Thickness, phase retardation, birefringence, and reflectance of the retinal nerve fiber layer in normal and glaucomatous non-human primates

Non-human primates as preclinical models for optic nerve research: advancing insights into their application and potential

Optic neuropathies are a group of disorders characterized by damage or dysfunction of the optic nerve, which transmits visual information from the retina to the brain. Common causes include glaucoma, ischemic optic neuropathy, optic neuritis, hereditary optic neuropathies and traumatic or compressive optic neuropathies. These conditions can result in vision loss, decreased visual acuity, color vision defects, and visual field abnormalities. The effective treatment strategies have been urgently addressed for long. Consequently, development of both spontaneous and experimental disease models is crucial to thoroughly illustrate disease property and biological mechanisms. As the largest ocular study conducted in non-human primates (NHPs), NHP eye study (NHPES) provided a comprehensive insight into optic nerve survey by launching normal range of relevant parameters and some spontaneous optic nerve disorders, laying the foundation for translation from monkey models to human clinical applications. NHPs are the most ideal animal models because of the marked species proximity through evolution between them and human, so substantial efforts have been attempted toward establishing NHP models for optic nerve research. These animals are of great importance for accelerating the exploitation of novel treatment targets, promoting advantageous drug delivery methods and enhancing patients' outcomes. Furthermore, the sophisticated structure and physiological function of monkeys faithfully replicate the typical pathology and progression of specific diseases. In the current narrative review, we provide an overview of why NHPs could be used to study the optic nerve and the significance of NHPES compared with other eye studies of monkeys.

Assessment of glaucoma with retinal nerve fiber layer optical density ratios from volumetric optical coherence tomography across various analytical radii

OBJECTIVE

To explore the impact of glaucoma on the retinal nerve fiber layer (RNFL) optical density ratio (ODR) by volumetric optical coherence tomography (OCT) under different analytical radii.

METHODS

Twenty-five eyes identified as healthy and 57 eyes with a glaucoma diagnosis (23 mild and 34 moderate-advanced cases) underwent volumetric OCT scans centered at the optic nerve head. Cross-sectional images were obtained through 5 distinct analytical circles with varying radii. The distribution of RNFL ODRs was analysis and compared between normal eyes and glaucomatous eyes.

RESULTS

RNFL ODRs displayed significant variation in relation to their location across all examined eyes and respected the ISTN rule (inferior > superior > nasal > temporal, all p < 0.05). The ODRs differed significantly between normal and glaucomatous groups (all p < 0.001), decreasing as glaucoma progresses, both on average and in each quadrant of all analytical circles (all p < 0.001). The RNFL ODRs correlated significantly with the MD (R2 ranging from 0.553 to 0.585, all p < 0.001), with the most pronounced difference noted in the inferior-temporal sector between groups.

CONCLUSIONS

RNFL ODRs by OCT imaging could serve as a valuable tool for detecting retinal nerve fiber defects in glaucomatous eyes.

Multifunctional adaptive optics optical coherence tomography allows cellular scale reflectometry, polarimetry, and angiography in the living human eye

Clinicians are unable to detect glaucoma until substantial loss or dysfunction of retinal ganglion cells occurs. To this end, novel measures are needed. We have developed an optical imaging solution based on adaptive optics optical coherence tomography (AO-OCT) to discern key clinical features of glaucoma and other neurodegenerative diseases at the cellular scale in the living eye. Here, we test the feasibility of measuring AO-OCT-based reflectance, retardance, optic axis orientation, and angiogram at specifically targeted locations in the living human retina and optic nerve head. Multifunctional imaging, combined with focus stacking and global image registration algorithms, allows us to visualize cellular details of retinal nerve fiber bundles, ganglion cell layer somas, glial septa, superior vascular complex capillaries, and connective tissues. These are key histologic features of neurodegenerative diseases, including glaucoma, that are now measurable in vivo with excellent repeatability and reproducibility. Incorporating this noninvasive cellular-scale imaging with objective measurements will significantly enhance existing clinical assessments, which is pivotal in facilitating the early detection of eye disease and understanding the mechanisms of neurodegeneration.

Design, methodology, and preliminary results of the non-human primates eye study

PURPOSE

To describe the normative profile of ophthalmic parameters in a healthy cynomolgus monkey colony, and to identify the characteristic of the spontaneous ocular disease non-human primates (NHP) models.

METHODS

The NHP eye study was a cross-sectional on-site ocular examination with about 1,000 macaques held in Guangdong Province, southeastern China. The NHPs (Macaca fascicularis, cynomolgus) in this study included middle-aged individuals with a high prevalence of the ocular disease. The NHP eye study (NHPES) performed the information including systematic data and ocular data. Ocular examination included measurement of intraocular pressure (IOP), anterior segment- optical coherence tomography (OCT), slit-lamp examination, fundus photography, autorefraction, electroretinography, etc. Ocular diseases included measurement of refractive error, anisometropia, cataract, pterygium, etc. RESULTS: A total of 1148 subjects were included and completed the ocular examination. The average age was 16.4 ± 4.93 years. Compared to the male participants, the females in the NHPES had shorter axial length and the mean Average retinal nerve fiber layer (RNFL) thickness (except for the nasal quadrants). The mean IOP, anterior chamber depth, lens thickness, axial length, central corneal thickness, choroid thickness and other parameters were similar in each group.

CONCLUSION

The NHPES is a unique and high-quality study, this is the first large macaque monkey cohort study focusing on ocular assessment along with comprehensive evaluation. Results from the NHPES will provide important information about the normal range of ophthalmic measurements in NHP.

Dual-modality digital holographic and polarization microscope to quantify phase and birefringence signals in biospecimens with a complex microstructure

Optical phase and birefringence signals occur in cells and thin, semi-transparent biomaterials. A dual-modality quantitative phase and polarization microscope was designed to study the interaction of cells with extracellular matrix networks and to relate optical pathlength and birefringence signals within structurally anisotropic biomaterial constructs. The design was based on an existing, custom-built digital holographic microscope, to which was added a polarization microscope utilizing liquid crystal variable retarders. Phase and birefringence channels were calibrated, and data was acquired sequentially from cell-seeded collagen hydrogels and electrofabricated chitosan membranes. Computed phase height and retardance from standard targets were accurate within 99.7% and 99.8%, respectively. Phase height and retardance channel background standard deviations were 35 nm and 0.6 nm, respectively. Human fibroblasts, visible in the phase channel, aligned with collagen network microstructure, with retardance and azimuth visible in the polarization channel. Electrofabricated chitosan membranes formed in 40 µm tall microfluidic channels possessed optical retardance ranging from 7 to 11 nm, and phase height from 37 to 39 µm. These results demonstrate co-registered dual-channel acquisition of phase and birefringence parameter maps from microstructurally-complex biospecimens using a novel imaging system combining digital holographic microscopy with voltage-controlled polarization microscopy.

A Simple Subjective Evaluation of Enface OCT Reflectance Images Distinguishes Glaucoma From Healthy Eyes

Purpose

We present a subjective approach to detecting glaucomatous defects in enface images and assess its diagnostic performance. We also test the hypothesis that if reflectivity changes precede thickness changes in glaucoma there should be reduced correlation between the modalities in glaucoma compared to controls.

Methods

Twenty glaucoma participants and 20 age-matched controls underwent high-resolution OCT scans of one eye. 4 µm-thick enface slabs were constructed through the retina. Enface indices were depths of first gap in visible retinal nerve fiber bundles (RNFBs) and last visible bundle, subjectively evaluated in six sectors of a 3.5 mm circle around the optic disc. Retinal nerve fiber layer thickness (RNFLT) along the same circle was extracted at angles corresponding to enface indices. Between-group differences were tested by linear mixed models. Diagnostic performance was measured by partial receiver operating characteristic area (pAUC).

Results

First gap and last visible bundle were closer to the inner limiting membrane in glaucoma eyes (both P < 0.0001). Enface indices showed excellent diagnostic performance (pAUCs 0.63-1.00), similar to RNFLT (pAUCs 0.63-0.95). Correlation between enface and RNFLT parameters was strong in healthy (r = 0.81-0.92) and glaucoma eyes (r = 0.73-0.80).

Conclusions

This simple subjective method reliably identifies glaucomatous defects in enface images with diagnostic performance at least as good as existing thickness indices. Thickness and reflectivity were similarly related in healthy and glaucoma eyes, providing no strong evidence of reflectivity loss preceding thinning. Objective analyses may realize further potential of enface OCT images in glaucoma.

Translational Relevance

Novel enface OCT indices may aid glaucoma diagnosis.

Interpreting Retinal Nerve Fiber Layer Reflectance Defects Based on Presence of Retinal Nerve Fiber Bundles

SIGNIFICANCE

Adaptive-optics scanning-laser-ophthalmoscopy (AOSLO) retinal imaging of the retinal nerve fiber layer (RNFL) helps predict the severity of perimetric damage based on absence of fibers and projection of the defects in en face images of the RNFL from spectral-domain optical coherence tomography (SD-OCT).

PURPOSE

En face images of the RNFL reveal reflectance defects in patients with glaucoma and predict locations of perimetric defects. These defects could arise from either loss of retinal nerve fiber bundles or reduced bundle reflectance. This study used AOSLO to assess presence of bundles in areas with RNFL reflectance defects on SD-OCT.

METHODS

Adaptive-optics scanning laser ophthalmoscopy was used to image a vertical strip of RNFL measuring approximately 30 × 3° between the optic disc and the fovea. Fifteen patients with glaucoma who had SD-OCT reflectance defects that passed through this region were chosen. Four patients had reflectance defects in both superior and inferior hemifields, so presence of bundles on AOSLO was assessed for 19 hemifields. Where bundles were present, the hemifield was scored for whether bundles seemed unusual (low contrast and/or low density). Perimetric defects were considered deep when sensitivity was below 15 dB.

RESULTS

Ten hemifields had a region with no fibers present on AOSLO; all had a corresponding deep perimetric defect. The other nine hemifields had no region in the AOSLO image without fibers: four with normal fibers and five with unusual fibers. The only one of these nine hemifields with a deep perimetric defect was one with low-contrast fibers and overall thin RNFL.

CONCLUSIONS

Retinal nerve fiber layer reflectance defects, which were associated with deep perimetric defects, usually had a region with absence of fibers on AOSLO images of RNFL. Ability to predict severity of perimetric damage from en face SD-OCT RNFL reflectance images could benefit from quantification that differentiated between absence of fibers and unusual fibers.

Early localized alterations of the retinal inner plexiform layer in association with visual field worsening in glaucoma patients

Glaucoma is a chronic neurodegenerative disease of the optic nerve and a leading cause of irreversible blindness, worldwide. While the experimental research using animal models provides growing information about cellular and molecular processes, parallel analysis of the clinical presentation of glaucoma accelerates the translational progress towards improved understanding, treatment, and clinical testing of glaucoma. Optic nerve axon injury triggers early alterations of retinal ganglion cell (RGC) synapses with function deficits prior to manifest RGC loss in animal models of glaucoma. For testing the clinical relevance of experimental observations, this study analyzed the functional correlation of localized alterations in the inner plexiform layer (IPL), where RGCs establish synaptic connections with retinal bipolar and amacrine cells. Participants of the study included a retrospective cohort of 36 eyes with glaucoma and a control group of 18 non-glaucomatous subjects followed for two-years. The IPL was analyzed on consecutively collected macular SD-OCT scans, and functional correlations with corresponding 10–2 visual field scores were tested using generalized estimating equations (GEE) models. The GEE-estimated rate of decrease in IPL thickness (R = 0.36, P<0.001) and IPL density (R = 0.36, P<0.001), as opposed to unchanged or increased IPL thickness or density, was significantly associated with visual field worsening at corresponding analysis locations. Based on multivariate logistic regression analysis, this association was independent from the patients’ age, the baseline visual field scores, or the baseline thickness or alterations of retinal nerve fiber or RGC layers (P>0.05). These findings support early localized IPL alterations in correlation with progressing visual field defects in glaucomatous eyes. Considering the experimental data, glaucoma-related increase in IPL thickness/density might reflect dendritic remodeling, mitochondrial redistribution, and glial responses for synapse maintenance, but decreased IPL thickness/density might correspond to dendrite atrophy. The bridging of experimental data with clinical findings encourages further research along the translational path.

Relationship between intraocular pressure and retinal nerve fibre thickness loss in a monkey model of chronic ocular hypertension

Chronic ocular hypertension (COHT) monkey models were established by destroying the trabecular meshwork, for investigating the relationship between intraocular pressure (IOP) and retinal nerve fibre layer (RNFL) thickness loss. IOP and RNFL thickness were measured before laser injury and weekly thereafter for 27 weeks using Tono Vet and Stratus optical coherence tomography (OCT). The quantitative relationship was as follows: (1) at 32-47 mmHg, the average damage rate was -3.08 ± 0.28 μm/week; (2) at 25-30 mmHg, it was -1.45 ± 0.19 μm/week. The inferior RNFL and superior RNFL turned out to be the most IOP-sensitive quadrants with the rate of RNFL change almost in parallel with IOP levels. The superior sector seemed to be resistant to high IOP conditions until a RNFL loss of ~20 μm was detected in the inferior sector. The rate of RNFL thickness loss was slowed with obvious turning points at RNFL thicknesses of ~75 μm, 65 μm, and 50 μm. The experimental results have achieved research significance. The COHT Monkey was an ideal animal model that can be used for evaluating the relationship between IOP and RNFL damage. Higher IOP was associated with faster RNFL thickness loss. The level of IOP was a vital factor for RNFL damage rate, and baseline/residual RNFL thickness was also important for subsequent RNFL damage. OCT was suitable for measuring RNFL thickness change in COHT monkey models.

Scattering-Angle-Resolved Optical Coherence Tomography of a Hypoxic Mouse Retina Model

Several studies have noted a correlation between retinal degeneration and traumatic encephalopathy (TE) making the retina a leading candidate for detection and assessment. Scattering-angle-resolved optical coherence tomography (SAR-OCT) is a candidate imaging modality to detect sub-resolution changes in retinal microstructure. SAR-OCT images of murine retinas that experience a hypoxic insult-euthanasia by isoflurane overdose-are presented. A total of 4 SAR-OCT measurement parameters are reported in 6 longitudinal experiments: blood flow volume fraction, total retinal thickness, reflectance index, and scattering angle. As each mouse expires, blood flow volume fraction decreases, total retinal thickness increases, reflectance index decreases, and scattering angle diversity increases. Contribution of the retinal vasculature to scattering angle diversity is discussed. Results of this study suggest the utility of SAR-OCT to measure TE using scattering angle diversity contrast in the retina.

Supercontinuum source-based multi-contrast optical coherence tomography for rat retina imaging

This study proposed an ultrahigh-resolution multi-contrast optical coherence tomography system integrated with fundus photography for in vivo retinal imaging of rodents. A supercontinuum light source was used in the system, providing an axial resolution of less than 3 µm within 1.8 mm (in the tissue). Three types of tissue contrast based on backscattered intensity, phase retardation, and microvasculature at a capillary level can be simultaneously obtained using the proposed system. Pigmented Long-Evans, non-pigmented (albino) Sprague Dawley, and Royal College of Surgeons rats were imaged and compared. In vivo imaging results were validated with histology.

Design Considerations for Murine Retinal Imaging Using Scattering Angle Resolved Optical Coherence Tomography

Optical coherence tomography (OCT), an optical imaging approach enabling cross-sectional analysis of turbid samples, is routinely used for retinal imaging in human and animal models of diseases affecting the retina. Scattering angle resolved (SAR-)OCT has previously been demonstrated as offering additional contrast in human studies, but no SAR-OCT system has been reported in detail for imaging the retinas of mice. An optical model of a mouse eye was designed and extended for validity at wavelengths of light around 1310 nm; this model was then utilized to develop a SAR-OCT design for murine retinal imaging. A Monte Carlo technique simulates light scattering from the retina, and the simulation results are confirmed with SAR-OCT images. Various images from the SAR-OCT system are presented and utility of the system is described. SAR-OCT is demonstrated as a viable and robust imaging platform to extend utility of retinal OCT imaging by incorporating scattering data into investigative ophthalmologic analysis.

Measuring polarization changes in the human outer retina with polarization-sensitive optical coherence tomography

Morphological changes in the outer retina such as drusen are established biomarkers to diagnose age-related macular degeneration. However, earlier diagnosis might be possible by taking advantage of more subtle changes that accompany tissues that bear polarization-altering properties. To test this hypothesis, we developed a method based on polarization-sensitive optical coherence tomography with which volumetric data sets of the macula were obtained from 10 young (<25 years) and 10 older (>54 years) subjects. All young subjects and 5 of the older subjects had retardance values induced by the retinal pigment epithelium and Bruch's membrane (RPE-BM) complex that were just above the noise floor measurement (5°-13° at 840 nm). In contrast, elevated retardance, up to 180°, was observed in the other 5 older subjects. Analysis of the degree of polarization uniformity (DOPU) demonstrates that reduced DOPU (<0.4) in the RPE is associated with elevated double pass phase retardation (DPPR) below the RPE-BM complex, suggesting that the observed elevated DPPR in older subjects is the result of increased scattering or polarization scrambling. Collectively, our measurements show that the outer retina can undergo dramatic change in its polarization properties with age, and in some cases still retain its clinically normal appearance.

Response of the Retinal Nerve Fiber Layer Reflectance and Thickness to Optic Nerve Crush

Purpose

To study the effects of acute optic nerve damage on the reflectance of the retinal nerve fiber layer (RNFL) and to compare the time courses of changes of RNFL reflectance and thickness.

Methods

A rat model of optic nerve crush (ONC) was compared with previously studied normal retinas. The reflectance and thickness of the RNFL were studied at 1 to 5 weeks after ONC. Reflectance spectra from 400 to 830 nm were measured for eyes with ONC, their contralateral untreated eyes, and eyes with sham surgery. Directional reflectance was studied by varying the angle of light incidence. RNFL thickness was measured by confocal microscopy.

Results

After ONC, the RNFL reflectance remained directional. At 1 week, RNFL reflectance decreased significantly at all wavelengths (P < 0.001), whereas there was no significant change in RNFL thickness (P = 0.739). At 2 weeks, both RNFL reflectance and thickness decreased significantly, and by 5 weeks they declined to approximately 40% and 30%, respectively, of the normal values. Although RNFL reflectance decreased at all wavelengths, there was a greater reduction at short wavelengths. Spectral shape at long wavelengths was similar to the normal. Some of these changes were also found in the contralateral untreated eyes, but none of these changes were found in eyes with sham surgery.

Conclusions

Decrease of RNFL reflectance after ONC occurs prior to thinning of the RNFL and the decrease is more prominent at short wavelengths. Direct measurement of RNFL reflectance, especially at short wavelengths, may provide early detection of axonal damage.

Attenuation Coefficients From SD-OCT Data: Structural Information Beyond Morphology on RNFL Integrity in Glaucoma

PURPOSE

The purpose of this study is to explore the attenuation coefficient (AC) of the retinal nerve fiber layer (RNFL) in spectral domain optical coherence tomography (OCT) images, in healthy eyes and eyes affected by glaucoma. To assess the relation between RNLF AC, disease severity, RNFL thickness, visual field sensitivity threshold, spatial location and age.

PATIENTS AND METHODS

We analyzed peripapillary circle scans of a clinical OCT device (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) in 102 glaucoma patients and 90 healthy controls. The images were fully automatically converted into depth-resolved AC images. Next, the median AC within the RNFL was calculated based on the Spectralis segmentation. We compared the RNFL AC between healthy, mild, moderate and advanced glaucomatous eyes and assessed the correlation with patient characteristics such as age and visual field sensitivity threshold (HFA, Carl Zeiss Meditec, Dublin, CA) in a generalized estimating equations (GEE) model. Finally, we explored the ability to discriminate between glaucomatous and healthy eyes by RNFL AC.

RESULTS

Median RNFL AC decreased with increasing disease severity up to moderate glaucoma (P<0.001) in all 4 sectors around the optic nerve head. The largest relative decrease occurred in the nasal sector. The RNFL AC (AUC, 0.834±0.028) effectively discriminated healthy from glaucomatous eyes, although RNFL thickness (AUC, 0.975±0.013) performed even better (P<0.001). Prediction of visual field sensitivity improved significantly when RNFL thickness was augmented with RNFL AC as covariates (P<0.001).

CONCLUSIONS

This study demonstrated that RNFL AC provides complementary information on the RNFL's health compared with RNFL thickness measurements alone.

Polarization sensitive optical coherence tomography - a review [Invited]

Optical coherence tomography (OCT) is now a well-established modality for high-resolution cross-sectional and three-dimensional imaging of transparent and translucent samples and tissues. Conventional, intensity based OCT, however, does not provide a tissue-specific contrast, causing an ambiguity with image interpretation in several cases. Polarization sensitive (PS) OCT draws advantage from the fact that several materials and tissues can change the light's polarization state, adding an additional contrast channel and providing quantitative information. In this paper, we review basic and advanced methods of PS-OCT and demonstrate its use in selected biomedical applications.

Cytoskeletal Alteration and Change of Retinal Nerve Fiber Layer Birefringence in Hypertensive Retina

PURPOSE

Glaucoma damages the retinal nerve fiber layer (RNFL). Both RNFL thickness and retardance can be used to assess the damage, but birefringence, the ratio of retardance to thickness, is a property of the tissue itself. This study investigated the relationship between axonal cytoskeleton and RNFL birefringence in retinas with hypertensive damage.

MATERIALS AND METHODS

High intraocular pressure (IOP) was induced unilaterally in rat eyes. RNFL retardance in isolated retinas was measured. Cytostructural organization and bundle thickness were evaluated by confocal imaging of immunohistochemical staining of the cytoskeletal components: microtubules (MTs), F-actin, and neurofilaments. Bundles with different appearances of MT stain were studied, and their birefringence was calculated at different radii from the optic nerve head (ONH) center.

RESULTS

Forty bundles in eight normal retinas and 37 bundles in 10 treated retinas were examined. In normal retinas, the stain of axonal cytoskeleton was approximately uniform within bundles, and RNFL birefringence did not change along bundles. In treated retinas, elevation of IOP caused non-uniform alteration of axonal cytoskeleton across the retina, and distortion of axonal MTs was associated with decreased birefringence. The study further demonstrated that change of RNFL birefringence profiles along bundles can imply altered axonal cytoskeleton, suggesting that ultrastructural change of the RNFL can be inferred from clinical measurements of RNFL birefringence. The study also demonstrated that measuring RNFL birefringence profiles along bundles, instead of at a single location, may provide a more sensitive way to detect axonal ultrastructural change.

CONCLUSIONS

Measurement of RNFL birefringence along bundles can provide estimation of cytoskeleton alteration and sensitive detection of glaucomatous damage.

Posterior rat eye during acute intraocular pressure elevation studied using polarization sensitive optical coherence tomography

Polarization sensitive optical coherence tomography (PS-OCT) operating at 840 nm with axial resolution of 3.8 µm in tissue was used for investigating the posterior rat eye during an acute intraocular pressure (IOP) increase experiment. IOP was elevated in the eyes of anesthetized Sprague Dawley rats by cannulation of the anterior chamber. Three dimensional PS-OCT data sets were acquired at IOP levels between 14 mmHg and 105 mmHg. Maps of scleral birefringence, retinal nerve fiber layer (RNFL) retardation and relative RNFL/retina reflectivity were generated in the peripapillary area and quantitatively analyzed. All investigated parameters showed a substantial correlation with IOP. In the low IOP range of 14-45 mmHg only scleral birefringence showed statistically significant correlation. The polarization changes observed in the PS-OCT imaging study presented in this work suggest that birefringence of the sclera may be a promising IOP-related parameter to investigate.

Structural and Functional Evaluations for the Early Detection of Glaucoma

The early detection of glaucoma is imperative in order to preserve functional vision. Structural and functional methods are utilized to detect and monitor glaucomatous damage and the vision loss it causes. The relationship between these detection measures is complex and differs between individuals, especially in early glaucoma. Using both measures together is advised in order to ensure the highest probability of glaucoma detection, and new testing methods are continuously developed with the goals of earlier disease detection and improvement of disease monitoring. The purpose of this review is to explore the relationship between structural and functional glaucoma detection and discuss important technological advances for early glaucoma detection.

Color Reflectivity Discretization Analysis of OCT Images in the Detection of Glaucomatous Nerve Fiber Layer Defects

PURPOSE

To compare the ability of Cirrus retinal nerve fiber layer (RNFL) thickness and the Color Reflectivity Discretization Analysis (CORDA), a novel optical coherence tomography (OCT) analysis method, to differentiate between normal subjects, glaucoma suspects, and glaucoma patients.

PATIENTS AND METHODS

Analysis of peripapillary OCT images using Cirrus SD-OCT (optic nerve head cube 200 × 200 protocol) and postacquisition CORDA analysis of peripapillary RNFL B-scan images was performed. In total, 291 eyes of 148 subjects (94 normal eyes, 100 primary open-angle glaucoma suspect eyes, and 97 eyes with primary open-angle glaucoma) were included. Area under the receiver operating characteristic curve was estimated for each region and method (Cirrus vs. CORDA) for differentiating eyes with glaucoma, and those that are glaucoma suspect, from normal eyes.

RESULTS

CORDA HR1 parameter discriminated glaucoma patients from normal subjects more accurately than Cirrus RNFL thickness in nasal (P = 0.003) and temporal (P = 0.001) regions. HR1 showed greater area under the receiver operating characteristic curve than Cirrus RNFL thickness when discriminating glaucoma suspects from normal subjects in the superior (P = 0.02), nasal (P = 0.003), and temporal (P = 0.001) regions. Both were similar for mean and the inferior regions.

CONCLUSIONS

In this study, the novel CORDA HR1 differentiated between normal subjects and glaucoma suspects more accurately than Cirrus RNFL, and in temporal and nasal regions when discriminating between normal and glaucomatous eyes. CORDA analysis may improve the diagnostic accuracy of Cirrus OCT for glaucoma and glaucoma suspects.

Changes in Retinal Nerve Fiber Layer Reflectance Intensity as a Predictor of Functional Progression in Glaucoma

PURPOSE

We determined whether longitudinal changes in retinal nerve fiber layer (RNFL) reflectance provide useful prognostic information about longitudinal changes in function in glaucoma.

METHODS

The reflectance intensity of each pixel within spectral-domain optical coherence tomography (SD-OCT) circle scans was extracted by custom software. A repeatability cohort comprising 53 eyes of 27 participants (average visual field mean deviation [MD] -1.65 dB) was tested five times within a few weeks. To minimize test-retest variability in their data, a reflectance intensity ratio was defined as the mean reflectance intensity of pixels within the RNFL divided by the mean between the RNFL and RPE. This was measured in a separate longitudinal cohort comprising 310 eyes of 205 participants tested eight times at 6-month intervals (average MD, -0.99 dB; median rate of change, -0.09 dB/y). The rate of change of this ratio, together with the rate of RNFL thinning, and their interaction, were used to predict the rate of change of MD.

RESULTS

In univariate analyses, the rate of RNFL thinning was predictive of the rate of MD change (P < 0.0001), but the rate of change of reflectance intensity ratio was not (P = 0.116). However, in a multivariable model, the interaction between these two rates significantly improved upon predictions of the rate of functional change made using RNFL thickness alone (P = 0.038).

CONCLUSIONS

For a given rate of RNFL thinning, a reduction in the RNFL reflectance intensity ratio is associated with more rapid functional deterioration. Incorporating SD-OCT reflectance information may improve the structure-function relation in glaucoma.

Polarization properties of single layers in the posterior eyes of mice and rats investigated using high resolution polarization sensitive optical coherence tomography

We present a high resolution polarization sensitive optical coherence tomography (PS-OCT) system for ocular imaging in rodents. The system operates at 840 nm and uses a broadband superluminescent diode providing an axial resolution of 5.1 µm in air. PS-OCT data was acquired at 83 kHz A-scan rate by two identical custom-made spectrometers for orthogonal polarization states. Pigmented (Brown Norway, Long Evans) and non-pigmented (Sprague Dawley) rats as well as pigmented mice (C57BL/6) were imaged. Melanin pigment related depolarization was analyzed in the retinal pigment epithelium (RPE) and choroid of these animals using the degree of polarization uniformity (DOPU). For all rat strains, significant differences between RPE and choroidal depolarization were observed. In contrast, DOPU characteristics of RPE and choroid were similar for C57BL/6 mice. Moreover, the depolarization within the same tissue type varied significantly between different rodent strains. Retinal nerve fiber layer thickness, phase retardation, and birefringence were mapped and quantitatively measured in Long Evans rats in vivo for the first time. In a circumpapillary annulus, retinal nerve fiber layer birefringence amounted to 0.16°/µm ± 0.02°/µm and 0.17°/µm ± 0.01°/µm for the left and right eyes, respectively.

Retinal nerve fiber layer reflectometry must consider directional reflectance

Recent studies reveal that measurements of retinal nerve fiber layer (RNFL) reflectance provide more sensitive detection of glaucomatous damage than RNFL thickness, but most do not consider directional reflectance of the RNFL, an important source of variability. This study quantitatively compared RNFL directional reflectance, represented by an angular spread function (ASF), measured at different scattering angles, different wavelengths and different distances from the optic nerve head (ONH) and for bundles with different thicknesses (T). An ASF was characterized by its amplitude (A) and width (W). Internal reflectance of a bundle was expressed as A/T. The study found that A varied significantly with scattering angle and wavelength and that A/T was different among bundles but constant along the same bundle, indicating that the internal structure of axons may vary among bundles but does not change with distance. This study also found that W was larger near the ONH and at longer wavelengths, but did not depend on scattering angle or T. Because a 4.3° change in incident angle can change reflected intensity by a factor of 2.7, accounting for directional reflectance should improve the accuracy and reproducibility of RNFL reflectance measurements.

The non-human primate experimental glaucoma model

The purpose of this report is to summarize the current strengths and weaknesses of the non-human primate (NHP) experimental glaucoma (EG) model through sections devoted to its history, methods, important findings, alternative optic neuropathy models and future directions. NHP EG has become well established for studying human glaucoma in part because the NHP optic nerve head (ONH) shares a close anatomic association with the human ONH and because it provides the only means of systematically studying the very earliest visual system responses to chronic intraocular pressure (IOP) elevation, i.e. the conversion from ocular hypertension to glaucomatous damage. However, NHPs are impractical for studies that require large animal numbers, demonstrate spontaneous glaucoma only rarely, do not currently provide a model of the neuropathy at normal levels of IOP, and cannot easily be genetically manipulated, except through tissue-specific, viral vectors. The goal of this summary is to direct NHP EG and non-NHP EG investigators to the previous, current and future accomplishment of clinically relevant knowledge in this model.

In vivo imaging methods to assess glaucomatous optic neuropathy

The goal of this review is to summarize the most common imaging methods currently applied for in vivo assessment of ocular structure in animal models of experimental glaucoma with an emphasis on translational relevance to clinical studies of the human disease. The most common techniques in current use include optical coherence tomography and scanning laser ophthalmoscopy. In reviewing the application of these and other imaging modalities to study glaucomatous optic neuropathy, this article is organized into three major sections: 1) imaging the optic nerve head, 2) imaging the retinal nerve fiber layer and 3) imaging retinal ganglion cell soma and dendrites. The article concludes with a brief section on possible future directions.

New developments in optical coherence tomography

PURPOSE OF REVIEW

Optical coherence tomography (OCT) has become the cornerstone technology for clinical ocular imaging in the past few years. The technology is still rapidly evolving with newly developed applications. This manuscript reviews recent innovative OCT applications for glaucoma diagnosis and management.

RECENT FINDINGS

The improvements made in the technology have resulted in increased scanning speed, axial and transverse resolution, and more effective use of the OCT technology as a component of multimodal imaging tools. At the same time, the parallel evolution in novel algorithms makes it possible to efficiently analyze the increased volume of acquired data.

SUMMARY

The innovative iterations of OCT technology have the potential to further improve the performance of the technology in evaluating ocular structural and functional characteristics and longitudinal changes in glaucoma.

Effect of image registration on longitudinal analysis of retinal nerve fiber layer thickness of non-human primates using Optical Coherence Tomography (OCT)

BACKGROUND

In this paper we determined the benefits of image registration on estimating longitudinal retinal nerve fiber layer thickness (RNFLT) changes.

METHODS

RNFLT maps around the optic nerve head (ONH) of healthy primate eyes were measured using Optical Coherence Tomography (OCT) weekly for 30 weeks. One automatic algorithm based on mutual information (MI) and the other semi-automatic algorithm based on log-polar transform cross-correlation using manually segmented blood vessels (LPCC_MSBV), were used to register retinal maps longitudinally. We compared the precision and recall between manually segmented image pairs for the two algorithms using a linear mixed effects model.

RESULTS

We found that the precision calculated between manually segmented image pairs following registration by LPCC_MSBV algorithm is significantly better than the one following registration by MI algorithm (p < <0.0001). Trend of the all-rings and temporal, superior, nasal and inferior (TSNI) quadrants average of RNFLT over time in healthy primate eyes are not affected by registration. RNFLT of clock hours 1, 2, and 10 showed significant change over 30 weeks (p = 0.0058, 0.0054, and 0.0298 for clock hours 1, 2 and 10 respectively) without registration, but stayed constant over time with registration.

CONCLUSIONS

The LPCC_MSBV provides better registration of RNFLT maps recorded on different dates than the automatic MI algorithm. Registration of RNFLT maps can improve clinical analysis of glaucoma progression.

Fiber-based polarization-sensitive OCT of the human retina with correction of system polarization distortions

In polarization-sensitive optical coherence tomography (PS-OCT) the use of single-mode fibers causes unpredictable polarization distortions which can result in increased noise levels and erroneous changes in calculated polarization parameters. In the current paper this problem is addressed by a new Jones matrix analysis method that measures and corrects system polarization distortions as a function of wavenumber by spectral analysis of the sample surface polarization state and deeper located birefringent tissue structures. This method was implemented on a passive-component depth-multiplexed swept-source PS-OCT system at 1040 nm which was theoretically modeled using Jones matrix calculus. High-resolution B-scan images are presented of the double-pass phase retardation, diattenuation, and relative optic axis orientation to show the benefits of the new analysis method for in vivo imaging of the human retina. The correction of system polarization distortions yielded reduced phase retardation noise, and better estimates of the diattenuation and the relative optic axis orientation in weakly birefringent tissues. The clinical potential of the system is shown by en face visualization of the phase retardation and optic axis orientation of the retinal nerve fiber layer in a healthy volunteer and a glaucoma patient with nerve fiber loss.

Retinal nerve fiber layer reflectance for early glaucoma diagnosis

PURPOSE

Compare performance of normalized reflectance index (NRI) and retinal nerve fiber layer thickness (RNFLT) parameters determined from optical coherence tomography (OCT) images for glaucoma and glaucoma suspect diagnosis.

METHODS

Seventy-five eyes from 71 human subjects were studied: 33 controls, 24 glaucomatous, and 18 glaucoma-suspects. RNFLT and NRI maps were measured using 2 custom-built OCT systems and the commercial instrument RTVue. Using area under the receiver operating characteristic curve, RNFLT and NRI measured in 7 RNFL locations were analyzed to distinguish between control, glaucomatous, and glaucoma-suspect eyes.

RESULTS

The mean NRI of the control group was significantly larger than the means of glaucomatous and glaucoma-suspect groups in most RNFL locations for all 3 OCT systems (P<0.05 for all comparisons). NRI performs significantly better than RNFLT at distinguishing between glaucoma-suspect and control eyes using RTVue OCT (P=0.008). The performances of NRI and RNFLT for classifying glaucoma-suspect versus control eyes were statistically indistinguishable for PS-OCT-EIA (P=0.101) and PS-OCT-DEC (P=0.227). The performances of NRI and RNFLT for classifying glaucomatous versus control eyes were statistically indistinguishable (PS-OCT-EIA: P=0.379; PS-OCT-DEC: P=0.338; RTVue OCT: P=0.877).

CONCLUSIONS

NRI is a promising measure for distinguishing between glaucoma-suspect and control eyes and may indicate disease in the preperimetric stage. Results of this pilot clinical study warrant a larger study to confirm the diagnostic power of NRI for diagnosing preperimetric glaucoma.

Usefulness of optical coherence tomography to detect central serous chorioretinopathy in monkeys

Many systemic drugs can induce ocular toxicity and several ocular side-effects have been identified in clinical studies. However, it is difficult to detect ocular toxicity in preclinical studies because of the lack of appropriate evaluation methods. Optical coherence tomography (OCT) is useful because it can provide real-time images throughout a study period, whereas histopathology only provides images of sacrificed animals. Using OCT alongside histopathology, attempts were made to find effective approaches for screening of drug-induced ocular toxicity in monkeys. Such approaches could be used in preclinical studies prior to human trials. Six male cynomolgus monkeys (Macaca fascicularis Raffles) were orally administered one of six candidate MAPK/ERK kinase (MEK) inhibitors. Central serous chorioretinopathy, a known side-effect of such inhibitors, was identified in four monkeys by OCT. Artifacts generated during tissue processing meant that histopathology could not detect edematous changes. Thus, OCT is a useful tool to detect ocular toxicity which cannot be detected by histopathology in preclinical studies.

Path-length-multiplexed scattering-angle-diverse optical coherence tomography for retinal imaging

A low-resolution path-length-multiplexed scattering angle diverse optical coherence tomography (PM-SAD-OCT) is constructed to investigate the scattering properties of the retinal nerve fiber layer (RNFL). Low-resolution PM-SAD-OCT retinal images acquired from a healthy human subject show the variation of RNFL scattering properties at retinal locations around the optic nerve head. The results are consistent with known retinal ganglion cell neural anatomy and principles of light scattering. Application of PM-SAD-OCT may provide potentially valuable diagnostic information for clinical retinal imaging.

Onset and progression of peripapillary retinal nerve fiber layer (RNFL) retardance changes occur earlier than RNFL thickness changes in experimental glaucoma

PURPOSE

Longitudinal measurements of peripapillary RNFL thickness and retardance were compared in terms of time to reach onset of damage and time to reach a specific progression endpoint.

METHODS

A total of 41 rhesus macaques with unilateral experimental glaucoma (EG) each had three or more weekly baseline measurements in both eyes of peripapillary RNFL thickness (RNFLT) and retardance. Laser photocoagulation was then applied to the trabecular meshwork of one eye to induce chronic elevation of intraocular pressure and weekly imaging continued. Pairwise differences between baseline observations were sampled by bootstrapping to determine the 95% confidence limits of each measurement's repeatability. The first two sequential measurements below the lower confidence limit defined the endpoint for each parameter. Segmented linear and exponential decay functions were fit to each RNFL-versus-time series to determine the time to damage onset.

RESULTS

In all, 29 (71%) of the EG eyes reached endpoint by RNFL retardance and 25 (61%) reached endpoint by RNFLT. In total, 33 (80%) reached endpoint by at least one of the RNFL parameters and 21 (51%) reached endpoint by both RNFL parameters. Of the 33 EG eyes reaching any endpoint, a larger proportion reached endpoint first by retardance (n = 26, 79%) than did by RNFLT (n = 7, 21%; P = 0.002). Survival analysis indicated a shorter time to reach endpoint by retardance than by RNFLT (P < 0.001). Of the 21 EG eyes that reached endpoint by both measures, the median duration to endpoint was 120 days for retardance and 223 days for RNFLT (P = 0.003, Wilcoxon test). The time to onset was faster for retardance than that for RNFLT based on either segmented fits (by 31 days; P = 0.008, average R(2) = 0.89) or exponential fits (by 102 days; P = 0.01, average R(2) = 0.89).

CONCLUSIONS

The onset of progressive loss of RNFL retardance occurs earlier than the onset of RNFL thinning. Endpoints of progressive loss from baseline also occurred more frequently and earlier for RNFL retardance as compared with RNFLT.

Reflectance speckle of retinal nerve fiber layer reveals axonal activity

PURPOSE

This study investigated the retinal nerve fiber layer (RNFL) reflectance speckle and tested the hypothesis that temporal change of RNFL speckle reveals axonal dynamic activity.

METHODS

RNFL reflectance speckle of isolated rat retinas was studied with monochromatic illumination. A series of reflectance images was collected every 5 seconds for approximately 15 minutes. Correlation coefficients (CC) of selected areas between a reference and subsequent images were calculated and plotted as a function of the time intervals between images. An exponential function fit to the time course was used to evaluate temporal change of speckle pattern. To relate temporal change of speckle to axonal activity, in vitro living retina perfused at a normal (34°C) and a lower (24°C) temperature, paraformaldehyde-fixed retina, and retina treated with microtubule depolymerization were used.

RESULTS

RNFL reflectance was not uniform; rather nerve fiber bundles had a speckled texture that changed with time. In normally perfused retina, the time constant of the CC change was 0.56 ± 0.26 minutes. In retinas treated with lower temperature and microtubule depolymerization, the time constants increased by two to four times, indicating that the speckle pattern changed more slowly. The speckled texture in fixed retina was stationary.

CONCLUSIONS

Fixation stops axonal activity; treatments with either lower temperature or microtubule depolymerization are known to decrease axonal transport. The results obtained in this study suggest that temporal change of RNFL speckle reveals structural change due to axonal activity. Assessment of RNFL reflectance speckle may offer a new means of evaluating axonal function.

Henle fiber layer phase retardation measured with polarization-sensitive optical coherence tomography

We developed a method based on polarization-sensitive optical coherence tomography (PS-OCT) to quantify the double pass phase retardation (DPPR) induced by Henle fiber layer in three subjects. Measurements of the retina were performed at a mean wavelength of 840 nm using two polarization states that were perpendicular in a Poincaré sphere representation and phase retardation contributions from tissue layers above and below the Henle fiber layer were excluded using appropriately placed reference and measurement points. These points were semi-automatically segmented from intensity data. Using a new algorithm to determine DPPR, the Henle fiber layer in three healthy subjects aged 50-60 years showed elevated DPPR in a concentric ring about the fovea, with an average maximum DPPR for the three subjects of 22.0° (range: 20.4° to 23.0°) occurring at an average retinal eccentricity of 1.8° (range: 1.5° to 2.25°). Outside the ring, a floor of approximately 6.8° was measured, which we show can mainly be attributed to phase noise that is induced in the polarization states. We also demonstrate the method can determine fast axis orientation of the retardation, which is found consistent with the known radial pattern of Henle fibers.