Real-time ultra-high optical coherence tomography monitoring of optical tissue effects caused by selective retina therapy

Purpose: Selective retina therapy (SRT) has shown great promise compared to conventional retinal laser photocoagulation as it avoids collateral damage and selectively targets the retinal pigment epithelium (RPE). Its use, however, is challenging in terms of therapy monitoring and dosage because an immediate tissue reaction is not biomicroscopically discernibel. To overcome these limitations, real-time optical coherence tomography (OCT) might be useful to monitor retinal tissue during laser application. We have thus evaluated a proprietary OCT system for its capability of mapping optical changes introduced by SRT in retinal tissue. Methods: Freshly enucleated porcine eyes, covered in DMEM upon collection were utilized and a total of 175 scans from ex-vivo porcine eyes were analyzed. The porcine eyes were used as an ex-vivo model and results compared to two time-resolved OCT scans, recorded from a patient undergoing SRT treatment (SRT Vario, Medical Laser Center Lübeck). In addition to OCT, fluorescin angiography and fundus photography were performed on the patient and OCT scans were subsequently investigated for optical tissue changes linked to laser application. Results: Biomicroscopically invisible SRT lesions were detectable in OCT by changes in the RPE / Bruch's complex both in vivo and the porcine ex-vivo model. Laser application produced clearly visible optical effects such as hyperreflectivity and tissue distortion in the treated retina. Tissue effects were even discernible in time-resolved OCT imaging when no hyper-reflectivity persisted after treatment. Data from ex-vivo porcine eyes showed similar to identical optical changes while effects visible in OCT appeared to correlate with applied pulse energy, leading to an additional reflective layer when lesions became visible in indirect ophthalmoscopy. Conclusions: Our results support the hypothesis that real-time high-resolution OCT may be a promising modality to obtain additional information about the extent of tissue damage caused by SRT treatment. Data shows that our exvivo porcine model adequately reproduces the effects occurring in-vivo, and thus can be used to further investigate this promising imaging technique.

Time-Resolved Ultra–High Resolution Optical Coherence Tomography for Real-Time Monitoring of Selective Retina Therapy

Purpose: Selective retina therapy (SRT) is a novel treatment for retinal pathologies, solely targeting the retinal pigment epithelium (RPE). During SRT, the detection of an immediate tissue reaction is challenging as tissue effects remain limited to intracellular RPE photodisruption. Time-resolved ultra-high axial resolution optical coherence tomography (OCT) is thus evaluated for the monitoring of dynamic optical changes at and around the RPE during SRT. Methods: An experimental OCT system with an ultra-high axial resolution of 1.78 µm was combined with an SRT system and time-resolved OCT M-scans of the target area were recorded from four patients undergoing SRT. OCT scans were analyzed and OCT morphology was correlated with findings in fluorescein angiography, fundus photography and cross-sectional OCT. Results: In cases where the irradiation caused RPE damage proven by fluorescein angiography, the lesions were well discernible in time-resolved OCT images but remained invisible in fundus photography and cross-sectional OCT acquired after treatment. If RPE damage was introduced, all applied SRT pulses led to detectable signal changes in the time-resolved OCT images. The extent of optical signal variation seen in the OCT data appeared to scale with the applied SRT pulse energy. Conclusion: The first clinical results proved that successful SRT irradiation induces detectable changes in the OCT M-scan signal while it remains invisible in conventional ophthalmoscopic imaging. Thus, real-time high-resolution OCT is a promising modality to monitor and analyze tissue effects introduced by selective retina therapy and may be used to guide SRT in an automatic feedback mode.

Automatic assessment of time-resolved OCT images for selective retina therapy

Purpose In recent years, selective retina laser treatment (SRT), a sub-threshold therapy method, avoids widespread damage to all retinal layers by targeting only a few. While these methods facilitate faster healing, their lack of visual feedback during treatment represents a considerable shortcoming as induced lesions remain invisible with conventional imaging and make clinical use challenging. To overcome this, we present a new strategy to provide location-specific and contact-free automatic feedback of SRT laser applications. Methods We leverage time-resolved optical coherence tomography (OCT) to provide informative feedback to clinicians on outcomes of location-specific treatment. By coupling an OCT system to SRT treatment laser, we visualize structural changes in the retinal layers as they occur via time-resolved depth images. We then propose a novel strategy for automatic assessment of such time-resolved OCT images. To achieve this, we introduce novel image features for this task that when combined with standard machine learning classifiers yield excellent treatment outcome classification capabilities. Results Our approach was evaluated on both ex vivo porcine eyes and human patients in a clinical setting, yielding performances above 95 % accuracy for predicting patient treatment outcomes. In addition, we show that accurate outcomes for human patients can be estimated even when our method is trained using only ex vivo porcine data. Conclusion The proposed technique presents a much needed strategy toward noninvasive, safe, reliable, and repeatable SRT applications. These results are encouraging for the broader use of new treatment options for neovascularization-based retinal pathologies.

Multiple retinal detachment surgery: A functional outcome study. The Houston Vision Assessment Test-Retina (HVAT-Retina)

Retinal detachment is a common ophthalmologic procedure, and outcome is typically measured by a single factor-improvement in visual acuity. Health related functional outcome testing, which quantifies patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. ^ A functional outcome test (the Houston Vision Assessment Test-Retina; HVAT-Retina) was developed and validated in patients with multiple retinal detachments in the same eye. The HVAT-Retina divides an estimated total impairment into subcomponents: contribution of visual disability (potentially correctable by retinal detachment surgery) and nonvisual physical disabilities (co-morbidities not affected by retinal detachment surgery. ^ Seventy-six patients participated in this prospective multicenter study. Seven patients were excluded from the analysis because they were not certain of their answers. Cronbach's alpha coefficient was 0.91 for presurgery HVAT-Retina and 0.94 post-surgery. The item-to-total correlation ranged from 0.50 to 0.88. Visual impairment score improved by 9 points from pre-surgery (p = 0.0003). Physical impairment score also improved from pre-surgery (p = 0.0002). ^ In conclusion, the results of this study demonstrate that the instrument is reliable and valid in patients presenting with recurrent retinal detachments. The HVAT-Retina is a simple instrument and does not burden the patient or the health professional in terms of time or cost. It may be self-administrated, not requiring an interviewer. Because the HVAT-Retina was designed to demonstrate outcomes perceivable by the patient, it has the potential to guide the decision making process between patient and physician. ^

Confocal analysis of synaptic connectivity of the rod pathway in the rabbit retina

The retina is a specialized neuronal structure that transforms the optical image into electrical signals which are transmitted to the brain via the optic nerve. As part of the strategy to cover a stimulus range as broad as 10 log units, from dim starlight to bright sunlight, retinal circuits are broadly divided into rod and cone pathways, responsible for dark and light-adapted vision, respectively. ^ In this dissertation, confocal microscopy and immunocytochemical methods were combined to study the synaptic connectivity of the rod pathway from the level of individual synapses to whole populations of neurons. The study was focused on synaptic interactions at the rod bipolar terminal. The purpose is to understand the synaptic structure of the dyad synapse made by rod bipolar terminals, including the synaptic components and connections, and their physiological functions in the rod pathway. In addition, some additional components and connections of the rod pathway were also studied in these experiments. The major results can be summarized as following: At the dyad synapse of rod bipolar terminals, three postsynaptic components—processes of All amacrine cells and the varicosities of S1 or S2 amacrine cells express different glutamate receptor subunits, which may underlie the functional diversity of these postsynaptic neurons. A reciprocal feedback system is formed by rod bipolar terminals and S1/S2 amacrine cells. Analysis showed these two wide-field GABA amacrine cells have stereotyped synaptic connections with the appropriate morphology and distribution to perform specific functions. In addition, S1 and S2 cells have different coupling patterns and, in general, there is no coupling between the two types. Besides the classic rod pathway though rod bipolar cells and All amacrine cells, the finding of direct connections between certain types of OFF cone bipolar cells and rods indicates the presence of an alternative rod pathway in the rabbit retina. ^ In summary, this dissertation presents a detailed view of the connection and receptors at rod bipolar terminals. Based on the morphology, distribution and coupling, different functional roles were identified for S1 and S2 amacrine cells. Finally, an alternative to the classic rod pathway was found in the rabbit retina. ^

Ontogenetic Effects of Hatching Plasticity in the Spotted Salamander (Ambystoma maculatum) due to Egg and Larval Predators

The ability to respond plastically to the environment has allowed amphibians to evolve a response to spatial and temporal variation in predation threat (Benard 2004). Embroys exposed to egg predation are expected to hatch out earlier than their conspecifics. Larval predation can induce a suite of phenotypic changes including growing a larger tail area. When presented with cues from both egg and larval predators, embryos are expected to respond to the egg predator by hatching out earlier because the egg predator presents an immediate threat. However, hatching early may be costly in the larval environment in terms of development, morphology, and/or behavior. We created a laboratory experiment in which we exposed clutches of spotted salamander (Ambystoma maculatum) eggs to both egg (caddisfly larvae) and larval (A. opacum) predators to test this hypothesis. We recorded hatching time and stage and took developmental and morphological data of the animals a week after hatching. Larvae were entered into lethal predation trials with a larval predatory sunfish (Lepomis sp.) in order to study behavior. We found that animals exposed to the egg predator cues hatched out earlier and at earlier developmental stages than conspecifics regardless of whether there was a larval predator present. Animals exposed to larval predator cues grew relatively larger tails and survived longer in the lethal predation trials. However the group exposed to both predators showed a cost of early hatching in terms of lower tail area and shorter survival time in predation trials. The morphological and developmental effects measured of hatching plasticity were transient as there were no developmental or morphological differences between the treatment groups at metamorphosis. Hatching plasticity may be transient but it is important to the development and survival of many amphibians.

Diversity of neuronal connexins in the mammalian retina

Many neurons in the mammalian retina are electrically coupled by intercellular channels or gap junctions, which are assembled from a family of proteins called connexins. Numerous studies indicate that gap junctions differ in properties such as conductance and tracer permeability. For example, A-type horizontal cell gap junctions are permeable to Lucifer Yellow, but B-type horizontal cell gap junctions are not. This suggests the two cell types express different connexins. My hypothesis is that multiple neuronal connexins are expressed in the mammalian retina in a cell type specific manner. Immunohistochemical techniques and confocal microscopy were used to localize certain connexins within well-defined neuronal circuits. The results of this study can be summarized as follows: AII amacrine cells, which receive direct input from rod bipolar cells, are well-coupled to neighboring AIIs. In addition, AII amacrine cells also form gap junctions with ON cone bipolar cells. This is a complex heterocellular network. In both rabbit and primate retina, connexin36 occurs at dendritic crossings in the AII matrix as well as between AIIs and ON cone bipolar cells. Coupling in the AII network is thought to reduce noise in the rod pathway while AII/bipolar gap junctions are required for the transmission of rod signals to ON ganglion cells. In the outer plexiform layer, connexin36 forms gap junctions between cones and between rods and cones via cone telodendria. Cone to cone coupling is thought to reduce noise and is partly color selective. Rod to cone coupling forms an alternative rod pathway thought to operate at intermediate light intensity. A-type horizontal cells in the rabbit retina are strongly coupled via massive low resistance gap junctions composed from Cx50. Coupling dramatically extends the receptive field of horizontal cells and the modulation of coupling is thought to change the strength of the feedback signal from horizontal cells to cones. Finally, there are other coupled networks, such as B-type horizontal cells and S1/S2 amacrine cells, which do not use either connexin36 or Cx50. These results confirm the hypothesis that multiple neuronal connexins are expressed in the mammalian retina and these connexins are localized to particular retinal circuits. ^

Desarrollo de una Interfaz de sustitución sensorial para el estudio de la percepción del flujo vibrotáctil (retina táctil)

En el presente trabajo fin de máster se ha concebido, diseñado e utilizado una interfaz háptica, adecuada para ser utilizada como dispositivo de sustitución sensorial, la cual hemos llamado retina táctil. Por cuanto trata de proporcionar información propia del sentido de la vista a través del sentido del tacto. Durante este trabajo, que fue desarrollado en el grupo de robótica y cibernética CAR UPM-CSIC, se ha trabajado en estrecha colaboración con el departamento de la facultad de psicología de la universidad autónoma de Madrid, los cuales han definido las bases de la información de alto orden, como podrían ser, gradientes de intensidades de vibración, mediante las cuales el individuo llega a tener una mejor comprensión del ambiente. El proyecto maneja teorías psicológicas recientes, como las teorías ecológicas y dinámicas que entienden que la percepción se basa en variables informacionales de alto orden. Ejemplos de tales variables son el flujo óptico, gradientes de movimiento, gradientes de intensidades, cambios en gradientes, etc. Sorprendentemente, nuestra percepción visual es mucho más sensible a variables de alto orden que a variables de bajo orden, lo cual descarta que variables de alto orden se infieran o calculen en base a variables de bajo orden. La hipótesis que maneja la teoría ecológica es que las variables de alto orden se detectan como unidades básicas, sin descomponerlas en variables de bajo orden. Imaginemos el caso de un objeto acercándose, intuitivamente pensaríamos que calculamos la distancia y la velocidad del objeto para determinar el momento en el cual este nos impactaría, ¿pero es este realmente el modo en el que actúa nuestro cerebro?, ¿no seremos capaces en determinar directamente el tiempo de contacto como una variable de alto orden presente en el entorno?, por ejemplo, determinar directamente la relación entre el tamaño del objeto y la tasa de crecimiento. También cabe preguntarse si todas estas suposiciones son válidas para estimulaciónes a través de los receptores táctiles en la piel. El dispositivo desarrollado está conformado por 13 módulos cada uno de los cuales maneja 6 tactores o vibradores, para hacer un total de 78 vibradores (ampliables al agregar módulos adicionales), cada uno de los tactores tiene 8mm de diámetro y proporciona información del flujo óptico asociado al entorno que rodea al usuario a través de información táctil, él mismo puede ser utilizado inalámbricamente a pesar de que el procesamiento de los datos se este realizando en una computadora de mesa, lo cual es muy útil al trabajar con ambientes virtuales. También se presenta la integración de la interfaz con el sistema operativo de robots ROS para usarlo en conjunto con las librerías que han sido desarrolladas para el control de la cámara Microsoft Kinect con la cual se puede obtener una matriz de distancias de puntos en el espacio, permitiendo de esta manera utilizar la interfaz en ambientes reales. Finalmente se realizaron experimentos para comprobar hipótesis sobre la variable de percepción del tiempo de contacto además de verificar el correcto funcionamiento del dispositivo de sustitución sensorial tanto en ambientes reales como en ambientes simulados así como comprobar hipótesis sobre la validéz del uso del flujo vibrotáctil para la determinación del tiempo de contacto.

A new approach to a model of the mammalian retina with optically programmable logic cells

This paper reports a model of the mammalian retina as well as an interpretation of some functions of the visual cortex. Its main objective is to simulate some of the behaviors observed at the different retina cells depending on the characteristics of the light impinging onto the photoreceptors. This simulation is carried out with a simple structure employed previously as basic building block of some optical computer architectures. Its possibility to perform any type of Boolean function allows a wide range of behaviors.

A model of the mammalian retina and the visual cortex. Disorders of vision

A model of the mammalian retina and the behavior of the first layers in the visual cortex is reported. The building blocks are optically programmable logic cells. A model of the retina, similar to the one reported by Dowling (1987) is presented. From the model of the visual cortex obtained, some types of symmetries and asymmetries are possible to be detected

Image processing based on a model of the mammalian retina

A first study in order to construct a simple model of the mammalian retina is reported. The basic elements for this model are Optical Programmable Logic Cells, OPLCs, previously employed as a functional element for Optical Computing. The same type of circuit simulates the five types of neurons present in the retina. Different responses are obtained by modifying either internal or external connections. Two types of behaviors are reported: symmetrical and non-symmetrical with respect to light position. Some other higher functions, as the possibility to differentiate between symmetric and non-symmetric light images, are performed by another simulation of the first layers of the visual cortex. The possibility to apply these models to image processing is reported.

Unattended motion detection system based on the mammalian retina

Sensing systems in living bodies offer a large variety of possible different configurations and philosophies able to be emulated in artificial sensing systems. Motion detection is one of the areas where different animals adopt different solutions and, in most of the cases, these solutions reflect a very sophisticated form. One of them, the mammalian visual system, presents several advantages with respect to the artificial ones. The main objective of this paper is to present a system, based on this biological structure, able to detect motion, its sense and its characteristics. The configuration adopted responds to the internal structure of the mammalian retina, where just five types of cells arranged in five layers are able to differentiate a large number of characteristics of the image impinging onto it. Its main advantage is that the detection of these properties is based purely on its hardware. A simple unit, based in a previous optical logic cell employed in optical computing, is the basis for emulating the different behaviors of the biological neurons. No software is present and, in this way, no possible interference from outside affects to the final behavior. This type of structure is able to work, once the internal configuration is implemented, without any further attention. Different possibilities are present in the architecture to be presented: detection of motion, of its direction and intensity. Moreover, some other characteristics, as symmetry may be obtained.

Functions of the two glutamate transporters GLAST and GLT-1 in the retina

In the retina, the glutamate transporter GLAST is expressed in Müller cells, whereas the glutamate transporter GLT-1 is found only in cones and various types of bipolar cells. To investigate the functional role of this differential distribution of glutamate transporters, we have analyzed GLAST and GLT-1 mutant mice. In GLAST-deficient mice, the electroretinogram b-wave and oscillatory potentials are reduced and retinal damage after ischemia is exacerbated, whereas GLT-1-deficient mice show almost normal electroretinograms and mild increased retinal damage after ischemia. These results demonstrate that GLAST is required for normal signal transmission between photoreceptors and bipolar cells and that both GLAST and GLT-1 play a neuroprotective role during ischemia in the retina.