Differing Associations between Optic Nerve Head Strains and Visual Field Loss in Patients with Normal- and High-Tension Glaucoma.

PURPOSE: To study the associations between optic nerve head (ONH) strains under intraocular pressure (IOP) elevation with retinal sensitivity in patients with glaucoma. DESIGN: Clinic-based cross-sectional study. PARTICIPANTS: Two hundred twenty-nine patients with primary open-angle glaucoma (subdivided into 115 patients with high-tension glaucoma [HTG] and 114 patients with normal-tension glaucoma [NTG]). METHODS: For 1 eye of each patient, we imaged the ONH using spectral-domain OCT under the following conditions: (1) primary gaze and (2) primary gaze with acute IOP elevation (to approximately 35 mmHg) achieved through ophthalmodynamometry. A 3-dimensional strain-mapping algorithm was applied to quantify IOP-induced ONH tissue strain (i.e., deformation) in each ONH. Strains in the prelaminar tissue (PLT), the retina, the choroid, the sclera, and the lamina cribrosa (LC) were associated (using linear regression) with measures of retinal sensitivity from the 24-2 Humphrey visual field test (Carl Zeiss Meditec). This was performed globally, then locally according to a previously published regionalization scheme. MAIN OUTCOME MEASURES: Associations between ONH strains and values of retinal sensitivity from visual field testing. RESULTS: For patients with HTG, we found (1) significant negative linear associations between ONH strains and retinal sensitivity (P < 0.001; on average, a 1% increase in ONH strains corresponded to a decrease in retinal sensitivity of 1.1 decibels [dB]), (2) that high-strain regions colocalized with anatomically mapped regions of high visual field loss, and (3) that the strongest negative associations were observed in the superior region and in the PLT. In contrast, for patients with NTG, no significant associations between strains and retinal sensitivity were observed except in the superotemporal region of the LC. CONCLUSIONS: We found significant negative associations between IOP-induced ONH strains and retinal sensitivity in a relatively large glaucoma cohort. Specifically, patients with HTG who experienced higher ONH strains were more likely to exhibit lower retinal sensitivities. Interestingly, this trend in general was less pronounced in patients with NTG, which could suggest a distinct pathophysiologic relationship between the two glaucoma subtypes.

Towards label-free 3D segmentation of optical coherence tomography images of the optic nerve head using deep learning.

Recently proposed deep learning (DL) algorithms for the segmentation of optical coherence tomography (OCT) images to quantify the morphological changes to the optic nerve head (ONH) tissues during glaucoma have limited clinical adoption due to their device specific nature and the difficulty in preparing manual segmentations (training data). We propose a DL-based 3D segmentation framework that is easily translatable across OCT devices in a label-free manner (i.e. without the need to manually re-segment data for each device). Specifically, we developed 2 sets of DL networks: the 'enhancer' (enhance OCT image quality and harmonize image characteristics from 3 devices) and the 'ONH-Net' (3D segmentation of 6 ONH tissues). We found that only when the 'enhancer' was used to preprocess the OCT images, the 'ONH-Net' trained on any of the 3 devices successfully segmented ONH tissues from the other two unseen devices with high performance (Dice coefficients > 0.92). We demonstrate that is possible to automatically segment OCT images from new devices without ever needing manual segmentation data from them.

A viscoelastic framework for inflation testing of gastrointestinal tissue.

Gastrointestinal (GI) diseases are often associated with hypertrophy of the layers of the GI wall, along with dilatation and a denervation of smooth muscle cells which alters the biomechanical properties of the tissue. 'Balloon distension' is a specialised experimental protocol performed on hollow organs to investigate their biomechanical properties. A balloon is inserted and pressurized during this procedure and the change in external diameter is monitored as a function of the applied pressure. A hyperelastic framework is often used in this context to evaluate the stresses in the wall after inflation. However, this only gives an idea about the final equilibrium state of the tissue, whereas the intermediate states of deformations are overlooked. GI soft tissues are viscoelastic, thus, the stress values during inflation are loading rate dependent and are higher than the equilibrium state values. Therefore, it is necessary to consider the time- and rate-dependent material properties during a balloon distension test. The aim of this work was to develop a viscoelastic framework for interpreting balloon distension experiments under finite deformation. To demonstrate the efficacy of the framework, it was used to recreate experimental results from intestinal and colonic tissue segments. In all cases, the simulation results were well matched (R2>0.9) with the experimental data.

A finite nonlinear hyper-viscoelastic model for soft biological tissues.

Soft tissues exhibit highly nonlinear rate and time-dependent stress-strain behaviour. Strain and strain rate dependencies are often modelled using a hyperelastic model and a discrete (standard linear solid) or continuous spectrum (quasi-linear) viscoelastic model, respectively. However, these models are unable to properly capture the materials characteristics because hyperelastic models are unsuited for time-dependent events, whereas the common viscoelastic models are insufficient for the nonlinear and finite strain viscoelastic tissue responses. The convolution integral based models can demonstrate a finite viscoelastic response; however, their derivations are not consistent with the laws of thermodynamics. The aim of this work was to develop a three-dimensional finite hyper-viscoelastic model for soft tissues using a thermodynamically consistent approach. In addition, a nonlinear function, dependent on strain and strain rate, was adopted to capture the nonlinear variation of viscosity during a loading process. To demonstrate the efficacy and versatility of this approach, the model was used to recreate the experimental results performed on different types of soft tissues. In all the cases, the simulation results were well matched (R2⩾0.99) with the experimental data.