Modern technologies for retinal scanning and imaging: an introduction for the biomedical engineer

Boris I Gramatikov, Boris I Gramatikov

Abstract

This review article is meant to help biomedical engineers and nonphysical scientists better understand the principles of, and the main trends in modern scanning and imaging modalities used in ophthalmology. It is intended to ease the communication between physicists, medical doctors and engineers, and hopefully encourage "classical" biomedical engineers to generate new ideas and to initiate projects in an area which has traditionally been dominated by optical physics. Most of the methods involved are applicable to other areas of biomedical optics and optoelectronics, such as microscopic imaging, spectroscopy, spectral imaging, opto-acoustic tomography, fluorescence imaging etc., all of which are with potential biomedical application. Although all described methods are novel and important, the emphasis of this review has been placed on three technologies introduced in the 1990's and still undergoing vigorous development: Confocal Scanning Laser Ophthalmoscopy, Optical Coherence Tomography, and polarization-sensitive retinal scanning.

Figures

Figure 1
Figure 1
The human eye. The object being observed is projected onto the macula, the central part of which is the fovea, the spot of the sharpest vision.
Figure 2
Figure 2
Fundus images taken with the FF450 Fundus Camera from Carl Zeiss Meditec, Inc. Left: color image; Middle: fluorescein angiography image; Right: zoom in the macular region. Courtesy of Carl Zeiss Meditec, Inc.
Figure 3
Figure 3
The principle of confocal microscopy. Only light reflected by structures very close to the focal plane can be detected.
Figure 4
Figure 4
A generalized diagram of a multispectral confocal scanning laser ophthalmoscope (cSLO).
Figure 5
Figure 5
Three-dimensional view of the retina reconstructed with the Heidelberg Retinal Tomograph (HRT). Left: 3-D view of optic nerve drusen. Right: 3-D image from a person with advanced glaucoma. Note the depth of the cup, steepness of the walls, and reduced rim tissue. Courtesy of Heidelberg Engineering.
Figure 6
Figure 6
A simplified general diagram of a scanning laser polarimeter (SLP), consisting of a scanning laser ophthalmoscope (SLO), a polarization-state generator (PSG) and a polarization-state detector (PSD). The SLP sends a laser beam to the posterior retina and assesses the change in polarization of the reflected beam. This birefringence in the case of the RNFL is caused by neurotubules within the ganglion cell axons.
Figure 7
Figure 7
Images generated by the GDx VCC. Left: the reflectance image, displayed as a color map; Right: the retardation map converted to color-coded RNFL thickness, with thinner regions displayed in blue or green, while thicker regions are displayed in yellow or red. Courtesy of Carl Zeiss Meditec, Inc.
Figure 8
Figure 8
Compensating the anterior segment birefringence in the GDx VCC (macula and optic nerve head). Left: The uncompensated retardation image, which includes the retardation from the cornea, lens and RNFL. The retardation profile in the macula is due to the cornea, lens, and macula itself (Henle fiber layer). The axis of birefringence is shown as a dashed line. Once the axis and the magnitude values are known, the variable compensator VCC can be set to compensate for the anterior segment birefringence. Right: The resulting compensated image. The retardation profile in the macula is now uniform due to compensation.
Figure 9
Figure 9
GDxVCC – exam printout of a normal subject. Key elements: a) the fundus image (top row; useful to check for image quality); b) the thickness map (second row) showing the thickness of the RNFL on a scale of 0 (dark blue) to 120 μm (red), with yellow-red colors for a healthy eye; c) the deviation maps (third row) revealing the location and severity of RNFL loss over the thickness map in serial comparison of thickness maps; d) the Temporal-Superior-Nasal-Inferior-Temporal (TSNIT) maps (bottom row), displaying the thickness values along the calculation circle starting temporally and moving superiorly, nasally, inferiorly and ending temporally, along with the shaded areas representing the 95% normal range for the patient’s particular age. The printout also includes parameters, such as the TSNIT average, Superior average, Inferior average, TSNIT standard deviation and Inter-eye Symmetry.
Figure 10
Figure 10
Retinal Birefringence Scanning (RBS). A birefringence image of the fovea with the scanning circle (3° of visual angle). The circle can be centered on the fovea during central fixation as in (a), or to the side of the center of the fovea during para-central fixation – as in (b).
Figure 11
Figure 11
Signals produced by RBS: a) during central fixation and b) during para-central fixation. The power spectrum (c) contains two peaks – one at 2fs, characteristic of central fixation, and one at fs, characteristic of para-central fixation.
Figure 12
Figure 12
Basic design of an RBS system. The light retro-reflected from the retina is of changed polarization, which is measured by a polarization-sensitive detector.
Figure 13
Figure 13
Typical optical setup of an OCT system containing a moving reference mirror (Time-Domain OCT). Free space design with no fiber optics.
Figure 14
Figure 14
A generalized design of a fiber-based Time-Domain OCT system.
Figure 15
Figure 15
Pathology examples detected with the TD OCT instrument STRATUS OCT™, courtesy of Carl Zeiss Meditec. The left panel shows a macular hole with posterior vitreous detachment. The right panel presents pigment epithelial detachment. The structures of the retina are color-coded.
Figure 16
Figure 16
A typical fiber-optic implementation of the Fourier domain OCT (FD OCT). The slow mechanical depth scan is replaced by a spectral measurement consisting of diffraction grating and photodetector array.
Figure 17
Figure 17
Pathology examples detected with the CIRRUS HD-OCT™ FD OCT, courtesy of Carl Zeiss Meditec. The left panel shows age-related macular degeneration. The right panel presents a lamellar macular hole.
Figure 18
Figure 18
Photoreceptor disruption of the retina (right), observed in a section marked with a green line on the transversal image (left). The image was obtained with the SPECTRALIS® FD OCT, courtesy of Heidelberg Engineering.
Figure 19
Figure 19
A Swept Source OCT system – typical design.
Figure 20
Figure 20
A simplified configuration of a Polarization Sensitive OCT (time-domain).

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