New Directions for Ophthalmic OCT - Handhelds, Surgery, and Robotics.

The introduction of optical coherence tomography (OCT) in the 1990s revolutionized diagnostic ophthalmic imaging. Initially, OCT's role was primarily in the adult ambulatory ophthalmic clinics. Subsequent advances in handheld form factors, integration into surgical microscopes, and robotic assistance have expanded OCT's utility and impact outside of its initial environment in the adult outpatient ophthalmic clinic.

Distortion-Corrected Posterior Ocular Shape in Myopic Eyes Assessed by Ultrawide OCT Detects Deformations Associated With Vision-Threatening Changes.

Purpose: To develop a quantitative tool for assessing the posterior ocular shape using widefield, volumetric optical coherence tomography (OCT) in eyes with myopia.

Methods: This observational, cross-sectional study included 178 eyes from 113 participants. Participants underwent a standardized eye examination, including ocular biometry and a custom ultrawide OCT.

Accelerating glacier volume loss on Juneau Icefield driven by hypsometry and melt-accelerating feedbacks.

Globally, glaciers and icefields contribute significantly to sea level rise. Here we show that ice loss from Juneau Icefield, a plateau icefield in Alaska, accelerated after 2005 AD. Rates of area shrinkage were 5 times faster from 2015-2019 than from 1979-1990.

RobOCTNet: Robotics and Deep Learning for Referable Posterior Segment Pathology Detection in an Emergency Department Population.

Purpose: To evaluate the diagnostic performance of a robotically aligned optical coherence tomography (RAOCT) system coupled with a deep learning model in detecting referable posterior segment pathology in OCT images of emergency department patients.

Methods: A deep learning model, RobOCTNet, was trained and internally tested to classify OCT images as referable versus non-referable for ophthalmology consultation. For external testing, emergency department patients with signs or symptoms warranting evaluation of the posterior segment were imaged with RAOCT.

NOVEL METHOD FOR VISUALIZING PERIPHERAL RETINAL STRUCTURES WITH MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY.

Background/purpose: Visualization of peripheral retinal structures with optical coherence tomography (OCT) can be challenging but can offer valuable clinical information. We describe a method for intraoperative OCT of the peripheral retina.

Methods: An investigational microscope-integrated OCT system with real-time 4D volumetric imaging was used in conjunction with a Goldmann style mirrored contact lens intraoperatively to capture peripheral images in three patients.

Robotic Optical Coherence Tomography of Human Subjects with Posture-Invariant Head and Eye Alignment in Six Degrees of Freedom.

Ophthalmic optical coherence tomography (OCT) has achieved remarkable clinical success but remains sequestered in ophthalmology specialty offices. Recently introduced robotic OCT systems seek to expand patient access but fall short of their full potential due to significant imaging workspace and motion planning restrictions. Here, we present a next-generation robotic OCT system capable of imaging in any head orientation or posture that is mechanically reachable.

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

During the COVID-19 pandemic, an emphasis was placed on contactless, physical distancing and improved telehealth; contrariwise, standard-of-care ophthalmic imaging of patients required present, trained personnel. Here, we introduce contactless, autonomous robotic alignment of optical coherence tomography (RAOCT) for imaging of retinal disease and compare measured retinal thickness and diagnostic readability to technician operated clinical OCT. In a powered study, we found no statistically significant difference in retinal thickness in both healthy and diseased retinas ( > 0.

Robotic Optical Coherence Tomography Retinal Imaging for Emergency Department Patients: A Pilot Study for Emergency Physicians' Diagnostic Performance.

Study Objective: To evaluate the diagnostic performance of emergency physicians' interpretation of robotically acquired retinal optical coherence tomography images for detecting posterior eye abnormalities in patients seen in the emergency department (ED).

Methods: Adult patients presenting to Duke University Hospital emergency department from November 2020 through October 2021 with acute visual changes, headache, or focal neurologic deficit(s) who received an ophthalmology consultation were enrolled in this pilot study. Emergency physicians provided standard clinical care, including direct ophthalmoscopy, at their discretion.

Global glacier change in the 21st century: Every increase in temperature matters.

Glacier mass loss affects sea level rise, water resources, and natural hazards. We present global glacier projections, excluding the ice sheets, for shared socioeconomic pathways calibrated with data for each glacier. Glaciers are projected to lose 26 ± 6% (+1.

Optical coherence tomography refraction and optical path length correction for image-guided corneal surgery.

Optical coherence tomography (OCT) may be useful for guidance of ocular microsurgeries such as deep anterior lamellar keratoplasty (DALK), a form of corneal transplantation that requires delicate insertion of a needle into the stroma to approximately 90% of the corneal thickness. However, visualization of the true shape of the cornea and the surgical tool during surgery is impaired in raw OCT volumes due to both light refraction at the corneal boundaries, as well as geometrical optical path length distortion due to the group velocity of broadband OCT light in tissue. Therefore, uncorrected B-scans or volumes may not provide an accurate visualization suitable for reliable surgical guidance.

Practice Patterns of Fundoscopic Examination for Diabetic Retinopathy Screening in Primary Care.

Importance: Primary care professionals (PCPs) have a central role in screening for diabetic retinopathy (DR), especially in settings where access to specialty eye care is limited. Data on current DR screening practice patterns in primary care are needed to inform screening strategies.

Objectives: To assess the practice patterns of fundoscopic examination for DR screening in a large primary care network and to evaluate the sensitivity and accuracy of PCP fundoscopy for detecting DR.

Computational 3D microscopy with optical coherence refraction tomography.

Optical coherence tomography (OCT) has seen widespread success as an in vivo clinical diagnostic 3D imaging modality, impacting areas including ophthalmology, cardiology, and gastroenterology. Despite its many advantages, such as high sensitivity, speed, and depth penetration, OCT suffers from several shortcomings that ultimately limit its utility as a 3D microscopy tool, such as its pervasive coherent speckle noise and poor lateral resolution required to maintain millimeter-scale imaging depths. Here, we present 3D optical coherence refraction tomography (OCRT), a computational extension of OCT which synthesizes an incoherent contrast mechanism by combining multiple OCT volumes, acquired across two rotation axes, to form a resolution-enhanced, speckle-reduced, refraction-corrected 3D reconstruction.

Nonlinear distortion correction for posterior eye segment optical coherence tomography with application to tree shrews.

We propose an empirical distortion correction approach for optical coherence tomography (OCT) devices that use a fan-scanning pattern to image the posterior eye segment. Two types of reference markers were used to empirically estimate the distortion correction approach in tree shrew eyes: retinal curvature from MRI images and implanted glass beads of known diameter. Performance was tested by correcting distorted images of the optic nerve head.

Robotically aligned optical coherence tomography with 5 degree of freedom eye tracking for subject motion and gaze compensation.

Optical coherence tomography (OCT) has revolutionized diagnostics in ophthalmology. However, OCT requires a trained operator and patient cooperation to carefully align a scanner with the subject's eye and orient it in such a way that it images a desired region of interest at the retina. With the goal of automating this process of orienting and aligning the scanner, we developed a robot-mounted OCT scanner that automatically aligned with the pupil while matching its optical axis with the target region of interest at the retina.

Ultrawide field, distortion-corrected ocular shape estimation with MHz optical coherence tomography (OCT).

Ocular deformation may be associated with biomechanical alterations in the structures of the eye, especially the cornea and sclera in conditions such as keratoconus, congenital glaucoma, and pathological myopia. Here, we propose a method to estimate ocular shape using an ultra-wide field MHz swept-source optical coherence tomography (SS-OCT) with a Fourier Domain Mode-Locked (FDML) laser and distortion correction of the images. The ocular biometrics for distortion correction was collected by an IOLMaster 700, and localized Gaussian curvature was proposed to quantify the ocular curvature covering a field-of-view up to 65°×62°.

Contactless optical coherence tomography of the eyes of freestanding individuals with a robotic scanner.

Clinical systems for optical coherence tomography (OCT) are used routinely to diagnose and monitor patients with a range of ocular diseases. They are large tabletop instruments operated by trained staff, and require mechanical stabilization of the head of the patient for positioning and motion reduction. Here we report the development and performance of a robot-mounted OCT scanner for the autonomous contactless imaging, at safe distances, of the eyes of freestanding individuals without the need for operator intervention or head stabilization.

Distributed Global Debris Thickness Estimates Reveal Debris Significantly Impacts Glacier Mass Balance.

Supraglacial debris affects glacier mass balance as a thin layer enhances surface melting, while a thick layer reduces it. While many glaciers are debris-covered, global glacier models do not account for debris because its thickness is unknown. We provide the first globally distributed debris thickness estimates using a novel approach combining sub-debris melt and surface temperature inversion methods.

Hot Spots of Glacier Mass Balance Variability in Central Asia.

The Tien Shan and Pamir mountains host over 28,000 glaciers providing essential water resources for increasing water demand in Central Asia. A disequilibrium between glaciers and climate affects meltwater release to Central Asian rivers, challenging the region's water availability. Previous research has neglected temporal variability.

quantitative analysis of anterior chamber white blood cell mixture composition using spectroscopic optical coherence tomography.

Anterior uveitis is the most common form of intraocular inflammation, and one of its main signs is the presence of white blood cells (WBCs) in the anterior chamber (AC). Clinically, the true composition of cells can currently only be obtained using AC paracentesis, an invasive procedure to obtain AC fluid requiring needle insertion into the AC. We previously developed a spectroscopic optical coherence tomography (SOCT) analysis method to differentiate between populations of RBCs and subtypes of WBCs, including granulocytes, lymphocytes and monocytes, both and in ACs of excised porcine eyes.

Accelerated global glacier mass loss in the early twenty-first century.

Glaciers distinct from the Greenland and Antarctic ice sheets are shrinking rapidly, altering regional hydrology, raising global sea level and elevating natural hazards. Yet, owing to the scarcity of constrained mass loss observations, glacier evolution during the satellite era is known only partially, as a geographic and temporal patchwork. Here we reveal the accelerated, albeit contrasting, patterns of glacier mass loss during the early twenty-first century.

Multimodal handheld adaptive optics scanning laser ophthalmoscope.

Non-confocal adaptive optics scanning laser ophthalmoscopy (AOSLO) has enhanced the study of human retinal photoreceptors by providing complementary information to standard confocal AOSLO images. Previously we developed the first confocal handheld AOSLO (HAOSLO) capable of in vivo cone photoreceptor imaging in supine and non-cooperative patients. Here, we introduce the first multimodal (M-)HAOSLO for confocal and non-confocal split-detection (SD) imaging to allow for more comprehensive patient data collection.

QUANTITATIVE TOPOGRAPHIC CURVATURE MAPS OF THE POSTERIOR EYE UTILIZING OPTICAL COHERENCE TOMOGRAPHY.

Purpose: Deformations of the retina such as staphylomas in myopia or scleral flattening in high intracranial pressure can be challenging to quantify with en face imaging. We describe an optical coherence tomography-based method for the generation of quantitative posterior eye topography maps in normal and pathologic eyes.

Methods: Using "whole eye" optical coherence tomography, we corrected for subjects' optical distortions to generate spatially accurate posterior eye optical coherence tomography volumes and created local curvature (KM, mm-1) topography maps for each consented subject.

Author Correction: Global glacier mass changes and their contributions to sea-level rise from 1961 to 2016.

An Amendment to this paper has been published and can be accessed via a link at the top of the paper.