Effective bidirectional scanning pattern for optical coherence tomography angiography

Megahertz multi-parametric ophthalmic OCT system for whole eye imaging

An ultrahigh-speed, wide-field OCT system for the imaging of anterior, posterior, and ocular biometers is crucial for obtaining comprehensive ocular parameters and quantifying ocular pathology size. Here, we demonstrate a multi-parametric ophthalmic OCT system with a speed of up to 1 MHz for wide-field imaging of the retina and 50 kHz for anterior chamber and ocular biometric measurement. A spectrum correction algorithm is proposed to ensure the accurate pairing of adjacent A-lines and elevate the A-scan speed from 500 kHz to 1 MHz for retinal imaging. A registration method employing position feedback signals was introduced, reducing pixel offsets between forward and reverse galvanometer scanning by 2.3 times. Experimental validation on glass sheets and the human eye confirms feasibility and efficacy. Meanwhile, we propose a revised formula to determine the "true" fundus size using all-axial length parameters from different fields of view. The efficient algorithms and compact design enhance system compatibility with clinical requirements, showing promise for widespread commercialization.

Optimizing numerical k-sampling for swept-source optical coherence tomography angiography

High-quality swept-source optical coherence tomography (SS-OCT) requires accurate k-sampling, which is equally vital for optical coherence tomography angiography (OCTA). Most SS-OCT systems are equipped with hardware-driven k-sampling. However, this conventional approach raises concerns over system cost, optical alignment, imaging depth, and stability in the clocking circuit. This work introduces an optimized numerical k-sampling method to replace the additional k-clock hardware. Using this method, we can realize high axial resolution (4.9-µm full-width-half-maximum, in air) and low roll-off (2.3 dB loss) over a 4-mm imaging depth. The high axial resolution and sensitivity achieved by this simple numerical method can reveal anatomic and microvascular structures with structural OCT and OCTA in both macular and deeper tissues, including the lamina cribrosa, suggesting its usefulness in imaging retinopathy and optic neuropathy.

Polarization-Diversity Optical Coherence Tomography Assessment of Choroidal Nevi

Purpose

The purpose of this study was to demonstrate the utility of polarization-diversity optical coherence tomography (PD-OCT), a noninvasive imaging technique with melanin-specific contrast, in the quantitative and qualitative assessment of choroidal nevi.

Methods

Nevi were imaged with a custom-built 55-degree field-of-view (FOV) 400 kHz PD-OCT system. Imaging features on PD-OCT were compared to those on fundus photography, auto-fluorescence, ultrasound, and non-PD-OCT images. Lesions were manually segmented for size measurement and metrics for objective assessment of melanin distributions were calculated, including degree of polarization uniformity (DOPU), attenuation coefficient, and melanin occupancy rate (MOR).

Results

We imaged 17 patients (mean age = 69.5 years, range = 37-90) with 11 pigmented, 3 non-pigmented, and 3 mixed pigmentation nevi. Nevi with full margin acquisition had an average longest basal diameter of 5.1 mm (range = 2.99-8.72 mm) and average height of 0.72 mm (range = 0.37 mm-2.09 mm). PD-OCT provided clear contrast of choroidal melanin content, distribution, and delineation of nevus margins for melanotic nevi. Pigmented nevi were found to have lower DOPU, higher attenuation coefficient, and higher MOR than non-pigmented lesions. Melanin content on PD-OCT was consistent with pigmentation on fundus in 15 of 17 nevi (88%).

Conclusions

PD-OCT allows objective assessment of choroidal nevi melanin content and distribution. In addition, melanin-specific contrast by PD-OCT enables clear nevus margin delineation and may improve serial growth surveillance. Further investigation is needed to determine the clinical significance and prognostic value of melanin characterization by PD-OCT in the evaluation of choroidal nevi.

Extended and adjustable field-of-view of variable interscan time analysis by ammonite-scanning swept-source optical coherence tomography angiography

A novel scanning protocol, ammonite scan, is proposed for widefield optical coherence tomography angiography (OCTA) and relative retinal blood flow velocity imaging in the human retina using variable interscan time analysis (VISTA). A repeated circle scan using a 400 kHz swept-source was employed to achieve an interscan time of 1.28 ms. The center of the repeated circular scan continuously moved spirally towards the peripheral region, ensuring an extended and adjustable scan range while preserving the short interscan time. Image artifacts due to eye movement were eliminated via extra motion-correction processing using data redundancy. The relative blood flow velocity in superficial and deep plexus layers was calculated from the VISTA image, and their ratio was used to explore the microvascular flow parameter in the healthy human eye.

Image-based cross-calibration method for multiple spectrometer-based OCT

A fast and practical computational cross-calibration of multiple spectrometers is described. A signal correlation matrix (CM) can be constructed from paired B-scans in a multiple-spectrometer optical coherence tomography (OCT), where the wavelength-corresponding pixels are indicated by high cross correlation. The CM can be used to either guide the physical alignment of spectrometers or to numerically match the spectra in the post-process. The performance is comparable to the previously reported optimization approach, as demonstrated by the mirror tests, qualitative comparison of OCT and optical coherence tomography angiography (OCTA) images, and quantitative comparison of image metrics.

Numerical calibration method for a multiple spectrometer-based OCT system

The present paper introduces a numerical calibration method for the easy and practical implementation of multiple spectrometer-based spectral-domain optical coherence tomography (SD-OCT) systems. To address the limitations of the traditional hardware-based spectrometer alignment across more than one spectrometer, we applied a numerical spectral calibration algorithm where the pixels corresponding to the same wavelength in each unit are identified through spatial- and frequency-domain interferometric signatures of a mirror sample. The utility of dual spectrometer-based SD-OCT imaging is demonstrated through in vivo retinal imaging at two different operation modes with high-speed and dual balanced acquisitions, respectively, in which the spectral alignment is critical to achieve improved retinal image data without any artifacts caused by misalignment of the spectrometers.

105° field of view non-contact handheld swept-source optical coherence tomography

We demonstrate a handheld swept-source optical coherence tomography (OCT) system with a 400 kHz vertical-cavity surface-emitting laser (VCSEL) light source, a non-contact approach, and an unprecedented single shot 105° field of view (FOV). We also implemented a spiral scanning pattern allowing real-time visualization with improved scanning efficiency. To the best of our knowledge, this is the widest FOV achieved in a portable non-contact OCT retinal imaging system to date. Improvements to the FOV may aid the evaluation of retinal diseases such as retinopathy of prematurity, where important vitreoretinal changes often occur in the peripheral retina.

Exact Scan Patterns of Rotational Risley Prisms Obtained with a Graphical Method: Multi-Parameter Analysis and Design

Rotational Risley prisms are one of the fastest two-dimensional (2D) optomechanical scanning systems. Their drawback is the strong non-linearity of the scan patterns they produce, in contrast to the most common (but slower) raster scanning modalities of 2D dual axis galvanometer scanners (GSs) or Micro-Electro-Mechanical Systems (MEMS) with oscillatory mirrors. The aim of this work is to develop a graphical method, which, to our knowledge, we have introduced to determine and characterize, using a commercially-available mechanical design program (for example CATIA V5R20 (Dassault Systems, Paris, France)) to simulate the exact scan patterns of rotational Risley prisms. Both the maximum and minimum angular and linear deviations of this type of scanner are deduced theoretically to characterize the outer diameter/Field-of-View (FOV) and the inner diameter (of the blind zone) of its ring-shaped patterns, respectively. This multi-parameter analysis is performed in correlation with the shape of the scan patterns, considering the four possible configurations of laser scanners with a pair of rotational Risley prisms, as well as all their parameters: prisms angles, refractive indexes, rotational speeds, distance between the two prisms, and the distance from the system to the scanned plane. Marshall’s synthetic parameters are also considered, i.e., the ratios of the rotational velocities and of the angles of the prisms. Rules-of-thumb for designing this optomechanical scanner are extracted from this analysis, regarding both shapes and dimensions of the scan patterns to be produced. An example of experimental validation completes the mathematical analysis and the performed simulations.

Phase stable swept-source optical coherence tomography with active mode-locking laser for contrast enhancements of retinal angiography

Swept-source optical coherence tomography (SS-OCT) is an attractive high-speed imaging technique for retinal angiography. However, conventional swept lasers vary the cavity length of the laser mechanically to tune the output wavelength. This causes sweep-timing jitter and hence low phase stability in OCT angiography. Here, we improve an earlier phase-stabilized, akinetic, SS-OCT angiography (OCTA) method by introducing coherent averaging. We develop an active mode-locking (AML) laser as a high phase-stable akinetic swept source for the OCTA system. The phase stability of the improved system was analyzed, and the effects of coherent averaging were validated using a retina phantom. The effectiveness of the coherent averaging method was further confirmed by comparing coherently and conventionally averaged en face images of human retinal vasculature for their contrast-to-noise ratio, signal-to-noise ratio, and vasculature connectivity. The contrast-to-noise ratio was approximately 1.3 times larger when applying the coherent averaging method in the human retinal experiment. Our coherent averaging method with the high phase-stability AML laser source for OCTA provides a valuable tool for studying healthy and diseased retinas.

Phase-corrected buffer averaging for enhanced OCT angiography using FDML laser

Megahertz-rate optical coherence tomography angiography (OCTA) is highly anticipated as an ultrafast imaging tool in clinical settings. However, shot-noise-limited sensitivity is inevitably reduced in high-speed imaging systems. In this Letter, we present a coherent buffer averaging technique for use with a Fourier-domain mode-locked (FDML) laser to improve OCTA contrast at 1060 nm MHz-rate retinal imaging. Full characterization of spectral variations among the FDML buffers and a numerical correction method are also presented, with the results demonstrating a 10-fold increase in the phase alignment among buffers. Coherent buffer averaging provided better OCTA contrast than the conventional multi-frame averaging approach with a faster acquisition time.

High-speed and widefield handheld swept-source OCT angiography with a VCSEL light source

Optical coherence tomography (OCT) and OCT angiography (OCTA) enable noninvasive structural and angiographic imaging of the eye. Portable handheld OCT/OCTA systems are required for imaging patients in the supine position. Examples include infants in the neonatal intensive care unit (NICU) and operating room (OR). The speed of image acquisition plays a pivotal role in acquiring high-quality OCT/OCTA images, particularly with the handheld system, since both the operator hand tremor and subject motion can cause significant motion artifacts. In addition, having a large field of view and the ability of real-time data visualization are critical elements in rapid disease screening, reducing imaging time, and detecting peripheral retinal pathologies. The arrangement of optical components is less flexible in the handheld system due to the limitation of size and weight. In this paper, we introduce a 400-kHz, 55-degree field of view handheld OCT/OCTA system that has overcome many technical challenges as a portable OCT system as well as a high-speed OCTA system. We demonstrate imaging premature infants with retinopathy of prematurity (ROP) in the NICU, a patient with incontinentia pigmenti (IP), and a patient with X-linked retinoschisis (XLRS) in the OR using our handheld OCT system. Our design may have the potential for improving the diagnosis of retinal diseases and help provide a practical guideline for designing a flexible and portable OCT system.

Use of the Retinal Vascular Histology to Validate an Optical Coherence Tomography Angiography Technique

Purpose

To determine the fidelity of optical coherence tomography angiography (OCTA) techniques by direct comparison of the retinal capillary network images obtained from the same region as imaged by OCTA and high-resolution confocal microscope.

Method

Ten porcine eyes were perfused with red blood cells for OCTA image acquisition from the area centralis and then perfusion-fixed, and the vessels were labeled for confocal imaging. Two approaches involving post-processing of two-dimensional projection images and vessel tracking on three dimensional image stacks were used to obtain quantitative measurements. Data collected include vessel density, length of visible vessel track, count of visible branch points, vessel track depth, vessel diameter, angle of vessel descent, and angle of dive for comparison and analysis.

Results

Comparing vascular images acquired from OCTA and confocal microscopy, we found (1) a good representation of the larger caliber retinal vessels, (2) an underrepresentation of retinal microvessels smaller than 10 µm and branch points in all four retinal vascular plexuses, particularly the intermediate capillary plexus, (3) reduced visibility associated with an increase in the angle of descent, (4) a tendency to loss visibility of vessel track at a branch point or during a sharp dive, and (5) a reduction in visibility with increase in retinal depth on OCTA images.

Conclusions

Current OCTA techniques can visualize the retinal capillary network, but some types of capillaries cannot be detected by OCTA, particularly in the middle to deeper layers.

Translational Relevance

The information indicates the limitation in clinical use and scopes for improvement in the current OCTA technologies.

Optimizing 3D retinal vasculature imaging in diabetic retinopathy using registration and averaging of OCT-A

High resolution visualization of optical coherence tomography (OCT) and OCT angiography (OCT-A) data is required to fully take advantage of the imaging modality's three-dimensional nature. However, artifacts induced by patient motion often degrade OCT-A data quality. This is especially true for patients with deteriorated focal vision, such as those with diabetic retinopathy (DR). We propose a novel methodology for software-based OCT-A motion correction achieved through serial acquisition, volumetric registration, and averaging. Motion artifacts are removed via a multi-step 3D registration process, and visibility is significantly enhanced through volumetric averaging. We demonstrate that this method permits clear 3D visualization of retinal pathologies and their surrounding features, 3D visualization of inner retinal capillary connections, as well as reliable visualization of the choriocapillaris layer.

Quantitative multi-contrast in vivo mouse imaging with polarization diversity optical coherence tomography and angiography

Retinal microvasculature and the retinal pigment epithelium (RPE) play vital roles in maintaining the health and metabolic activity of the eye. Visualization of these retina structures is essential for pre-clinical studies of vision-robbing diseases, such as age-related macular degeneration (AMD). We have developed a quantitative multi-contrast polarization diversity OCT and angiography (QMC-PD-OCTA) system for imaging and visualizing pigment in the RPE using degree of polarization uniformity (DOPU), along with flow in the retinal capillaries using OCT angiography (OCTA). An adaptive DOPU averaging kernel was developed to increase quantifiable values from visual data, and QMC en face images permit simultaneous visualization of vessel location, depth, melanin region thickness, and mean DOPU values, allowing rapid identification and differentiation of disease symptoms. The retina of five different mice strains were measured in vivo, with results demonstrating potential for pre-clinical studies of retinal disorders.

Sensorless adaptive-optics optical coherence tomographic angiography

Optical coherence tomographic angiography (OCTA) can image the retinal blood flow but visualization of the capillary caliber is limited by the low lateral resolution. Adaptive optics (AO) can be used to compensate ocular aberrations when using high numerical aperture (NA), and thus improve image resolution. However, previously reported AO-OCTA instruments were large and complex, and have a small sub-millimeter field of view (FOV) that hinders the extraction of biomarkers with clinical relevance. In this manuscript, we developed a sensorless AO-OCTA prototype with an intermediate numerical aperture to produce depth-resolved angiograms with high resolution and signal-to-noise ratio over a 2 × 2 mm FOV, with a focal spot diameter of 6 µm, which is about 3 times finer than typical commercial OCT systems. We believe these parameters may represent a better tradeoff between resolution and FOV compared to large-NA AO systems, since the spot size matches better that of capillaries. The prototype corrects defocus, astigmatism, and coma using a figure of merit based on the mean reflectance projection of a slab defined with real-time segmentation of retinal layers. AO correction with the ability to optimize focusing in arbitrary retinal depths - particularly the plexuses in the inner retina - could be achieved in 1.35 seconds. The AO-OCTA images showed greater flow signal, signal-to-noise ratio, and finer capillary caliber compared to commercial OCTA. Projection artifacts were also reduced in the intermediate and deep capillary plexuses. The instrument reported here improves OCTA image quality without excessive sacrifice in FOV and device complexity, and thus may have potential for clinical translation.

High-resolution wide-field OCT angiography with a self-navigation method to correct microsaccades and blinks

In this study, we demonstrate a novel self-navigated motion correction method that suppresses eye motion and blinking artifacts on wide-field optical coherence tomographic angiography (OCTA) without requiring any hardware modification. Highly efficient GPU-based, real-time OCTA image acquisition and processing software was developed to detect eye motion artifacts. The algorithm includes an instantaneous motion index that evaluates the strength of motion artifact on en face OCTA images. Areas with suprathreshold motion and eye blinking artifacts are automatically rescanned in real-time. Both healthy eyes and eyes with diabetic retinopathy were imaged, and the self-navigated motion correction performance was demonstrated.

Real-time en-face Gabor optical coherence tomographic angiography on human skin using CUDA GPU

We recently proposed an optical coherence tomographic angiography (OCTA) algorithm, Gabor optical coherence tomographic angiography (GOCTA), which can extract microvascular signals from a spectral domain directly with lower computational complexity compared to other algorithms. In this manuscript, we combine a programmable swept source, an OCT complex signal detecting unit, and graphics process units (GPU) to achieve a real-time en-face GOCTA system for human skin microvascular imaging. The programmable swept source can balance the A-scan rate and the spectral tuning range; the polarization-modulation based complex signal detecting unit can double the imaging depth range, and the GPU can accelerate data processing. C++ and CUDA are used as the programming platform where five parallel threads are created for galvo-driving signal generation, data acquisition, data transfer, data processing, and image display, respectively. Two queues (for the raw data and en-face images, respectively) are used to improve the data exchange efficiency among different devices. In this study, the data acquisition time and data processing time for each 3D complex volume (256×304×608 pixels,) are 405.3 and 173.7 milliseconds respectively. To the best of our knowledge, this is the first time to show en-face microvascular images covering 3×3 mm² at a refresh rate of 2.5 Hz.

75-degree non-mydriatic single-volume optical coherence tomographic angiography

Optical coherence tomography (OCT) and OCT angiography (OCTA) enable three-dimensional, high-resolution imaging of the eye. Yet, while they provide unprecedented structural and angiographic imaging detail, both have only limited fields of view in comparison to other imaging modalities like fundus photography. In this paper, we present a high-speed, high-sensitivity, swept source laser-based system that can acquire non-mydriatic 75-degree field of view OCT and OCTA images in a single complete scan without resorting to montaging techniques. The system uses an optimized scanning protocol and achieves capillary-level image quality. Such data may improve early detection of pathology and provide valuable information during disease monitoring.

Handheld probe for quantitative micro-elastography

Optical coherence elastography (OCE) has been proposed for a range of clinical applications. However, the majority of these studies have been performed using bulky, lab-based imaging systems. A compact, handheld imaging probe would accelerate clinical translation, however, to date, this had been inhibited by the slow scan rates of compact devices and the motion artifact induced by the user's hand. In this paper, we present a proof-of-concept, handheld quantitative micro-elastography (QME) probe capable of scanning a 6 × 6 × 1 mm volume of tissue in 3.4 seconds. This handheld probe is enabled by a novel QME acquisition protocol that incorporates a custom bidirectional scan pattern driving a microelectromechanical system (MEMS) scanner, synchronized with the sample deformation induced by an annular PZT actuator. The custom scan pattern reduces the total acquisition time and the time difference between B-scans used to generate displacement maps, minimizing the impact of motion artifact. We test the feasibility of the handheld QME probe on a tissue-mimicking silicone phantom, demonstrating comparable image quality to a bench-mounted setup. In addition, we present the first handheld QME scans performed on human breast tissue specimens. For each specimen, quantitative micro-elastograms are co-registered with, and validated by, histology, demonstrating the ability to distinguish stiff cancerous tissue from surrounding soft benign tissue.

High dynamic range optical coherence tomography angiography (HDR-OCTA)

The dynamic range of current optical coherence tomography (OCT) angiography (OCTA) images is limited by the fixed scanning intervals. High speed OCT devices introduce the possibility of extending the flow signal dynamic range. In this study, we created a novel scanning pattern for achieving high dynamic range (HDR)-OCTA with a superior scanning efficiency. We implemented a bidirectional, interleaved scanning pattern that is sensitive to different flow speeds by adjustable adjacent inter-scan time intervals. We found that an improved flow dynamic range can be achieved by generating 3 different B-scan time intervals using 3 repetitions.

Multi-scale and -contrast sensorless adaptive optics optical coherence tomography

Background

The roles of the retinal microvasculature and the retinal pigment epithelium (RPE) in maintaining the health and metabolic activity of the retina lend great clinical value to their high-resolution visualization.

Methods

By integrating polarization diversity detection (PDD) into multi-scale and -contrast sensorless adaptive optics optical coherence tomography (MSC-SAO-OCT), we have developed a novel multi-contrast SAO OCT system for imaging pigment in the RPE as well as flow in the retinal capillaries using OCT angiography (OCTA). Aberration correction was performed based on the image quality using transmissive deformable optical elements.

Results

MSC-SAO-OCTA imaging was performed at multiple fields-of-view (FOVs) with adjustable numerical aperture (NA). Retinal flow and RPE structural images for in vivo healthy and pathological human posterior eyes were demonstrated to show clinical feasibility of the system.

Conclusions

High-resolution imaging of retinal vasculature at both large and small FOVs, as well as characterization of RPE topology and deformation, enables more sophisticated and concise investigation of retinal pathologies for in vivo human imaging. MSC imaging may permit detection and analysis of even subtle deformations in the RPE layer using a single instrument.

Development of a clinical prototype of a miniature hand-held optical coherence tomography probe for prematurity and pediatric ophthalmic imaging

We report a novel design and operation of a highly integrated miniature handheld OCT probe, with high-speed angiography function that can be used in clinical settings for young children and infants, providing rapid, non-invasive structural and angiographic imaging of the retina and choroid. The imaging system is operated at 200 kHz, with 3D OCT and OCTA scan time of 0.8 and 3.2 seconds, respectively, and the scanning angle on the pupil is ± 36°, covering the full perifoveal region. Operator assisting features of the direct-view iris camera and on-probe display are integrated into the hand-held probe, and the fixation target can display animations to attract the attention of young subjects. Compared to conventional OCT systems, the high-speed hand-held OCT system significantly improves the operator's experience and scanning efficiency, which is important for imaging infants. Imaging results indicate a significant reduction in total time consumption in pediatric ophthalmic imaging sessions, as well as the image quality of OCT angiography.

Embedded deep learning in ophthalmology: making ophthalmic imaging smarter

Deep learning has recently gained high interest in ophthalmology due to its ability to detect clinically significant features for diagnosis and prognosis. Despite these significant advances, little is known about the ability of various deep learning systems to be embedded within ophthalmic imaging devices, allowing automated image acquisition. In this work, we will review the existing and future directions for 'active acquisition'-embedded deep learning, leading to as high-quality images with little intervention by the human operator. In clinical practice, the improved image quality should translate into more robust deep learning-based clinical diagnostics. Embedded deep learning will be enabled by the constantly improving hardware performance with low cost. We will briefly review possible computation methods in larger clinical systems. Briefly, they can be included in a three-layer framework composed of edge, fog, and cloud layers, the former being performed at a device level. Improved egde-layer performance via 'active acquisition' serves as an automatic data curation operator translating to better quality data in electronic health records, as well as on the cloud layer, for improved deep learning-based clinical data mining.