Optic disc haemorrhage audit

Poster section INTRODUCTION. Retrospective Analysis PURPOSE. To evaluate the morphology and location of optic disc haemorrhages (ODH) identified at diabetic retinopathy (DR) screening to establish whether particular ODH are predictive of ocular disease (e.g. glaucoma). METHODS. Retrospective analysis of 77 patients who presented with ODH at DR screening in the Birmingham and Black Country screening programme between June 2009-March 2010. Mean age was 71 years (range 39-89). Cup/disc ratio (CDR), location and morphology of the haemorrhage were recorded. The outcome of the referral and the status of the ODH were followed up a year later. RESULTS. Of the 77 referred, 34 patients were unassessed for possible glaucoma. Of the 43 patients that were assessed in the hospital eye service for glaucoma, 11 (26%) were diagnosed with glaucoma. These glaucoma patients mostly presented with flame haemorrhages (64%) and blot haemorrhages (36%). Haemorrhages tended to adjoin the margin of the OD (64%), and were more commonly flame shaped (64%). They less commonly occurred in the optic disc itself (36%), and were all blot shaped. The OD Cup/disc ratio (CDR) of the patients with glaucoma (n=11) ranged from 0.33-0.57. It is interesting to note the highest CDR was 0.68 in the 77 patients referred. 32 patients were confirmed as not having glaucoma. 24 (75%) of these patients presented with an ODH adjoining the margin, of which 20 (83%) were flame, and 4 blot (17%) shaped. Only 8 (25%) presented with an ODH in the OD, of which 6 (75%) were blot shaped. One year follow up of the 77 referred cases revealed that the ODH resolved in 45 (57%) patients while 10 (13%) still had an ODH present. 15 (21%) were still under ophthalmology hence digital retinal photos were not available for assessment. Six patients (8%) (age range 71-91 years) died within the year, and one lost to follow up. CONCLUSIONS. The results suggest that a significant number of patients with ODH have glaucoma and that the differing morphology of the haemorrhage is not a major predictor i.e. blot versus flame shaped, adjoining or in the optic disc. The cup/disc ratio did not predict glaucoma either.

The significance of microaneurysms and haemorrhages within one optic disc diameter of the fovea

Free paper session INTRODUCTION. Microaneurysms and haemorrhages within the macula area are a poor predictor of macular oedema as shown by optical coherence tomography (OCT). Our research suggests that it is safe and cost effective to screen patients who present with these surrogate markers annually. PURPOSE. To determine whether microaneurysms (ma) and haemorrhages (hm) within one optic disc diameter of the fovea (ma/hm<1DD) are significant predictors of macular oedema. METHODS. Data were collected over a one-year period from patients attending digital diabetic retinopathy screening. Patients who presented with ma/hm<1DD also had an OCT scan. The fast macula scan on the Stratus OCT was used and an ophthalmologist reviewed the scans to determine whether macular oedema was present. Macular oedema was identified by thickening on the OCT cross-sections. Patients were split into two groups. Group one (325 eyes) included those with best VA?6/9 and group two (30 eyes) with best VA =6/12. Only patients who had no other referable features of diabetic retinopathy were selected. RESULTS. In group one, 6 (1.8%) out of 325 eyes showed thickening on the OCT and were referred to hospital eye service (HES) for further investigation. In group two, 6 (20%) out of 30 eyes showed thickening and were referred to HES. CONCLUSIONS. Ma/hm<1DD become more significant predictors of macular oedema when VA is reduced. Results confirm the grading criteria concerning microaneurysms predicting macular oedema for referable maculopathy in the English national screening programme. OCT is a useful method to accurately identify patients requiring referral to HES.

New developments in the study of optical parabolic pulses in normally dispersive fibers

We report two recent studies dealing with the evolution of parabolic pulses in normally dispersive fibres. On the one hand, the nonlinear reshaping from a Gaussian intensity profile towards the asymptotic parabolic shape is experimentally investigated in a Raman amplifier. On the other hand, the significant impact of the fourth order dispersion on a passive propagation is theoretically discussed: we numerically demonstrate flat-top, coherent supercontinuum generation in an all-normal dispersion-flattened photonic crystal fiber. This shape is associated to a strong reshaping of the temporal profile what becomes triangular.

Dissipative nonlinear structures in optical fiber systems II : self-similar parabolic pulses in active fibers

In this second talk on dissipative structures in fiber applications, we overview theoretical aspects of the generation, evolution and characterization of self-similar parabolic-shaped pulses in fiber amplifier media. In particular, we present a perturbation analysis that describes the structural changes induced by third-order fiber dispersion on the parabolic pulse solution of the nonlinear Schrödinger equation with gain. Promising applications of parabolic pulses in optical signal post-processing and regeneration in communication systems are also discussed.

A quantitative analysis of optic nerve axons in elderly control subjects and patients with Alzheimer's disease

Objective: To study the density and cross-sectional area of axons in the optic nerve in elderly control subjects and in cases of Alzheimer's disease (AD) using an image analysis system. Methods: Sections of optic nerves from control and AD patients were stained with toluidine blue to reveal axon profiles. Results: The density of axons was reduced in both the center and peripheral portions of the optic nerve in AD compared with control patients. Analysis of axons with different cross-sectional areas suggested a specific loss of the smaller sized axons in AD, i.e., those with areas less that 1.99 μm2. An analysis of axons >11 μm2 in cross-sectional area suggested no specific loss of the larger axons in this group of patients. Conclusions: The data suggest that image analysis provides an accurate and reproducible method of quantifying axons in the optic nerve. In addition, the data suggest that axons are lost throughout the optic nerve with a specific loss of the smaller-sized axons. Loss of the smaller axons may explain the deficits in color vision observed in a significant proportion of patients with AD.

Band-limited airy pulses for invariant propagation in single mode fibers

By spectral analysis, and using joint time-frequency representations, we present the theoretical basis to design invariant band-limited Airy pulses with an arbitrary degree of robustness, and an arbitrary range of single mode fiber chromatic dispersion. The numerically simulated examples confirm the theoretically predicted pulse partial invariance in the propagation of the pulse in the fiber.

Respiratory function monitoring using a real-time three-dimensional fiber-optic shaping sensing scheme based upon fiber Bragg gratings

An array of in-line curvature sensors on a garment is used to monitor the thoracic and abdominal movements of a human during respiration. The results are used to obtain volumetric changes of the human torso in agreement with a spirometer used simultaneously at the mouth. The array of 40 in-line fiber Bragg gratings is used to produce 20 curvature sensors at different locations, each sensor consisting of two fiber Bragg gratings. The 20 curvature sensors and adjoining fiber are encapsulated into a low-temperature-cured synthetic silicone. The sensors are wavelength interrogated by a commercially available system from Moog Insensys, and the wavelength changes are calibrated to recover curvature. A three-dimensional algorithm is used to generate shape changes during respiration that allow the measurement of absolute volume changes at various sections of the torso. It is shown that the sensing scheme yields a volumetric error of 6%. Comparing the volume data obtained from the spirometer with the volume estimated with the synchronous data from the shape-sensing array yielded a correlation value 0.86 with a Pearson's correlation coefficient p <0.01.

On the theory of autosoliton propagation in optical fibers guided by in-line nonlinear devices

A theoretical model is developed to describe the propagation of ultra-short optical pulses in fiber transmission systems in the quasi-linear regime, with periodically inserted in-line lumped nonlinear optical devices. Stable autosoliton solutions are obtained for a particular application of the general theory.

Dispersion-dominated nonlinear fiber-optic channel

We propose to apply a large predispersion (having the same sign as the transmission fiber) to an optical signal before the uncompensated fiber transmission in coherent communication systems. This technique is aimed at simplifica- tion of the following digital signal processing of nonlinear impairments. We derive a model describing pulse propagation in the dispersion-dominated nonlinear fiber channel. In the limit of very strong initial predispersion, the nonlinear propagation equations for each Fourier mode become local and decoupled. This paves the way for new techniques to manage fiber nonlinearity.

Acousto-optic modulation in a microstructured plastic optical fibre Bragg grating

The present work addresses the control of the mPOF Bragg grating spectrum properties through acousto-optic modulation. For the first time, the interaction of a flexural acoustic wave, generated by longitudinal excitation of different frequencies, with the Bragg grating will be presented. Also it will be demonstrated the quasi linear relationship between PZT load and maximum reflected power/ 3dB bandwidth of the reflected spectrum.

Two-section fiber optic Raman polarizer

We report on a theoretical study of polarization impairments in periodically spun fiber Raman amplifiers. Based on the Stochastic Generator approach we have derived averaged equations to calculate polarization dependent gain and mean-square gain fluctuations. We show that periodically spun fiber can work as a Raman polarizer but it suffers from increased polarization dependent gain and gain fluctuations. Unlike this, application of a depolarizer can result in suppression of polarization dependent gain and gain fluctuations. We demonstrate that it is possible to design a new fiber Raman polarizer by combining a short fiber without spin and properly chosen parameters and a long periodically spun fiber. This polarizer provides almost the same polarization pulling for all input signal states of polarization and so has very small polarization dependent gain.

Acousto-optic effect in microstructured polymer fiber bragg gratings : simulation and experimental overview

A fine control of the microstructured polymer fiber Bragg grating spectrum properties, such as maximum reflected power and 3-dB bandwidth, through acousto-optic modulation is presented. For simulation purposes, the device is modelled as a single structure, comprising a silica horn and a fiber Bragg grating. For similar sized structures a good correlation between the numerical results and the experimental data is obtained, allowing the strain field to be completely characterized along the whole structure. It is also shown that the microstructured polymer fiber Bragg grating requires less effort from the piezoelectric actuator to produce modification in the grating spectrum when compared with a silica fiber Bragg grating. This technique has potential to be applied on tunable optical filters and tunable cavities for photonic applications.

Elevated left and reduced right orbitomedial prefrontal fractional anisotropy in adults with bipolar disorder revealed by tract-based spatial statistics

Context - Diffusion tensor imaging (DTI) studies in adults with bipolar disorder (BD) indicate altered white matter (WM) in the orbitomedial prefrontal cortex (OMPFC), potentially underlying abnormal prefrontal corticolimbic connectivity and mood dysregulation in BD. Objective - To use tract-based spatial statistics (TBSS) to examine WM skeleton (ie, the most compact whole-brain WM) in subjects with BD vs healthy control subjects. Design - Cross-sectional, case-control, whole-brain DTI using TBSS. Setting - University research institute. Participants - Fifty-six individuals, 31 having a DSM-IV diagnosis of BD type I (mean age, 35.9 years [age range, 24-52 years]) and 25 controls (mean age, 29.5 years [age range, 19-52 years]). Main Outcome Measures - Fractional anisotropy (FA) longitudinal and radial diffusivities in subjects with BD vs controls (covarying for age) and their relationships with clinical and demographic variables. Results - Subjects with BD vs controls had significantly greater FA (t > 3.0, P = .05 corrected) in the left uncinate fasciculus (reduced radial diffusivity distally and increased longitudinal diffusivity centrally), left optic radiation (increased longitudinal diffusivity), and right anterothalamic radiation (no significant diffusivity change). Subjects with BD vs controls had significantly reduced FA (t > 3.0, P = .05 corrected) in the right uncinate fasciculus (greater radial diffusivity). Among subjects with BD, significant negative correlations (P < .01) were found between age and FA in bilateral uncinate fasciculi and in the right anterothalamic radiation, as well as between medication load and FA in the left optic radiation. Decreased FA (P < .01) was observed in the left optic radiation and in the right anterothalamic radiation among subjects with BD taking vs those not taking mood stabilizers, as well as in the left optic radiation among depressed vs remitted subjects with BD. Subjects having BD with vs without lifetime alcohol or other drug abuse had significantly decreased FA in the left uncinate fasciculus. Conclusions - To our knowledge, this is the first study to use TBSS to examine WM in subjects with BD. Subjects with BD vs controls showed greater WM FA in the left OMPFC that diminished with age and with alcohol or other drug abuse, as well as reduced WM FA in the right OMPFC. Mood stabilizers and depressed episode reduced WM FA in left-sided sensory visual processing regions among subjects with BD. Abnormal right vs left asymmetry in FA in OMPFC WM among subjects with BD, likely reflecting increased proportions of left-sided longitudinally aligned and right-sided obliquely aligned myelinated fibers, may represent a biologic mechanism for mood dysregulation in BD.