Retinal layer thicknesses retrieved with different segmentation algorithms from optical coherence tomography scans acquired under different signal-to-noise ratio conditions

Glaucomatous damage can be quantified by measuring the thickness of different retinal layers. However, poor image quality may hamper the accuracy of the layer thickness measurement. We determined the effect of poor image quality (low signal-to-noise ratio) on the different layer thicknesses and compared different segmentation algorithms regarding their robustness against this degrading effect. For this purpose, we performed OCT measurements in the macular area of healthy subjects and degraded the image quality by employing neutral density filters. We also analysed OCT scans from glaucoma patients with different disease severity. The algorithms used were: The Canon HS-100's built-in algorithm, DOCTRAP, IOWA, and FWHM, an approach we developed. We showed that the four algorithms used were all susceptible to noise at a varying degree, depending on the retinal layer assessed, and the results between different algorithms were not interchangeable. The algorithms also differed in their ability to differentiate between young healthy eyes and older glaucoma eyes and failed to accurately separate different glaucoma stages from each other. (c) 2020 Optical Society of America under the terms of the OSA Open Access Publishing Agreemen

Influence of coherence length, signal-to-noise ratio, log transform, and low-pass filtering on layer thickness assessment with OCT in the retina

Optical coherence tomography (OCT) images of the retina are inevitably affected by the finite width of the coherence function and noise. To make low-reflective layers visible, the raw OCT signal is log transformed; to reduce the effect of noise the images can be low-pass filtered. We determined the effects of these operations on layer thickness assessment, as a function of signal-to-noise ratio (SNR), by performing measurements in a phantom eye and modeling. The log transform appeared to be the key factor in a SNR-dependent overestimation of peak widths and a less predictive bias in the widths of low-reflective layers. (C) 2016 Optical Society of Americ

Imaging retinal nerve fiber bundles using optical coherence tomography with adaptive optics

AbstractEarly detection of axonal tissue loss in retinal nerve fiber layer (RNFL) is critical for effective treatment and management of diseases such as glaucoma. This study aims to evaluate the capability of ultrahigh-resolution optical coherence tomography with adaptive optics (UHR-AO-OCT) for imaging the RNFL axonal bundles (RNFBs) with 3×3×3μm3 resolution in the eye. We used a research-grade UHR-AO-OCT system to acquire 3°×3° volumes in four normal subjects and one subject with an arcuate retinal nerve fiber layer defect (n=5; 29–62years). Cross section (B-scans) and en face (C-scan) slices extracted from the volumes were used to assess visibility and size distribution of individual RNFBs. In one subject, we reimaged the same RNFBs twice over a 7month interval and compared bundle width and thickness between the two imaging sessions. Lastly we compared images of an arcuate RNFL defect acquired with UHR-AO-OCT and commercial OCT (Heidelberg Spectralis). Individual RNFBs were distinguishable in all subjects at 3° retinal eccentricity in both cross-sectional and en face views (width: 30–50μm, thickness: 10–15μm). At 6° retinal eccentricity, RNFBs were distinguishable in three of the five subjects in both views (width: 30–45μm, thickness: 20–40μm). Width and thickness RNFB measurements taken 7months apart were strongly correlated (p<0.0005). Mean difference and standard deviation of the differences between the two measurement sessions were −0.1±4.0μm (width) and 0.3±1.5μm (thickness). UHR-AO-OCT outperformed commercial OCT in terms of clarity of the microscopic retina. To our knowledge, these are the first measurements of RNFB cross section reported in the living human eye

Ultrahigh speed 1050nm swept source / Fourier domain OCT retinal and anterior segment imaging at 100,000 to 400,000 axial scans per second

We demonstrate ultrahigh speed swept source/Fourier domain ophthalmic OCT imaging using a short cavity swept laser at 100,000 – 400,000 axial scan rates. Several design configurations illustrate tradeoffs in imaging speed, sensitivity, axial resolution, and imaging depth. Variable rate A/D optical clocking is used to acquire linear-in-k OCT fringe data at 100kHz axial scan rate with 5.3um axial resolution in tissue. Fixed rate sampling at 1 GSPS achieves a 7.5mm imaging range in tissue with 6.0um axial resolution at 100kHz axial scan rate. A 200kHz axial scan rate with 5.3um axial resolution over 4mm imaging range is achieved by buffering the laser sweep. Dual spot OCT using two parallel interferometers achieves 400kHz axial scan rate, almost 2X faster than previous 1050nm ophthalmic results and 20X faster than current commercial instruments. Superior sensitivity roll-off performance is shown. Imaging is demonstrated in the human retina and anterior segment. Wide field 12×12mm data sets include the macula and optic nerve head. Small area, high density imaging shows individual cone photoreceptors. The 7.5mm imaging range configuration can show the cornea, iris, and anterior lens in a single image. These improvements in imaging speed and depth range provide important advantages for ophthalmic imaging. The ability to rapidly acquire 3D-OCT data over a wide field of view promises to simplify examination protocols. The ability to image fine structures can provide detailed information on focal pathologies. The large imaging range and improved image penetration at 1050nm wavelengths promises to improve performance for instrumentation which images both the retina and anterior eye. These advantages suggest that swept source OCT at 1050nm wavelengths will play an important role in future ophthalmic instrumentation.National Institutes of Health (U.S.) (5R01-EY011289-23)National Institutes of Health (U.S.) (5R01-EY013178-10)National Institutes of Health (U.S.) (2R01-EY013516-07)National Institutes of Health (U.S.) (1R01-EY019029-02)United States. Air Force Office of Scientific Research (Contract Number FA9550-07-1-0014)United States. Dept. of Defense. Medical Free Electron Laser Program (Contract Number FA9550-07-1-0101

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy.

Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques

Aspects of Inquiry Applied in Japan and Australia

The author reflects on his experience as a participant in the Professional Development Program (PDP) in 2005 and 2006 and how he has implemented elements of inquiry learning in his curricu-lum. He taught courses in Japan and Australia and touches on his perception of how the students in his units learned, and what the effects of (learning) culture are on inquiry learning. Through his experiences, the author found that in the first stages of a learning process, inquiry learning can help to engage and motivate students. In the end stage of learning, inquiry learning can help stu-dents to demonstrate their ability to think and work independently. One should carefully consider the learning background of students before implementing aspects of inquiry learning, as it can be affected by the culture in which they grew up

Aspects of Inquiry Applied in Japan and Australia

The author reflects on his experience as a participant in the Professional Development Program (PDP) in 2005 and 2006 and how he has implemented elements of inquiry learning in his curricu-lum. He taught courses in Japan and Australia and touches on his perception of how the students in his units learned, and what the effects of (learning) culture are on inquiry learning. Through his experiences, the author found that in the first stages of a learning process, inquiry learning can help to engage and motivate students. In the end stage of learning, inquiry learning can help stu-dents to demonstrate their ability to think and work independently. One should carefully consider the learning background of students before implementing aspects of inquiry learning, as it can be affected by the culture in which they grew up