologies available to dermatologists to aid in diagnosis and management. This 2-part review article will discuss these emerging technologies including: digital photographic imaging, confocal microscopy, optical coherence tomography, and high-frequency ultrasound, as well as several additional modalities in development. In this first installment, the authors describe the breadth of technologies available and the science behind them. Then, in the second article, the authors discuss the applications and limitations of these technologies and future directions.

Cluster-based filtering framework for speckle reduction in OCT images

Optical coherence tomography (OCT) has become a popular modality in the dermatology discipline due to its moderate resolution and penetration depth. OCT images, however, contain a grainy pattern called speckle. To date, a variety of filtering techniques have been introduced to reduce speckle in OCT images. However, further improvement is required to reduce edge smoothing and the deterioration of small structures in OCT images after despeckling. In this manuscript, we present a novel cluster-based speckle reduction framework (CSRF) that consists of a clustering method, followed by a despeckling method. Since edges are borders of two adjacent clusters, the proposed framework leaves the edges intact. Moreover, the multiplicative speckle noise could be modeled as additive noise in each cluster. To evaluate the performance of CSRF and demonstrate its generic nature, a clustering method, namely k-means (KM), and, two pixelwise despeckling algorithms, including Lee filter (LF) and adaptive Wiener filter (AWF), are used. The results indicate that CSRF significantly improves the performance of despeckling algorithms. These improvements are evaluated on healthy human skin images in vivo using two numerical assessment measures including signal-to-noise ratio (SNR), and structural similarity index (SSIM).

Combination of High-Resolution Optical Coherence Tomography and Raman Spectroscopy for Improved Staging and Grading in Bladder Cancer

We present a combination of optical coherence tomography (OCT) and Raman spectroscopy (RS) for improved diagnosis and discrimination of different stages and grades of bladder cancer ex vivo by linking the complementary information provided by these two techniques. Bladder samples were obtained from biopsies dissected via transurethral resection of the bladder tumor (TURBT). As OCT provides structural information rapidly, it was used as a red-flag technology to scan the bladder wall for suspicious lesions with the ability to discriminate malignant tissue from healthy urothelium. Upon identification of degenerated tissue via OCT, RS was implemented to determine the molecular characteristics via point measurements at suspicious sites. Combining the complementary information of both modalities allows not only for staging, but also for differentiation of low-grade and high-grade cancer based on a multivariate statistical analysis. OCT was able to clearly differentiate between healthy and malignant tissue by tomogram inspection and achieved an accuracy of 71% in the staging of the tumor, from pTa to pT2, through texture analysis followed by k-nearest neighbor classification. RS yielded an accuracy of 93% in discriminating low-grade from high-grade lesions via principal component analysis followed by k-nearest neighbor classification. In this study, we show the potential of a multi-modal approach with OCT for fast pre-screening and staging of cancerous lesions followed by RS for enhanced discrimination of low-grade and high-grade bladder cancer in a non-destructive, label-free and non-invasive way.

Rapid tissue histology using multichannel confocal fluorescence microscopy with focus tracking

BACKGROUND

Simplified hematoxylin and eosin (H&E) staining followed by cryo-sectioning enables rapid identification of cancerous tissue within the procedure room during Mohs micrographic surgery. Yet, a faster evaluation method is desirable as the staining protocol requires physically sectioning of the tissue after freezing, which leads to prolonged sectioning time along with the frozen artifacts that may occur in frozen sectioning.

METHODS

We present a multichannel confocal microscopy system to rapidly evaluate cancerous tissue. Using the optical sectioning capability of the confocal microscope, optically sectioned images of the freshly excised mouse tissue were acquired and converted into images resembling H&E histology. To show details of the nuclei and structure of the tissue, we applied a newly developed rapid tissue staining method using Hoechst 33342 and Eosin-Y. Line scanning and stitching was performed to overcome the limited field of view of the confocal microscope. Unlike previous confocal systems requiring an additional mechanical device to tilt the sample and match the focus of the objective lens, we developed a focus tracking method to rapidly scan large sample area. The focus tracking provides an effective means of keeping the image of the thick tissue in focus without additional devices. We then evaluated the performance of the confocal microscope to obtain optically sectioned images in thick tissue by comparing fluorescence stained slide images. We also obtained the corresponding H&E histology image to assess the potential of the system as a diagnostic tool.

RESULTS

We successfully imaged freshly excised mouse organs including stomach, tumor, and heart within a few minutes using the developed multichannel confocal microscopy and the tissue staining method. Using the pseudocolor method, colors of the acquired confocal grayscale images are converted to furthermore resemble Hematoxylin and Eosin histology. Due to the focus tracking and the line scanning, optically sectioned images were obtained over the large field of view. Comparisons with H&E histology have shown that the confocal images can acquire large details such as the ventricle as well as small details such as muscle fibers and nuclei.

CONCLUSIONS

This study confirms the use of confocal fluorescence microscopy technique to acquire rapid pathology results using optical sectioning, line scanning and focus tracking. We anticipate that the presented method will enable intraoperative histology and significantly reduce stress on patients undergoing surgery requiring repeated histology examinations.

Latest Clinical Approaches in the Ocular Management of Cystinosis: A Review of Current Practice and Opinion from the Ophthalmology Cystinosis Forum

Cystinosis, a rare autosomal recessive disease caused by intracellular cystine accumulation, occurs in an estimated 1/100,000-200,000 live births. Ocular non-nephropathic cystinosis is typically diagnosed during adulthood, when patients present with corneal crystal deposition and no systemic involvement. Due to the rarity of the condition, diagnosis is often delayed and can have a significant impact on the overall prognosis of the disease. Early diagnosis is therefore imperative to ensure successful treatment and improve quality of life, as most of its clinical manifestations can be prevented or delayed. Early detection strategies and practical approaches for the ocular management of cystinosis were discussed during the Ophthalmology Cystinosis Forum, a 1-day meeting held in Berlin, Germany during June 2017. Recommendations for early detection comprise ophthalmic assessment, including self- and clinician-assessed recording of photophobia, and visual acuity, slit-lamp examination and tonometry ophthalmic examinations. In vivo confocal microscopy and anterior segment optical coherence tomography were highlighted as valuable techniques in evaluating cystine crystals in the cornea, in vivo and non-invasively. The mainstay of ocular cystinosis treatment is the cystine-depleting aminothiol cysteamine. Indeed, early treatment with and strict adherence to cysteamine therapy has a considerable impact on the long-term prognosis of ocular cystinosis. In rare diseases such as ocular cystinosis, standardised guidelines and recommendations for detection, patient care and follow-up assessments are essential. Such guidelines provide a support tool for healthcare professionals caring for ocular cystinosis patients. Multidisciplinary teams (MDTs) are essential for delivering gold standard care and improving quality of life for patients and their families. This review paper highlights current early detection policies, clinical treatment strategies and practical approaches for the ocular management of cystinosis, including implementing a cystinosis MDT. Additionally, discussions of the Ophthalmology Cystinosis Forum held in 2017 are summarised. FUNDING: Orphan Europe. Plain language summary available for this article.

Transverse Separation of the Outer Retinal Layer at the Peripapillary in Glaucomatous Myopes

Glaucoma specialists often overlook the outer retinal changes because the glaucomatous optic neuropathy typically involves retinal nerve fiber layer (RNFL). By detailed inspection of the outer retina in myopic eyes, we observed a separation of the inner nuclear layer (INL) from the outer nuclear layer (ONL) at the peripapillary sclera (pp-sclera). Therefore, we conducted a retrospective observation of 108 eyes of 108 Korean subjects with myopia assessed by swept-source optical coherence tomography (SSOCT) and divided into normal and glaucomatous eyes. Mean subject age, refractive error and axial length difference between 2 groups were insignificant, respectively. To quantify the ONL-INL separation, straight-line distance from ONL endpoint to INL endpoint was measured at the center of the optic disc by SSOCT horizontal scan. The glaucomatous group had significantly large ONL-INL separation than the non-glaucomatous group (p = 0.027) but had no significant difference in INL – Anterior scleral canal opening (ASCO) separation. The width of ONL-INL separation were associated with β-peripapillary atrophy (β-PPA), degree of horizontal tilt of the optic disc and worse glaucomatous RNFL defect by Pearson’s correlation analysis (all p < 0.001, respectively). In conclusion, we demonstrate transverse separation of INL from ONL at the peripapillary region, which was significantly associated with glaucomatous optic nerve damage. These observations may be of interest to elucidate the role of PPA in glaucoma pathogenesis and a clinical index to take notice for myopic subjects.

Non-Destructive Classification of Diversely Stained Capsicum annuum Seed Specimens of Different Cultivars Using Near-Infrared Imaging Based Optical Intensity Detection

The non-destructive classification of plant materials using optical inspection techniques has been gaining much recent attention in the field of agriculture research. Among them, a near-infrared (NIR) imaging method called optical coherence tomography (OCT) has become a well-known agricultural inspection tool since the last decade. Here we investigated the non-destructive identification capability of OCT to classify diversely stained (with various staining agents) Capsicum annuum seed specimens of different cultivars. A swept source (SS-OCT) system with a spectral band of 1310 nm was used to image unstained control C. annuum seeds along with diversely stained Capsicum seeds, belonging to different cultivar varieties, such as C. annuum cv. PR Ppareum, C. annuum cv. PR Yeol, and C. annuum cv. Asia Jeombo. The obtained cross-sectional images were further analyzed for the changes in the intensity of back-scattered light (resulting due to dye pigment material and internal morphological variations) using a depth scan profiling technique to identify the difference among each seed category. The graphically acquired depth scan profiling results revealed that the control specimens exhibit less back-scattered light intensity in depth scan profiles when compared to the stained seed specimens. Furthermore, a significant back-scattered light intensity difference among each different cultivar group can be identified as well. Thus, the potential capability of OCT based depth scan profiling technique for non-destructive classification of diversely stained C. annum seed specimens of different cultivars can be sufficiently confirmed through the proposed scheme. Hence, when compared to conventional seed sorting techniques, OCT can offer multipurpose advantages by performing sorting of seeds in respective to the dye staining and provides internal structural images non-destructively.

Room-temperature quantum cascade superluminescent light emitters with wide bandwidth and high temperature stability

The realization of room-temperature (RT) mid-infrared (MIR) broadband light sources is fundamentally interesting and highly desirable for a number of applications. Recently, superluminescent light emitters (SLEs) based on quantum cascade (QC) structures have emerged as excellent candidates among mid-infrared broadband light sources. However, it is challenging to achieve RT-QCSLEs due to the very low efficiency of the spontaneous emission in the intersubband transitions. Here, we demonstrate the realization of a set of ~5 μm RT-SLEs under continuous wave (CW) or quasi-CW (10% duty circle) operation by using a two-phonon resonant QC active region and monolithic integrated waveguide structures. In addition, with the design of an inclined tapered cavity, the SLEs exhibit high milliwatt power, large spectral width of more than 200 cm^-1 and good temperature characteristic. These demonstrated results are believed to be a big step forward to the applications of broadband MIR semiconductor light sources.

A pilot study on the effects of direct contact of two different surgical burs on the cadaveric lingual nerve

The lingual guttering technique for third molar surgery carries the risk of injury to the lingual nerve if the surgical bur comes into direct contact with it. This study investigated the extent of nerve injury caused by two different burs, a tungsten carbide bur and the Dentium implant bur; the latter is designed to be soft tissue friendly. This study also examined whether ultrasound and magnetic resonance imaging are able to detect any injury inflicted. This cadaveric research involved subjecting 12 lingual nerves to the drilling effect of two different burs at two different speeds. The amount of damage caused was measured using different imaging modalities to assess their ability to detect the injury inflicted. At high speed, the Dentium bur caused a deeper and wider laceration than the carbide bur. At low speed, the laceration depths and widths caused by the two burs did not differ significantly. Ultrasound scanning was able to detect the nerve laceration at damaged sites observed using optical coherence tomography. Thus, a carbide bur (at low speed) would be preferable for lingual bone guttering, as it causes less laceration to the lingual nerve. In the event of a suspected injury, ultrasound scanning would provide an objective evaluation of the amount of nerve damage in vivo.

Relationship between the morphology of the foveal avascular zone, retinal structure, and macular circulation in patients with diabetes mellitus

Diabetic Retinopathy (DR) is an extremely severe and common degenerative disease. The purpose of this study was to quantify the relationship between various parameters including the Foveal Avascular Zone (FAZ) morphology, retinal layer thickness, and retinal hemodynamic properties in healthy controls and patients with diabetes mellitus (DM) with and with no mild DR (MDR) using Spectral-Domain Optical Coherence Tomography (Spectralis SDOCT, Heidelberg Engineering GmbH, Germany) and the Retinal Function Imager (Optical Imaging, Ltd., Rehovot, Israel). Our results showed a higher FAZ area and diameter in MDR patients. Blood flow analysis also showed that there is a significantly smaller venous blood flow velocity in MDR patients. Also, a significant difference in roundness was observed between DM and MDR groups supporting the development of asymmetrical FAZ expansion with worsening DR. Our results suggest a potential anisotropy in the mechanical properties of the diabetic retina with no retinopathy that may trigger the FAZ elongation in a preferred direction resulting in either thinning or thickening of intraretinal layers in the inner and outer segments of the retina as a result of autoregulation. A detailed understanding of these relationships may facilitate earlier detection of DR, allowing for preservation of vision and better clinical outcomes.

Near-infrared and mid-infrared semiconductor broadband light emitters

Semiconductor broadband light emitters have emerged as ideal and vital light sources for a range of biomedical sensing/imaging applications, especially for optical coherence tomography systems. Although near-infrared broadband light emitters have found increasingly wide utilization in these imaging applications, the requirement to simultaneously achieve both a high spectral bandwidth and output power is still challenging for such devices. Owing to the relatively weak amplified spontaneous emission, as a consequence of the very short non-radiative carrier lifetime of the inter-subband transitions in quantum cascade structures, it is even more challenging to obtain desirable mid-infrared broadband light emitters. There have been great efforts in the past 20 years to pursue high-efficiency broadband optical gain and very low reflectivity in waveguide structures, which are two key factors determining the performance of broadband light emitters. Here we describe the realization of a high continuous wave light power of >20 mW and broadband width of >130 nm with near-infrared broadband light emitters and the first mid-infrared broadband light emitters operating under continuous wave mode at room temperature by employing a modulation p-doped InGaAs/GaAs quantum dot active region with a 'J'-shape ridge waveguide structure and a quantum cascade active region with a dual-end analogous monolithic integrated tapered waveguide structure, respectively. This work is of great importance to improve the performance of existing near-infrared optical coherence tomography systems and describes a major advance toward reliable and cost-effective mid-infrared imaging and sensing systems, which do not presently exist due to the lack of appropriate low-coherence mid-infrared semiconductor broadband light sources.

Motion-invariant SRT treatment detection from direct M-scan OCT imaging

PURPOSE

Selective retina therapy (SRT) is a laser treatment targeting specific posterior retinal layers. It is focused on inducing damage to the retinal pigment epithelium (RPE), while sparing other retinal tissue compared to traditional photocoagulation. However, the targeted RPE layer is invisible with most imaging modalities and induced SRT lesions cannot be monitored. In this work, imaging scans acquired from an experimental setup that couples the SRT laser beam with an optical coherence tomography (OCT) beam are analyzed in order to evaluate the treatment as they occur.

METHODS

We isolated a small part of the time-resolved scan corresponding to the end of the treatment, for which we have microscopic evidence of the SRT outcome. We then use a convolutional neural network to correspond each scan to the treatment result. We explore which aspects of the scan convey more valuable information for a robust therapy evaluation. By only using this adequately small part, we can achieve an online estimation, while being resilient to eye movement.

RESULTS

The available dataset consists of time- resolved OCT scans of 98 ex vivo porcine eyes, treated with different energy levels. The proposed method yields high performance in the task of predicting whether the applied energy was adequate for SRT treatment, by focusing on the immediate OCT signal acquired during treatment time.

CONCLUSIONS

We propose a strategy toward online noninvasive SRT treatment assessment, able to provide a satisfying evaluation of a treatment status, that therefore could be used for the planning of the treatment continuation.

Seeing cilia: imaging modalities for ciliary motion and clinical connections

The respiratory tract is lined with multiciliated epithelial cells that function to move mucus and trapped particles via the mucociliary transport apparatus. Genetic and acquired ciliopathies result in diminished mucociliary clearance, contributing to disease pathogenesis. Recent innovations in imaging technology have advanced our understanding of ciliary motion in health and disease states. Application of imaging modalities including transmission electron microscopy, high-speed video microscopy, and micron-optical coherence tomography could improve diagnostics and be applied for precision medicine. In this review, we provide an overview of ciliary motion, imaging modalities, and ciliopathic diseases of the respiratory system including primary ciliary dyskinesia, cystic fibrosis, chronic obstructive pulmonary disease, and idiopathic pulmonary fibrosis.

Polymeric endovascular strut and lumen detection algorithm for intracoronary optical coherence tomography images

Polymeric endovascular implants are the next step in minimally invasive vascular interventions. As an alternative to traditional metallic drug-eluting stents, these often-erodible scaffolds present opportunities and challenges for patients and clinicians. Theoretically, as they resorb and are absorbed over time, they obviate the long-term complications of permanent implants, but in the short-term visualization and therefore positioning is problematic. Polymeric scaffolds can only be fully imaged using optical coherence tomography (OCT) imaging-they are relatively invisible via angiography-and segmentation of polymeric struts in OCT images is performed manually, a laborious and intractable procedure for large datasets. Traditional lumen detection methods using implant struts as boundary limits fail in images with polymeric implants. Therefore, it is necessary to develop an automated method to detect polymeric struts and luminal borders in OCT images; we present such a fully automated algorithm. Accuracy was validated using expert annotations on 1140 OCT images with a positive predictive value of 0.93 for strut detection and an R2 correlation coefficient of 0.94 between detected and expert-annotated lumen areas. The proposed algorithm allows for rapid, accurate, and automated detection of polymeric struts and the luminal border in OCT images.

Tools for studying growth patterns and chemical dynamics of aggregated Pseudomonas aeruginosa exposed to different electron acceptors in an alginate bead model

In chronic infections, bacterial pathogens typically grow as small dense cell aggregates embedded in a matrix consisting of, e.g., wound bed sludge or lung mucus. Such biofilm growth mode exhibits extreme tolerance towards antibiotics and the immune defence system. The bacterial aggregates are exposed to physiological heterogeneity and O2 limitation due to steep chemical gradients through the matrix, which is are hypothesised to contribute to antibiotic tolerance. Using a novel combination of microsensor and bioimaging analysis, we investigated growth patterns and chemical dynamics of the pathogen Pseudomonas aeruginosa in an alginate bead model, which mimics growth in chronic infections better than traditional biofilm experiments in flow chambers. Growth patterns were strongly affected by electron acceptor availability and the presence of chemical gradients, where the combined presence of O2 and nitrate yielded highest bacterial growth by combined aerobic respiration and denitrification.

Virtual phase conjugation based optical tomography for single-shot three-dimensional imaging

We propose a virtual phase conjugation (VPC) based optical tomography (VPC-OT) for realizing single-shot optical tomographic imaging systems. Using a computer-based numerical beam propagation, the VPC combines pre-modulation and post-demodulation of the probe beam's wavefront, which provides an optical sectioning capability for resolving the depth coordinates. In VPC-OT, the physical optical microscope system and VPC are coupled using digital holography. Therefore, in contrast to conventional optical tomographic imaging (OTI) systems, this method does not require additional elements such as low-coherence light sources or confocal pinholes. It is challenging to obtain single-shot three-dimensional (3D) tomographic images using a conventional OTI system; however, this can be achieved using VPC-OT, which employs both digital holography and computer based numerical beam propagation. In addition, taking into account that VPC-OT is based on a complex amplitude detection using digital holography, this method allows us to simultaneously obtain quantitative phase contrast images. Using an objective lens with a numerical aperture (NA) of 0.8, we demonstrate a single-shot 3D imaging of frog blood cells with a depth resolution of 0.94 μm.

Diagnostic accuracy of optical coherence tomography in bladder cancer patients: A systematic review and meta-analysis

A meta-analysis was performed to evaluate the accuracy of optical coherence tomography (OCT) for diagnostic accuracy studies in bladder cancer patients. English language studies reporting the diagnostic accuracy of OCT for bladder cancer were retrieved from the PubMed, EMBASE and Cochrane Library databases in December 2014. Histopathology was a reference standard. Sensitivities, specificities, positive likelihood ratios and negative likelihood ratios were calculated, and summary receiver operating characteristic curves were drawn to determine the diagnostic accuracy of OCT. Finally, 9 eligible studies (468 patients) were included in our meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of OCT were 0.96 [95% confidence interval (CI): 0.94-0.98], 0.82 (95% CI: 0.80-0.85), 6.83 (95% CI: 3.24-14.1) and 0.05 (95% CI: 0.02-0.16), respectively. The summary diagnostic odds ratio was 138.88 (95% CI: 29.63-650.89) and the overall area under the curve was 0.9735. These results suggest that OCT has excellent diagnostic performance in patients with bladder cancer and recurrent lesions.

Optical coherence tomography for precision brain imaging, neurosurgical guidance and minimally invasive theranostics

This review focuses on optical coherence tomography (OCT)-based neurosurgical application for imaging and treatment of brain tumors. OCT has emerged as one of the most innovative and successful translational biomedical-diagnostic techniques. It is a useful imaging tool for noninvasive, in vivo, in situ and real-time imaging in soft biological tissues, such as brain tumor imaging. OCT can detect the structure of biological tissue in a micrometer scale, and functional OCT has some clinical researches and applications, such as nerve fiber tracts and neurovascular imaging. OCT is able to identify tumor margins, and it gives intraoperative precision identification and resection guidance. OCT-based theranostics is introduced into preclinical neurosurgical resection, such as the integration of OCT and laser ablation. We discuss the challenges and opportunities of OCT-based system in the field of combination of intraoperative structural and functional imaging, neurosurgical guidance and minimally invasive theranostics. We point out that OCT and laser ablation-based theranostics can give more precision and intelligence for intraoperative diagnosis and therapeutics in clinical applications. The theranostics can precisely locate, or specifically target cancerous tissues, and then as much as possiblly eliminate them.

The corneal subbasal nerve plexus and thickness of the retinal layers in pediatric type 1 diabetes and matched controls

Optical coherence tomography (OCT) of the retina and corneal confocal laser scanning microscopy (CLSM) of the subbasal nerve plexus (SBP) are noninvasive techniques for quantification of the ocular neurodegenerative changes in individuals with type 1 diabetes mellitus (T1DM). In adult T1DM patients these changes are hardly related to T1DM only. Instead, ageing and/or lifestyle associated comorbidities have to be considered as putative confounding variables. Therefore, we investigated pediatric T1DM patients (n = 28; 14.2 ± 2.51 y; duration of disease: 5.39 ± 4.16 y) without clinical signs of diabetic retina disease, neuropathy, vasculopathy or nephropathy and compared our findings with those obtained in healthy controls (n = 46; 14.8 ± 1.89 y). The SBP was characterized by the averaged length, thickness, and tortuosity of nerve fibers as well as the number of branching and connecting points. OCT was used to determine the total thickness of the retina (ALL) and the thickness of each retinal layer. Both methods revealed signs of early neurodegenerative changes, e.g. thinning of distinct retinal layers at the pericentral ring and shortening of corneal nerve fibers that are already present in pediatric T1DM patients. Standardization of instruments and algorithms are urgently required to enable uniform comparison between different groups and define normative values to introduce in the clinical setting.