Polarization-Diversity Optical Coherence Tomography Assessment of Choroidal Nevi.

Purpose: The purpose of this study was to demonstrate the utility of polarization-diversity optical coherence tomography (PD-OCT), a noninvasive imaging technique with melanin-specific contrast, in the quantitative and qualitative assessment of choroidal nevi. Methods: Nevi were imaged with a custom-built 55-degree field-of-view (FOV) 400 kHz PD-OCT system. Imaging features on PD-OCT were compared to those on fundus photography, auto-fluorescence, ultrasound, and non-PD-OCT images. Lesions were manually segmented for size measurement and metrics for objective assessment of melanin distributions were calculated, including degree of polarization uniformity (DOPU), attenuation coefficient, and melanin occupancy rate (MOR). Results: We imaged 17 patients (mean age = 69.5 years, range = 37-90) with 11 pigmented, 3 non-pigmented, and 3 mixed pigmentation nevi. Nevi with full margin acquisition had an average longest basal diameter of 5.1 mm (range = 2.99-8.72 mm) and average height of 0.72 mm (range = 0.37 mm-2.09 mm). PD-OCT provided clear contrast of choroidal melanin content, distribution, and delineation of nevus margins for melanotic nevi. Pigmented nevi were found to have lower DOPU, higher attenuation coefficient, and higher MOR than non-pigmented lesions. Melanin content on PD-OCT was consistent with pigmentation on fundus in 15 of 17 nevi (88%). Conclusions: PD-OCT allows objective assessment of choroidal nevi melanin content and distribution. In addition, melanin-specific contrast by PD-OCT enables clear nevus margin delineation and may improve serial growth surveillance. Further investigation is needed to determine the clinical significance and prognostic value of melanin characterization by PD-OCT in the evaluation of choroidal nevi.

Clinical explainable differential diagnosis of polypoidal choroidal vasculopathy and age-related macular degeneration using deep learning.

BACKGROUND: This study aims to achieve an automatic differential diagnosis between two types of retinal pathologies with similar pathological features - Polypoidal choroidal vasculopathy (PCV) and wet age-related macular degeneration (AMD) from volumetric optical coherence tomography (OCT) images, and identify clinically-relevant pathological features, using an explainable deep-learning-based framework. METHODS: This is a retrospective study with data from a cross-sectional cohort. The OCT volume of 73 eyes from 59 patients was included in this study. Disease differentiation was achieved through single-B-scan-based classification followed by a volumetric probability prediction aggregation step. We compared different labeling strategies with and without identifying pathological B-scans within each OCT volume. Clinical interpretability was achieved through normalized aggregation of B-scan-based saliency maps followed by maximum-intensity-projection onto the en face plane. We derived the PCV score from the proposed differential diagnosis framework with different labeling strategies. The en face projection of saliency map was validated with the pathologies identified in Indocyanine green angiography (ICGA). RESULTS: Model trained with both labeling strategies achieved similar level differentiation power (>90%), with good correspondence between pathological features detected from the projected en face saliency map and ICGA. CONCLUSIONS: This study demonstrated the potential clinical application of non-invasive differential diagnosis using AI-driven OCT-based analysis, with minimal requirement of labeling efforts, along with clinical explainability achieved through automatically detected disease-related pathologies.

Multi-scale and -contrast sensorless adaptive optics optical coherence tomography.

BACKGROUND: The roles of the retinal microvasculature and the retinal pigment epithelium (RPE) in maintaining the health and metabolic activity of the retina lend great clinical value to their high-resolution visualization. METHODS: By integrating polarization diversity detection (PDD) into multi-scale and -contrast sensorless adaptive optics optical coherence tomography (MSC-SAO-OCT), we have developed a novel multi-contrast SAO OCT system for imaging pigment in the RPE as well as flow in the retinal capillaries using OCT angiography (OCTA). Aberration correction was performed based on the image quality using transmissive deformable optical elements. RESULTS: MSC-SAO-OCTA imaging was performed at multiple fields-of-view (FOVs) with adjustable numerical aperture (NA). Retinal flow and RPE structural images for in vivo healthy and pathological human posterior eyes were demonstrated to show clinical feasibility of the system. CONCLUSIONS: High-resolution imaging of retinal vasculature at both large and small FOVs, as well as characterization of RPE topology and deformation, enables more sophisticated and concise investigation of retinal pathologies for in vivo human imaging. MSC imaging may permit detection and analysis of even subtle deformations in the RPE layer using a single instrument.

Simultaneous investigation of vascular and retinal pigment epithelial pathologies of exudative macular diseases by multifunctional optical coherence tomography.

PURPOSE: To investigate exudative macular disease, multifunctional optical coherence tomography (MF-OCT) using a 1-µm probe band was developed. The clinical utility of MF-OCT was examined in a descriptive case series. METHODS: Ten eyes of nine subjects with exudative macular disease, including one eye with age-related macular degeneration (AMD), one eye with idiopathic neovascular maculopathy, and eight eyes with polypoidal choroidal vasculopathy (PCV), were investigated. Areas of 6 × 6 mm(2) around the pathologic region were scanned with 512 × 1024 depth scans in 6.6 seconds. Structural OCT, Doppler optical coherence angiography (OCA), and cumulative phase retardation images were obtained with a single measurement. Each MF-OCT image visualized the structure, vasculature, and birefringence. Degree of polarization uniformity values were also obtained for selective visualization of the retinal pigment epithelium (RPE). The MF-OCT images were compared with conventional ophthalmic images. RESULTS: Abnormal vasculatures were observed with Doppler OCA in all eyes, which presented high similarity to indocyanine green angiography in the midphase. The RPE and exudation in the pathologic regions were discriminated in one eye with AMD and five of eight eyes with PCV. Cumulative phase retardation visualized fibrosis scars in two of the PCV cases. CONCLUSIONS: Multifunctional OCT revealed depth-resolved abnormal vasculatures, the integrity of the RPE and choroid, discrimination of the RPE and exudation, and existence of fibrosis scars in exudative macular diseases. Interpretation of MF-OCT examination is well matched with conventional ophthalmic examination. These results suggest that MF-OCT can be used as a noninvasive ophthalmic examination tool prior to conventional examinations in clinical routines.

Noninvasive investigation of deep vascular pathologies of exudative macular diseases by high-penetration optical coherence angiography.

PURPOSE: A newly developed high-penetration Doppler optical coherence angiography (HP-OCA) with a 1-µm probe beam for noninvasive investigation of vascular pathology of exudative macular diseases is introduced. A descriptive case series is presented to discuss the clinical utility of HP-OCA. METHODS: Eleven eyes of 10 subjects with exudative macular disease, including two eyes with myopic choroidal neovascularization (mCNV); four eyes with AMD; and five eyes with polypoidal choroidal vasculopathy (PCV) were investigated. Two Doppler scanning modes (bidirectional and high-sensitive) of HP-OCA were used for the investigation. HP-OCA provides depth-resolved and en face angiograms and a structural OCT noninvasively. The HP-OCA images were compared with fluorescein angiography (FA); indocyanine green angiography (ICGA); and color fundus images. RESULTS: The abnormal vasculature patterns observed with high-sensitive HP-OCA presented high similarity to the midphase of ICGA. Several abnormal Doppler signals were observed in the en face high-sensitive HP-OCA and were colocated with FA leakage. This colocation was found in one eye with mCNV, four eyes with AMD, and one eye with PCV. Doppler tomogram of the bidirectional mode showed abnormal Doppler signals in three of five PCV cases beneath the pigment epithelium detachment. With the high-sensitive mode, Doppler signals were found beneath the elevated retinal pigment epithelium in all untreated cases. CONCLUSIONS: HP-OCA revealed depth-resolved abnormal vasculatures in exudative macular diseases. The en face HP-OCA images showed high similarity with FA and ICGA images. These results suggest HP-OCA can be used for noninvasive and three-dimensional angiography in a clinical routine.