Ex vivo and computer model study on retinal thermal laser-induced damage in the visible wavelength range

Nanosecond multipulse retinal damage thresholds of elongated irradiance profiles in explant measurements and simulations

Significance

The database for multipulse retinal damage thresholds for the laser safety standard (IEC 60825-1:2014) is confined, especially for elongated irradiation profiles. To ensure eye safety, retinal damage thresholds (ED 50 values) need to be determined.

Aim

This study aims to examine nanosecond multipulse scenarios.

Approach

To determine ED 50 values in ex vivo measurements, an optical laser setup is presented. Porcine explant tissue is irradiated with rectangular top-hat profiles. Thermal simulations are carried out on a validated computer model and retinal injury thresholds are obtained.

Results

The measurements resulted in ED 50 values from 8.46 to 42.72    μ J with a slope from 1.15 to 1.4. A thermal damage in the measurements can be excluded due to the level value in combination with a different type of declining behavior for increasing pulses compared to the simulations. A dependence with increasing elongation or area of the retinal image emerges in the simulations but could not be confirmed in the measurements due to the influencing factors (biological variability, focusing, and measuring procedure).

Conclusions

Using slit apertures for beam shaping, variable rectangular spot geometries are realized without changing elements in the setup. For further evaluation of the behavior of elongated irradiation profiles, additional measurements to improve the measurement accuracy are necessary.

Nonuniform Exposure to the Cornea from Millimeter Waves

This study examines the nonuniform exposure to the cornea from incident millimeter waves at 94-100 GHz. Two previous studies measured temperature increases in the rhesus cornea exposed to brief (1-6 s) pulses of high-fluence millimeter waves (94 GHz), one of which also estimated thresholds for corneal damage (reported as ED50, the dose resulting in a visible lesion 50% of the time). Both studies noted large variations in the temperature increase across the surface of the cornea due to wave interference effects. This study examines this variability using high-resolution simulations of mm-wave absorption and temperature increase in the human cornea from exposures to plane wave energy at 100 GHz. Calculations are based on an earlier study. The simulations show that the peak temperature increases in the cornea from short exposures (up to 10 s) to high-intensity mm-wave pulses are 1.7-2.8 times the median increase depending on the polarization of the incident energy. A simple one-dimensional "baseline" model provides a good estimate of the median temperature increase in the cornea. Two different estimates are presented for the thresholds for producing thermal lesions, expressed in terms of the minimum fluence of incident 100 GHz pulses. The first estimate is based on thresholds for thermal damage from pulsed infrared energy, and the second is based on a thermal damage model. The mm-wave pulses presently considered far exceed current IEEE or ICNIRP exposure limits but may be produced by some nonlethal weapons systems. Interference effects due to wave reflections from structures in and near the eye result in highly localized variations in energy absorbed in the cornea and surrounding facial tissues and are important to consider in a hazard analysis for exposures to intense pulsed millimeter waves.

Capabilities and limitations of a new thermal finite volume model for the evaluation of laser-induced thermo-mechanical retinal damage

Many experimental studies focus on the physical damage mechanisms of short-term exposure to laser radiation. In the nanosecond (ns) pulse range, damage in the Retinal Pigment Epithelium (RPE) will most likely occur at threshold levels due to bubble formation at the surface of the absorbing melanosome. The energy uptake of the melanosomes is one key aspect in modeling the bubble formation and damage thresholds. This work presents a thermal finite volume model for the investigation of rising temperatures and the temperature distribution of irradiated melanosomes. The model takes the different geometries and thermal properties of melanosomes into account, such as the heat capacity and thermal conductivity of the heterogeneous absorbing melanosomes and the surrounding tissue. This is the first time the size and shape variations on the melanosomes' thermal behavior are considered. The calculations illustrate the effect of the geometry on the maximum surface temperature of the irradiated melanosome and the impact on the bubble formation threshold. A comparison between the calculated bubble formation thresholds and the RPE cell damage thresholds within a pulse range of 3 to 5000 ns leads to a mean deviation of μ=22mJ/cm2 with a standard deviation of σ=21mJ/cm2. The best results are achieved between the simulation and RPE cell damage thresholds for pulse durations close to the thermal confinement time of individual melanosomes.

Biomedical optics applications of advanced lasers and nonlinear optics

SIGNIFICANCE

2019 SPIE Photonics West conference hosted over 5000 presentations. Some important presentations in the Industrial Laser, Laser Source and Application (LASE) and Optoelectronics, Photonic Materials and Devices (OPTO) sections of the SPIE Photonics West conference have a risk of being overlooked by the biomedical community despite their implications for the field of biophotonics. We review some recent advances in the area of development coherent radiation sources in the infrared (IR), ultraviolet (UV), and terahertz (THz) regimes.

AIM

Recent advances in coherent radiation sources in the IR, deep UV, and THz regimes were outlined, and the importance of each presentation to one or more promising biomedical applications was assessed.

APPROACH

Presentations and proceedings from the LASE and OPTO sections were reviewed for inclusion. Emphasis was placed on talks from the Nonlinear Frequency Generation and Conversion: Materials and Devices XVIII conference, and the Terahertz, RF, Millimeter, and Submillimeter-Wave Technology and Applications XII conference. Conference sections that directly focused on biomedical applications were excluded.

RESULTS

Enhanced IR supercontinuum generation with compact supercontinuum sources may allow for real-time biomarker detection and create new opportunities for imaging tissues using the third biological window (1600 to 1850 nm). Efficient methods to generate deep UV (200 to 260 nm) radiation allow for the study of biologically important molecules through techniques such as resonance Raman spectroscopy while avoiding fluorescence overlap. Likewise, novel and improved THz generation methods seek to bridge the "THz gap" that has previously limited biomedical applications.

CONCLUSIONS

Advances in coherent radiation sources in the IR, UV, and THz regimes have created new opportunities for biomedical optics research.

Corneal Damage Effects Induced by a 770-2,500 nm Supercontinuum Light Source

BACKGROUND AND OBJECTIVES

Widespread applications of supercontinuum (SC) source lead to the possibility of ocular damages. However, the corneal damage effects induced by SC have not been explored before. The objectives of this study are to determine the rabbit corneal injury threshold for SC radiation and to examine whether the existing safety guidelines and standards are suitable for the hazard evaluation of this new kind of light source.

STUDY DESIGN/MATERIALS AND METHODS

A series of experiments was conducted in the New Zealand white rabbit model to determine the corneal damage thresholds induced by a 770-2,500 nm SC source, with a corneal 1/e beam diameter of 0.37 mm. Through slit-lamp biomicroscope, optical coherence tomography (OCT), and histopathology the corneal damage characteristics at the threshold level were revealed. By employing the action spectra determined through the analysis of safety guidelines and standards, the damage thresholds for SC source could be compared with the corresponding exposure limits.

RESULTS

The determined damage thresholds given in terms of the peak radiant exposure for exposure durations of 2.0 and 10.0 seconds were 2.1 × 10³ and 7.4 × 10³  J/cm² , respectively. At threshold level, corneal damages involved the epithelium and the shallower stroma, and no obvious changes could be found in the deep stroma, Descemet's membrane, and endothelium.

CONCLUSIONS

The exposure limits for the anterior parts of the eye in the wavelength range of 700-1,200 nm are overly conservative. The obtained results contribute to the knowledge base for the hazard evaluation of SC source. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Effect of ambient temperature and intracellular pigmentation on photothermal damage rate kinetics

Computational models predicting cell damage responses to transient temperature rises generated by exposure to lasers have implemented the damage integral (Ω), which time integrates the chemical reaction rate constant described by Arrhenius. However, few published reports of empirical temperature histories (thermal profiles) correlated with damage outcomes at the cellular level are available to validate the breadth of applicability of the damage integral. In our study, an analysis of photothermal damage rate processes in cultured retinal pigment epithelium cells indicated good agreement between temperature rise, exposure duration (τ), and threshold cellular damage. Full-frame thermograms recorded at high magnification during laser exposures were overlaid with fluorescence damage images taken 1 h postexposure. From the image overlays, pixels of the thermogram correlated with the boundary of cell death were used to extract threshold thermal profiles. Assessing photothermal responses at these boundaries standardized all data points, irrespective of laser irradiance, damage size, or optical and thermal properties of the cells. These results support the hypothesis that data from boundaries of cell death were equivalent to a minimum visible lesion, where the damage integral approached unity (Ω  =  1) at the end of the exposure duration. Empirically resolved Arrhenius coefficients for use in the damage integral determined from exposures at wavelengths of 2  μm and 532 nm and durations of 0.05-20 s were consistent with literature values. Varying ambient temperature (Tamb) between 20°C and 40°C during laser exposure did not change the τ-dependent threshold peak temperature (Tp). We also show that, although threshold laser irradiance varied due to pigmentation differences, threshold temperatures were irradiance independent.

Ocular damage effects from 1338-nm pulsed laser radiation in a rabbit eye model

The ocular damage effects induced by transitional near-infrared (NIR) lasers have been investigated for years. However, no retinal damage thresholds are determined in a wide interval between 0.65 ms and 80 ms, and a definite relationship between corneal damage threshold and spot size cannot be drawn from existing data points. In this paper, the in-vivo corneal damage thresholds (ED₅₀s) were determined in New Zealand white rabbits for a single 5 ms pulse at the wavelength of 1338 nm for spot sizes from 0.28 mm to 3.55 mm. Meanwhile, the retinal damage threshold for this laser was determined in chinchilla grey rabbits under the condition that the beam was collimated, and the incident corneal spot diameter was 5.0 mm. The corneal ED₅₀s given in terms of the corneal radiant exposure for spot diameters of 0.28, 0.94, 1.91, and 3.55 mm were 70.3, 35.6, 29.6 and 30.3 J/cm², respectively. The retinal ED₅₀ given in terms of total intraocular energy (TIE) was 0.904 J. The most sensitive ocular tissue to this laser changed from the cornea to retina with the increase of spot size.

A prediction model for ocular damage - Experimental validation

With the increasing number of laser applications in medicine and technology, accidental as well as intentional exposure of the human eye to laser sources has become a major concern. Therefore, a prediction model for ocular damage (PMOD) is presented within this work and validated for long-term exposure. This model is a combination of a raytracing model with a thermodynamical model of the human and an application which determines the thermal damage by the implementation of the Arrhenius integral. The model is based on our earlier work and is here validated against temperature measurements taken with porcine eye samples. For this validation, three different powers were used: 50mW, 100mW and 200mW with a spot size of 1.9mm. Also, the measurements were taken with two different sensing systems, an infrared camera and a fibre optic probe placed within the tissue. The temperatures were measured up to 60s and then compared against simulations. The measured temperatures were found to be in good agreement with the values predicted by the PMOD-model. To our best knowledge, this is the first model which is validated for both short-term and long-term irradiations in terms of temperature and thus demonstrates that temperatures can be accurately predicted within the thermal damage regime.

Damage threshold from large retinal spot size repetitive-pulse laser exposures

The retinal damage thresholds for large spot size, multiple-pulse exposures to a Q-switched, frequency doubled Nd:YAG laser (532 nm wavelength, 7 ns pulses) have been measured for 100 μm and 500 μm retinal irradiance diameters. The ED50, expressed as energy per pulse, varies only weakly with the number of pulses, n, for these extended spot sizes. The previously reported threshold for a multiple-pulse exposure for a 900 μm retinal spot size also shows the same weak dependence on the number of pulses. The multiple-pulse ED50 for an extended spot-size exposure does not follow the n dependence exhibited by small spot size exposures produced by a collimated beam. Curves derived by using probability-summation models provide a better fit to the data.

Consideration of dynamic photothermal effect for evaluation of scanning light sources in optical devices using pulsed source criteria

Quantitative evaluation of the potential radiation hazards of scanning light sources in medical optical devices is critical. Currently, point scanning light sources of continuous radiation are treated as pulsed sources, where the dwell time at each point is equal to the pulse duration. This study compares the photothermal effects from scanning light and pulsed sources using numerical calculation for scanning without restricting aperture and with various spot sizes. The calculation results show that the thermal damage threshold of scanning source not restricted by measurement aperture does not significantly differ from that of pulsed source. Temporal temperature response and size-dependent photothermal effect also confirm the similarity between scanning and pulsed sources.

A new understanding of multiple-pulsed laser-induced retinal injury thresholds

Laser safety standards committees have struggled for years to formulate adequately a sound method for treating repetitive-pulse laser exposures. Safety standards for lamps and LEDs have ignored this issue because averaged irradiance appeared to treat the issue adequately for large retinal image sizes and skin exposures. Several authors have recently questioned the current approach of three test conditions (i.e., limiting single-pulse exposure, average irradiance, and a single-pulse-reduction factor) as still insufficient to treat pulses of unequal energies or certain pulse groupings. Schulmeister et al. employed thermal modeling to show that a total-on-time pulse (TOTP) rule was conservative. Lund further developed the approach of probability summation proposed by Menendez et al. to explain pulse-additivity, whereby additivity is the result of an increasing probability of detecting injury with multiple pulse exposures. This latter argument relates the increase in detection probability to the slope of the probit curve for the threshold studies. Since the uncertainty in the threshold for producing an ophthalmoscopically detectable minimal visible lesion (MVL) is large for retinal exposure to a collimated laser beam, safety committees traditionally applied large risk reduction factors ("safety factors") of one order of magnitude when deriving intrabeam, "point-source" exposure limits. This reduction factor took into account the probability of visually detecting the low-contrast lesion among other factors. The reduction factor is smaller for large spot sizes where these difficulties are quite reduced. Thus the N⁻⁰·²⁵ reduction factor may result from the difficulties in detecting the lesion. Recent studies on repetitive pulse exposures in both animal and in vitro (retinal explant) models support this interpretation of the available data.

ICNIRP Guidelines on Limits of Exposure to Laser Radiation of Wavelengths between 180 nm and 1,000 μm

Since the publication of the ICNIRP Revision of the Guidelines on Limits of Exposure to Laser Radiation (), further research supports amending the retinal thermal exposure limits in terms of spot size dependence, pulse duration dependence for short pulses and wavelength dependence between 1,200 nm and 1,400 nm. A detailed discussion of the rational for the changes is presented in the Appendix of these Guidelines (Rationale for updating the Guidelines).

Using a melanin granule lattice model to study the thermal effects of pulsed and scanning light irradiations through a measurement aperture

Optical radiation hazards of scanning light sources are often evaluated using pulsed light source criteria, with the relevant pulse parameter equivalent to the scanning light source determined by the energy delivered through a measurement aperture. However, physical equivalence has not been completely understood: a pulsed light source is temporally dynamic but spatially stationary, while a scanning light source is temporally stationary but spatially dynamic. This study introduces a numerical analysis based upon the melanin granule lattice model to investigate the equivalence of scanning and pulsed light sources through a measurement aperture and their respective thermal effects in the pigmented retinal layer. The numerical analysis calculates the thermal contribution of individual melanin granules with varying temporal sequence, and finds that temperature changes and thermal damage thresholds for the two different types of light sources were not equal. However, dwell times of 40 to 200 μsec did not produce significant differences between pulsed and scanning light sources in temperature change and thermal damage thresholds to the sample tissue.

Simulation of the temperature increase in human cadaver retina during direct illumination by 150-kHz femtosecond laser pulses

We have developed a two-dimensional computer model to predict the temperature increase of the retina during femtosecond corneal laser flap cutting. Simulating a typical clinical setting for 150-kHz iFS advanced femtosecond laser (0.8- to 1-μJ laser pulse energy and 15-s procedure time at a laser wavelength of 1053 nm), the temperature increase is 0.2°C. Calculated temperature profiles show good agreement with data obtained from ex vivo experiments using human cadaver retina. Simulation results obtained for different commercial femtosecond lasers indicate that during the laser in situ keratomileusis procedure the temperature increase of the retina is insufficient to induce damage.

Improving the therapeutic window of retinal photocoagulation by spatial and temporal modulation of the laser beam

Decreasing the pulse duration helps confine damage, shorten treatment time, and minimize pain during retinal photocoagulation. However, the safe therapeutic window (TW), the ratio of threshold powers for thermomechanical rupture of Bruch's membrane and mild coagulation, also decreases with shorter exposures. Two potential approaches toward increasing TW are investigated: (a) decreasing the central irradiance of the laser beam and (b) temporally modulating the pulse. An annular beam with adjustable central irradiance was created by coupling a 532-nm laser into a 200-μm core multimode optical fiber at a 4-7 deg angle to normal incidence. Pulse shapes were optimized using a computational model, and a waveform generator was used to drive a PASCAL photocoagulator (532 nm), producing modulated laser pulses. Acute thresholds for mild coagulation and rupture were measured in Dutch-Belted rabbit in vivo with an annular beam (154-163 μm retinal diameter) and modulated pulse (132 μm, uniform irradiance "flat-top" beam) with 2-50 ms pulse durations. Thresholds with conventional constant-power pulse and a flat-top beam were also determined. Both annular beam and modulated pulse provided a 28% increase in TW at 10-ms duration, affording the same TW as 20-ms pulses with conventional parameters.

Review of thresholds and recommendations for revised exposure limits for laser and optical radiation for thermally induced retinal injury

Exposure limits (ELs) for laser and optical broadband radiation that are derived to protect the retina from adverse thermally-induced effects vary as a function of wavelength, exposure duration, and retinal irradiance diameter (spot size) expressed as the angular subtense α. A review of ex vivo injury threshold data shows that, in the ns regime, the microcavitation-induced damage mechanism results in retinal injury thresholds below thermal denaturation-induced thresholds. This appears to be the reason that the injury thresholds for retinal spot sizes of about 80 μm (α = 6 mrad) and pulse durations of about 5 ns in the green wavelength range are very close to current ELs, calling for a reduction of the EL in the ns regime. The ELs, expressed in terms of retinal radiant exposure or radiance dose, currently exhibit a 1/α dependence up to a retinal spot size of 100 mrad, referred to as αmax. For α ≥ αmax, the EL is a constant retinal radiant exposure (no α dependence) for any given exposure duration. Recent ex vivo, computer model, and non-human primate in vivo threshold data provide a more complete assessment of the retinal irradiance diameter dependence for a wide range of exposure durations. The transition of the 1/α dependence to a constant retinal radiant exposure (or constant radiance dose) is not a constant αmax but varies as a function of the exposure duration. The value of αmax of 100 mrad reflects the spot size dependence of the injury thresholds only for longer duration exposures. The injury threshold data suggest that αmax could increase as a function of the exposure duration, starting in the range of 5 mrad in the μs regime, which would increase the EL for pulsed exposure and extended sources by up to a factor of 20, while still assuring an appropriate reduction factor between the injury threshold and the exposure limit.