Effect of skin color on optical properties and the implications for medical optical technologies: a review.

Significance: Skin color affects light penetration leading to differences in its absorption and scattering properties. COVID-19 highlighted the importance of understanding of the interaction of light with different skin types, e.g., pulse oximetry (PO) unreliably determined oxygen saturation levels in people from Black and ethnic minority backgrounds. Furthermore, with increased use of other medical wearables using light to provide disease information and photodynamic therapies to treat skin cancers, a thorough understanding of the effect skin color has on light is important for reducing healthcare disparities. Aim: The aim of this work is to perform a thorough review on the effect of skin color on optical properties and the implication of variation on optical medical technologies. Approach: Published in vivo optical coefficients associated with different skin colors were collated and their effects on optical penetration depth and transport mean free path (TMFP) assessed. Results: Variation among reported values is significant. We show that absorption coefficients for dark skin are ∼6% to 74% greater than for light skin in the 400 to 1000 nm spectrum. Beyond 600 nm, the TMFP for light skin is greater than for dark skin. Maximum transmission for all skin types was beyond 940 nm in this spectrum. There are significant losses of light with increasing skin depth; in this spectrum, depending upon Fitzpatrick skin type (FST), on average 14% to 18% of light is lost by a depth of 0.1 mm compared with 90% to 97% of the remaining light being lost by a depth of 1.93 mm. Conclusions: Current published data suggest that at wavelengths beyond 940 nm light transmission is greatest for all FSTs. Data beyond 1000 nm are minimal and further study is required. It is possible that the amount of light transmitted through skin for all skin colors will converge with increasing wavelength enabling optical medical technologies to become independent of skin color.

Relevance and utility of the in-vivo and ex-vivo optical properties of the skin reported in the literature: a review [Invited].

Imaging non-invasively into the human body is currently limited by cost (MRI and CT scan), image resolution (ultrasound), exposure to ionising radiation (CT scan and X-ray), and the requirement for exogenous contrast agents (CT scan and PET scan). Optical imaging has the potential to overcome all these issues but is currently limited by imaging depth due to the scattering and absorption properties of human tissue. Skin is the first barrier encountered by light when imaging non-invasively, and therefore a clear understanding of the way that light interacts with skin is required for progress on optical medical imaging to be made. Here we present a thorough review of the optical properties of human skin measured in-vivo and compare these to the previously collated ex-vivo measurements. Both in-vivo and ex-vivo published data show high inter- and intra-publication variability making definitive answers regarding optical properties at given wavelengths challenging. Overall, variability is highest for ex-vivo absorption measurements with differences of up to 77-fold compared with 9.6-fold for the in-vivo absorption case. The impact of this variation on optical penetration depth and transport mean free path is presented and potential causes of these inconsistencies are discussed. We propose a set of experimental controls and reporting requirements for future measurements. We conclude that a robust in-vivo dataset, measured across a broad spectrum of wavelengths, is required for the development of future technologies that significantly increase the depth of optical imaging.

Development of hydrogel-based standards and phantoms for non-linear imaging at depth.

Significance: Rapid advances in medical imaging technology, particularly the development of optical systems with non-linear imaging modalities, are boosting deep tissue imaging. The development of reliable standards and phantoms is critical for validation and optimization of these cutting-edge imaging techniques. Aim: We aim to design and fabricate flexible, multi-layered hydrogel-based optical standards and evaluate advanced optical imaging techniques at depth. Approach: Standards were made using a robust double-network hydrogel matrix consisting of agarose and polyacrylamide. The materials generated ranged from single layers to more complex constructs consisting of up to seven layers, with modality-specific markers embedded between the layers. Results: These standards proved useful in the determination of the axial scaling factor for light microscopy and allowed for depth evaluation for different imaging modalities (conventional one-photon excitation fluorescence imaging, two-photon excitation fluorescence imaging, second harmonic generation imaging, and coherent anti-Stokes Raman scattering) achieving actual depths of 1550, 1550, 1240, and 1240 µm, respectively. Once fabricated, the phantoms were found to be stable for many months. Conclusions: The ability to image at depth, the phantom's robustness and flexible layered structure, and the ready incorporation of "optical markers" make these ideal depth standards for the validation of a variety of imaging modalities.

Generalization of the Lyot filter and its application to snapshot spectral imaging.

A snapshot multi-spectral imaging technique is described which employs multiple cascaded birefringent interferometers to simultaneously spectrally filter and demultiplex multiple spectral images onto a single detector array. Spectral images are recorded directly without the need for inversion and without rejection of light and so the technique offers the potential for high signal-to-noise ratio. An example of an eight-band multi-spectral movie sequence is presented; we believe this is the first such demonstration of a technique able to record multi-spectral movie sequences without the need for computer reconstruction.

Application of a wide-field phantom eye for optical coherence tomography and reflectance imaging.

Optical coherence tomography (OCT) and reflectance imaging are used in clinical practice to measure the thickness and transverse dimensions of retinal features. The recent trend towards increasing the field of view (FOV) of these devices has led to an increasing significance of the optical aberrations of both the human eye and the device. We report the design, manufacture and application of the first phantom eye that reproduces the off-axis optical characteristics of the human eye, and allows the performance assessment of wide-field ophthalmic devices. We base our design and manufacture on the wide-field schematic eye, [Navarro, R. J. Opt. Soc. Am. A, 1985,2.] as an accurate proxy to the human eye and enable assessment of ophthalmic imaging performance for a [Formula: see text] external FOV. We used multi-material 3D-printed retinal targets to assess imaging performance of the following ophthalmic instruments: the Optos 200Tx, Heidelberg Spectralis, Zeiss FF4 fundus camera and Optos OCT SLO and use the phantom to provide an insight into some of the challenges of wide-field OCT.

Validation of human whole blood oximetry, using a hyperspectral fundus camera with a model eye.

PURPOSE: To assess the accuracy of human blood oximetry measurements in a model eye with a hyperspectral fundus camera. METHODS: Seven human whole blood samples (two arterial, five venous) were obtained, the oxygen saturations measured with a CO oximeter, and the samples inserted into quartz tubes with internal diameters of 100 and 150 µm. The tubes (n = 20; ten 100 µm and ten 150 µm) were placed within a model eye in front of a background reflectance surface with reflectivities of 20%, 60%, and 99%. Spectral images at wavelengths between 500 and 650 nm were acquired with a hyperspectral fundus camera and analyzed with an oximetric model to calculate the oxygen saturation of blood within the tubes. The calculated oxygen saturations were compared with the measured oxygen saturations. The effects of the background reflectivity and tube size on the accuracy of the calculated oxygen saturations were evaluated. RESULTS: Background reflectivity and tube size had no significant effect on the mean oxygen saturation difference (P = 0.18 and P = 0.99, respectively; repeated-measures, two-way ANOVA). The mean differences (SD) between the measured and calculated oxygen saturations in segments of the 100 and 150 µm tubes overlying the 20%, 60%, and 99% background reflectivities were (100 µm) -4.0% (13.4%), -6.4% (9.9%), and -5.5% (10.2%) and (150 µm) -5.3% (10.8%), -5.2% (10.7%), and -5.2% (10.9%), respectively. CONCLUSIONS: There was reasonable agreement between the measured oxygen saturation values and those calculated by the oximetry model. The oximetry model could be used to determine the functional health of the retina.