Retinal imaging in infants

Digital retinal imaging is at the core of a revolution that is continually improving the screening, diagnosis, documentation, monitoring, and treatment of infant retinal diseases. Historically, imaging the retina of infants had been limited and difficult to obtain. Recent advances in photographic instrumentation have significantly improved the ability to obtain high quality multimodal images of the infant retina. These include color fundus photography with different camera angles, ultrasonography, fundus fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. We provide a summary of the current literature on retinal imaging in infants and highlight areas where further research is required.     

Adaptive optics scanning laser ophthalmoscopy in fundus imaging, a review and update

Adaptive optics scanning laser ophthalmoscopy (AO-SLO) has been a promising technique in funds imaging with growing popularity. This review firstly gives a brief history of adaptive optics (AO) and AO-SLO. Then it compares AO-SLO with conventional imaging methods (fundus fluorescein angiography, fundus autofluorescence, indocyanine green angiography and optical coherence tomography) and other AO techniques (adaptive optics flood-illumination ophthalmoscopy and adaptive optics optical coherence tomography). Furthermore, an update of current research situation in AO-SLO is made based on different fundus structures as photoreceptors (cones and rods), fundus vessels, retinal pigment epithelium layer, retinal nerve fiber layer, ganglion cell layer and lamina cribrosa. Finally, this review indicates possible research directions of AO-SLO in future.     

【In Press】 Adaptive optics scanning laser ophthalmoscopy in fundus imaging, a review and update

Adaptive optics scanning laser ophthalmoscopy (AO-SLO) has been a promising technique in funds imaging with growing popularity. This review firstly gives a brief history of adaptive optics (AO) and AO-SLO. Then it compares AO-SLO with conventional imaging methods (fundus fluorescein angiography, fundus autofluorescence, indocyanine green angiography and optical coherence tomography) and other AO techniques (adaptive optics flood-illumination ophthalmoscopy and adaptive optics optical coherence tomography). Furthermore, an update of current research situation in AO-SLO is made based on different fundus structures as photoreceptors (cones and rods), fundus vessels, retinal pigment epithelium layer, retinal nerve fiber layer, ganglion cell layer and lamina cribrosa. Finally, this review indicates possible research directions of AO-SLO in future.     

周边视网膜变性广角多模影像研究进展

周边视网膜变性是眼科临床常见的病变,不同类型的变性影响不同的视网膜层次,可能对视力造成威胁。尽管现代眼底成像技术被应用于研究其病理生理机制,由于其所处的特殊部位,影像学检查困难,因此发病机制仍不清楚。本文总结了有关周边视网膜变性的多种广角成像技术的影像特征,包括超广角眼底成像、广角频域光学相干断层扫描、光学相干断层扫描血管成像、荧光素眼底血管造影等,及其发病机制或病理特点的新观点,为临床诊疗提供新的思路。由于样本量非常少,且缺乏前瞻性、长期的多模态影像的观察研究,因而目前仍无法全面评价不同类型病变的进展性及危险性。期望在更广的范围内应用多模态广角成像技术对此类疾病进行研究,指导临床干预决策。     

Current status and future possibilities of retinal imaging in diabetic retinopathy care applicable to low- and medium-income countries

Diabetic retinopathy (DR) is a leading cause of blindness among adults and the numbers are projected to rise. There have been dramatic advances in the field of retinal imaging since the first fundus image was captured by Jackman and Webster in 1886. The currently available imaging modalities in the management of DR include fundus photography, fluorescein angiography, autofluorescence imaging, optical coherence tomography, optical coherence tomography angiography, and near-infrared reflectance imaging. These images are obtained using traditional fundus cameras, widefield fundus cameras, handheld fundus cameras, or smartphone-based fundus cameras. Fluorescence lifetime ophthalmoscopy, adaptive optics, multispectral and hyperspectral imaging, and multicolor imaging are the evolving technologies which are being researched for their potential applications in DR. Telemedicine has gained popularity in recent years as remote screening of DR has been made possible. Retinal imaging technologies integrated with artificial intelligence/deep-learning algorithms will likely be the way forward in the screening and grading of DR. We provide an overview of the current and upcoming imaging modalities which are relevant to the management of DR.     

基于自适应光学的视网膜成像技术应用进展

自适应光学(AO)是一种通过减少波前畸变来降低光学像差影响，从而改进光学系统性能的技术。基于AO的视网膜成像技术减少了屈光系统光学像差的产生，从而提高了视网膜成像的分辨率和质量，这种活体视网膜细胞水平的成像技术，具有巨大的眼科应用潜力。AO与眼底相机、扫描激光检眼镜、光学相干断层扫描技术及光学相干断层血管造影结合，可以应用于健康人群眼底视锥细胞分布情况、形态特征和功能作用观察，并在更精细的血管层面了解视网膜血管形态和灌注情况； 可以对病变眼底中细胞数量和形态、筛板以及视网膜微血管系统和神经组织等微观结构进行定性和定量分析，从而作为糖尿病视网膜病变、年龄相关性黄斑变性、青光眼、遗传性视网膜疾病等眼病早期诊断、进展检测和治疗效果随访观察的新手段。     

Imaging in retinal vascular disease: A review

Retinal vascular diseases represent a broad field of ocular pathologies. Retinal imaging is an important tool for diagnosis, prognosis and follow up of retinal vascular diseases. It includes a wide variety of imaging techniques ranging from colour fundus photography and optical coherence tomography to dynamic diagnostic options such as fluorescein angiography, and optical coherence tomography angiography. The newest developments in respective imaging techniques include widefield imaging to assess the retinal periphery, which is of especial interest in retinal vascular diseases. Automatic image analysis and artificial intelligence may support the image analysis and may prove valuable for prognostic purposes. This review provides a broad overview of the imaging techniques that have been used in the past, today and maybe in the future to stage and monitor retinal vascular disease with focus on the main disease entities including diabetic retinopathy, retinal vein occlusion, and retinal artery occlusion.     

眼底疾病影像学检查的合理应用及联合应用

近年来,眼底的影像学诊断技术发展很快,为深入认识和准确诊断眼底病提供了最新的方法.常用的光学影像学方法有彩色相、无赤光相、自发荧光相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和频域光学相干断层扫描(S-OCT)等.充分掌握眼底影像学的基本知识,合理选择影像学方法,有针对性地进行检查,仔细分析和评价检查结果,对视网膜脉络膜疾病的诊断、鉴别诊断、治疗方案的制定和随访都具有重要的临床意义.     

Clinical use and research applications of Heidelberg retinal angiography and spectral-domain optical coherence tomography – a review

Fluorescein angiography (FA) was discovered by Nowotny and Alvis in the 1960s of the 20th century and has evolved to become the 'Gold standard' for macular diagnostics. Scanning laser imaging technology achieved enhancement of contrast and resolution. The combined Heidelberg retina angiograph (HRA2) adds novel innovative features to established fundus cameras. The principle of confocal scanning laser imaging provides a high resolution of retinal and choroidal vasculature with low light exposure providing comfort and safety for the patient. Enhanced contrast, details and image sharpness image are generated using confocality. For the visualization of the choroid an indocyanine green angiography (ICGA) is the most suitable application. The main indications for ICGA are age-related macular degeneration, choroidal polypoidal vasculopathy and choroidal haemangiomas. Simultaneous digital FA and ICGA images with three-dimensional resolution offer improved diagnosis of retinal and choroidal pathologies. High-speed ICGA dynamic imaging can identify feeder vessels and retinal choroidal anastomoses, ensuring safer treatment of choroidal neovascularization. Autofluorescence imaging and fundus reflectance imaging with blue and infrared light offer new follow-up parameters for retinal diseases. Finally, the real-time optical coherence tomography provides a new level of accuracy for assessment of the angiographic and morphological correlation. The combination of various macular diagnostic tools, such as infrared, blue reflectance, fundus autofluorescence, FA, ICGA and also spectral domain optical coherence tomography, lead to a better understanding and improved knowledge of macular diseases.     

开展小儿视网膜疾病影像检查，提高小儿视网膜疾病诊断治疗水平

随着眼底影像检查设备技术的进步以及应用水平的提高，视频检眼镜、眼底照相、荧光素眼底血管造影、光相干断层扫描以及眼部超声等眼底病影像检查手段逐步应用于小儿视网膜疾病的检查、诊断、治疗过程中。这些实时、精确、可重复的检查手段所提供的小儿眼底检查信息，不仅有助于更好地理解和观察小儿视网膜发育，揭示小儿特有的视网膜疾病的发病机制和病程进展，监测治疗效果和预后，而且使众多既往不能早期发现和诊断的小儿视网膜疾病的早期诊断成为可能。通过多学科专业合作，使这些小儿视网膜疾病影像检查过程更简便、安全，检查结果更加全面、客观，则将进一步扩大影像检查在小儿视网膜疾病诊断治疗过程中的应用，提高小儿视网膜疾病的诊断治疗水平。     

中心性浆液性脉络膜视网膜病变伴发脉络膜新生血管的研究进展

中心性浆液性脉络膜视网膜病变(CSCR)是第四位最常见可能导致视力损害的获得性视网膜疾病,近年被认为是脉络膜肥厚谱系疾病之一。脉络膜新生血管(CNV)的发生发展是导致CSCR患者长期随访视力下降的主要原因之一,也是其重要并发症。关注CSCR患者伴发CNV的危险因素及相关影像学特征,及时给予诊断并制定相应的治疗策略是非常重要的。利用包括眼底自发荧光照相、荧光素眼底血管造影(FFA及ICGA)、SS-OCT及OCTA多模影像学检查有助于眼科医生更快地发现这类疾病并作出正确诊断,尤其是OCTA的应用有利于临床发现更多的CSCR伴发CNV。光动力学疗法及抗VEGF治疗目前已应用于很多CNV相关疾病的治疗,但对于CSCR所继发的CNV尚无统一的治疗标准。本文就CSCR继发CNV的相关危险因素以及目前的影像学检查和治疗研究作一综述。     

Detection of shallow detachments in central serous chorioretinopathy.

PURPOSE: To study the correlation between symptoms, clinical findings, fundus photographic morphology, and optical coherence tomography in patients with symptoms of central serous chorioretinopathy, but ambiguous biomicroscopic findings and no late-phase fluorescein angiographic leakage. METHODS: Biomicroscopic slit-lamp examination, greyscale digital fundus photography in red-free illumination, fundus fluorescein angiography, optical coherence tomography, and focal retinal argon laser photocoagulation. Seven consecutive patients aged 32-69 years, of whom four received focal retinal photocoagulation treatment. RESULTS: All patients demonstrated a shallow serous detachment on optical coherence tomography. After treatment the detachment resolved, as did the relative scotoma, the prolonged dark adaptation, and the dyschromatopsia. Micropsia was markedly reduced in all, but not completely eliminated in two of the patients. CONCLUSION: Patients with central serous chorioretinopathy may have shallow foveal detachments that can only be detected by optical coherence tomography, whereas clinical and angiographic signs of detachment may be missing. Classical symptoms coupled with a normal or only mildly reduced visual acuity are highly indicative of the presence of a serous neuroretinal detachment, but fluorescein angiography is necessary to establish the diagnosis and the target for treatment.     

蝶形视网膜色素上皮营养不良患者的多模式眼底影像学特征

目的:探讨蝶形视网膜色素上皮营养不良(BPD)患者的多模式眼底影像特征。方法:回顾分析2016-01/2019-07经多模式影像检查确诊BPD的患者18例36眼的眼底彩照、红外照相、自发荧光、荧光造影、脉络膜造影、光学相干断层扫描(OCT)及眼底血流成像OCT(OCTA)等多模式眼底影像检查。结果:典型的眼底彩色照相可显示色素异常沉着而呈现的蝶翅样病变外观,病变进展后蝶形外观不明显,而相应区域萎缩;红外照相显示BPD患者的眼底黄色病灶,表现为白色高亮影像;自发荧光可有斑片状、点状所勾勒的蝶翅表现,也可有以上特征重叠的表现,当病变进展萎缩明显时,自发荧光不能显示典型的蝶形改变,但可以反映出色素上皮细胞的破坏程度范围;眼底荧光血管造影和脉络膜造影除了显示蝶形病变外,能更为精准地显示血管病变情况,尤其是脉络膜新生血管(CNV)的检查;OCT显示病变位于视网膜色素上皮(RPE)之上与光感受器之间。随病变进展,色素上皮表现相应扩大的损伤,继发CNV者可见突破RPE的高反射信号;OCTA显示病变对视网膜深层和浅层损伤不明显,但脉络膜血流信号不同程度丢失,可敏感检出CNV的血流影像。结论:多模式眼底...     

Outer retinal abnormalities associated with inner retinal pathology in nonglaucomatous and glaucomatous optic neuropathies

Inner and outer retinal morphology were quantified in vivo for 6 nonglaucomatous and 10 glaucomatous optic neuropathy patients. Custom, ultrahigh-resolution imaging modalities were used to evaluate segmented retinal layer thickness in 3D volumes (Fourier-domain optical coherence tomography), cone photoreceptor density (adaptive optics fundus camera), and the length of inner and outer segments of cone photoreceptors (adaptive optics-optical coherence tomography). Quantitative comparisons were made with age-matched controls, or by comparing affected and nonaffected retinal areas defined by changes in visual fields. The integrity of outer retinal layers on optical coherence tomography B-scans and density of cone photoreceptors were correlated with visual field sensitivity at corresponding retinal locations following reductions in inner retinal thickness. The photoreceptor outer segments were shorter and exhibited greater variability in retinal areas associated with visual field losses compared with normal or less affected areas of the same patient's visual field. These results demonstrate that nonglaucomatous and glaucomatous optic neuropathies are associated with outer retinal changes following long-term inner retinal pathology.     

Optical coherence tomography of successfully repaired idiopathic macular holes

PURPOSE: To present the cross-sectional retinal imaging results of optical coherence tomography in eyes with successfully repaired idiopathic macular hole and their relevance to visual recovery. METHODS: We studied 33 eyes with successful repair of an idiopathic macular hole through vitrectomy and fluid-gas exchange from 32 patients (11 men and 21 women) with ages ranging from 48 to 78 years, with a median age of 66 years. Preoperative conditions in eyes with primary surgery disclosed nine eyes with stage 2, 14 eyes with stage 3, and four eyes with stage 4 macular hole. An additional six eyes underwent a second surgery because the previous surgery was unsuccessful. Measurement of best-corrected visual acuity, slit-lamp biomicroscopy with fundus contact lens, fundus photographs, and optical coherence tomographic examination were performed between 6 and 9 months after surgery in 29 eyes and between 15 and 36 months after surgery in four eyes. RESULTS: Optical coherence tomographic images of the repaired macular holes were categorized into three patterns. U-type (normal foveal contour; 13 eyes) showed mildly to moderately backscattering layers with a smooth circular surface covering retinal pigment epithelium and choriocapillaris layers. In eyes with V-type (steep foveal contour; 13 eyes), the retinal pigment epithelium and choriocapillaris layers were covered with moderately backscattering layers with a notch. W-type (foveal defect of neurosensory retina; seven eyes) showed abruptly or gradually terminating sensory retinal layers to expose the surface of the retinal pigment epithelium and choriocapillaris layers. Postoperative acuity was well correlated with these patterns of optical coherence tomographic images. CONCLUSION: Assessment of successfully repaired idiopathic macular holes with optical coherence tomographic images provides a useful correlation with postoperative visual recovery.     

Past,present and future role of retinal imaging in neurodegenerative disease

Retinal imaging technology is rapidly advancing and can provide ever-increasing amounts of information about the structure, function and molecular composition of retinal tissue in humans in vivo. Most importantly, this information can be obtained rapidly, non-invasively and in many cases using Food and Drug Administration-approved devices that are commercially available. Technologies such as optical coherence tomography have dramatically changed our understanding of retinal disease and in many cases have significantly improved their clinical management. Since the retina is an extension of the brain and shares a common embryological origin with the central nervous system, there has also been intense interest in leveraging the expanding armamentarium of retinal imaging technology to understand, diagnose and monitor neurological diseases. This is particularly appealing because of the high spatial resolution, relatively low-cost and wide availability of retinal imaging modalities such as fundus photography or OCT compared to brain imaging modalities such as magnetic resonance imaging or positron emission tomography. The purpose of this article is to review and synthesize current research about retinal imaging in neurodegenerative disease by providing examples from the literature and elaborating on limitations, challenges and future directions. We begin by providing a general background of the most relevant retinal imaging modalities to ensure that the reader has a foundation on which to understand the clinical studies that are subsequently discussed. We then review the application and results of retinal imaging methodologies to several prevalent neurodegenerative diseases where extensive work has been done including sporadic late onset Alzheimer's Disease, Parkinson's Disease and Huntington's Disease. We also discuss Autosomal Dominant Alzheimer's Disease and cerebrovascular small vessel disease, where the application of retinal imaging holds promise but data is currently scarce. Although cerebrovascular disease is not generally considered a neurodegenerative process, it is both a confounder and contributor to neurodegenerative disease processes that requires more attention. Finally, we discuss ongoing efforts to overcome the limitations in the field and unmet clinical and scientific needs.     

高度近视患者眼底改变的研究进展:基于OCTA观察

近视是我国最常见的眼科疾病之一,高度近视患者由于眼轴增长易导致机械应变伴随的一系列病理性近视眼底血管改变,进而导致视觉质量的进行性下降,严重时可致盲.OCTA是一种新的非侵入性成像技术,可在几秒内获得可视化的视网膜和脉络膜微血管分层系统图像.本文将综述OCTA近年来在观察高度近视眼底血管密度、血流面积及常见相关并发症方...     

Optical coherence tomography of choroidal osteoma

PURPOSE: To examine the cross-sectional structure of a choroidal osteoma using optical coherence tomography. METHODS: Observational case report. A choroidal osteoma in the right eye of a 22-year-old woman was studied with fluorescein and indocyanine green fundus angiograms and optical coherence tomography. RESULTS: The optical coherence tomography showed that a creamy-white lesion in the tumor had an increased reflectivity with a cavernous structure, whereas an orange lesion showed less reflectivity beneath the apparently intact retinal pigment epithelium. The area of less-intense whiteness in the creamy-white lesion showed higher reflectivity at the level of the retinal pigment epithelium, which precluded our viewing the deeper structure of the tumor. CONCLUSION: Optical coherence tomography can demonstrate the cavernous structure of a choroidal osteoma at a selective stage of a tumor's evolution, namely, when the retinal pigment epithelium is atrophied and the ossification is premature.     

Retinal imaging in uveitis

Ancillary investigations are the backbone of uveitis workup for posterior segment inflammations. They help in establishing the differential diagnosis and making certain diagnosis by ruling out certain pathologies and are a useful aid in monitoring response to therapy during follow-up. These investigations include fundus photography including ultra wide field angiography, fundus autofluorescence imaging, fluorescein angiography, optical coherence tomography and multimodal imaging. This review aims to be an overview describing the role of these retinal investigations for posterior uveitis.     

新生血管性老年性黄斑变性亚型报告的国际新命名专家共识解读

随着眼底成像技术的快速发展,在多模式影像新概念的基础上建立新生血管性老年性黄斑变性（nAMD）新命名系统对于指导临床工作具有重要意义。2020年,由视网膜专家、眼底读片专家以及眼病理学家组成的nAMD研究组经过反复讨论并达成共识,在原有荧光素眼底血管造影和病理认识的基础上,结合吲哚青绿血管造影、光相干断层扫描及光相干断...