THE OPHTHALMOLOGIST S NEEDS FOR THE ANALYSIS OF THE RETINA

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Drusilla Ramsey
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1 biophotonics end-users needs THE OPHTHALMOLOGIST S NEEDS FOR THE ANALYSIS OF THE RETINA Dr Matonti Frédéric CHU Nord / INT AMU Marseille

2 ANATOMY OF THE RETINA

3 ANATOMY OF THE RETINA

4 ANATOMY OF THE RETINA Optical fibers Ganglionar cell Bipolar Cell LIGHT Photoreceptors Pigmentary epithelium Choroid

5 The visual function and retinal structure are parameters intimately connected structural examination of the retina

6 Clinical examination Indirect or direct ophtalmoscopy

7 Ophtalmoscopy What we actually do at each consultation The fundus is seen through a slit lamp Uses a light source and an aspherical convergent lens Stereo vision but only a small field visible

8 Paraclinical exams RETINOGRAPHY

9 RETINOGRAPHY Objective: pictures of the eye fundus with different wavelengths

10 RETINOGRAPHY Colored pictures: Uses white light Stereoscopic pictures are possible

11 Monochromatic light: Blue (500nm) => surface of the retina xantophyle pigment, optical fibers Optical fibers Ganglionar cell Bipolar Cell Photoreceptors Pigmentary epithelium Choroid

12 Green (570nm) => vessels and hemorrhages no vision of the choroid Optical fibers Ganglionar cell Bipolar Cell Photoreceptors Pigmentary epithelium Choroid

13 Red (645 nm)=> pigments atrophy, detached EP and under the EP Optical fibers Ganglionar cell Bipolar Cell Photoreceptors Pigmentary epithelium Choroid

14 Autofluorescent 480nm with a barrier : fluorescence light dysfunctions of the RPE

15 Paraclinical exams ANGIOGRAPHY

16 ANGIOGRAPHY Study the vascularization of the retina

17 Conventional angiographs 1st conventional angiographs with flash light The light was glared and time acquisition long

18 SLO Now we use Scanning Laser Ophtalmoscopy =SLO It uses a laser beam that scans the retina in a confocal system

19 Fluoro angiography blue light - fluorescence of the dye Fluorescein - Fluorescein is excited by nm light - Fluorescence light : nm Captor

20 Interests: Shows us: - Leackage of the vessels - Neovascularization - Abnormalities of the vessels: aneurysms, stenosis,, ischaemia

21 Paraclinical exams Indocyanine Green angiography

22 Objective: Shows the deep vascularization = below the EP =the choroidal vascularization Optical fibers Ganglionar cell Bipolar Cell Photoreceptors Pigmentary epithelium Choroid

23 ICG Angiography Infra red light Green indocyanin is excited with infrared light ICG Infrared light has a poor absorption by the RPE => the choroid below is visible Captor

24 ICG Angiography Interests: Shows the choroidal vascularization Less allergenic Used for ARMD diagnosis +++ Limits: Limited resolution

25 Optical Coherence Tomography = OCT

26 Optical Coherence Tomography Analysis of the light reflectivity in the different layers of the retina using spectrometry 2 to 3 seconds to perform a hundred cross-sectional images on a square of 6x6 mm

27 Optical Coherence Tomography None invasive study of the retina : cross-sectional images 1 st generation in the 90 s : time domain (10 µm) Actually: OCT spectral domain (5µm)

28 OCT en face: Analyses the different layers of the retina not with cross sectionnal images but in the frontal plan To detect the path of the neovessels Surface of the lesions

29 Limits: Not a dynamic examination

30 Paraclinical exams Angio-OCT

31 Angio-OCT Based on the concept that the only movable structures in the eye are the blood particles

32 Angio-OCT Analyses the vascularization of the retina WITHOUT dye To obtain a 3D visualization of the microvascularization of the retina

Decorrelation Algorithm Use movment of cells in vessels

33 Angio-OCT Maté Streho-Explore Vision Optovue Optovue XR ADVANTI Module SSADA : Split-Spectrum Amplitude Decorrelation Algorithm Use movment of cells in vessels But if the movement is too fast or too slow there is no signal

34 Maté Streho-Explore Vision Avantages Direct visualization of CNV Diagnosis Limits No staining No diffusion analysis

35 Adaptative Optics The first in vivo retinal «microscope» Visualisation of cells and vascular walls The rtx1 adaptive optics retinal camera from Imagine Eyes

36 Cellular resolution SLO (Scanning laser Adaptive optics ophthalmoscopy) Adaptive optics (zoom in) SLO (zoom in) Resolution µm microscopics structures are invisible Resolution 2-4 µm Retinal cells are visible Images: courtesy of Gocho, Kameya et al., Nippon Medical School Hokusoh Hospital, Chiba, Japan

37 OD i2k-retina image stitching software Fovea Nasal OS Rétine normale Temporal Fovea Courtesy Gocho & Pâques, Quinze-Vingts National Hospital, Paris I2k is a registered trademark of DualAlign L

38 i2k-retina image stitching software Courtesy Gocho & Pâques, Quinze-Vingts National Hospital, Paris Cone-rod dystrophy (CRD) I2k is a registered trademark of DualAlign L

39 The cluster OPTITEC in partnership with ONERA and Astrophysics Laboratory of Marseille (LAM) have opened the pooled European platform for adaptive optics (PEMOA)

40 40 Clinic Learning Pre clinical PEMOA Finance research logistics organization RTX1 + RH Cerimed - Provision of lecture halls Finance research Installation project technical validation project partnership Last available lab expertise Imagine Eyes Expertise Devices project partnership development Industrialization and Commercialization AP HM Other parteners Facilities Clinical trials Doctors Clinical learning Fresnel Animal models Technical or academic partner (Pharmaceutical group?)

41 Partnership POMA / CERIMED Promote the transfer of technology for the development of innovative products in the field of medical imaging Technical development PEMOA Pre Clinical Validation Cérimed / INT Clinical Validation AP-HM Partenaires Consortium PEMOA Financeurs

42 The PEMOA platform is active since the end of 2014, is the result of a successful collaboration between various public and private actors on the theme of adaptive optics (AO).

43 Conclusion Retinal imaging and ophthalmological imaging is a changing world The expectations of practitioners in their daily practice are mainly directed towards : - higher resolution : cellular imaging - Higher speed and larger field of view - Combined imaging (multimodal and/or functional imaging) - Dynamic imaging (vessels) - Targeted imaging (cell markers) Partnerships with all actors are key to progress

44 Thank you for your attention Dr F. Matonti Marseille

Fundus Autofluorescence. Jonathan A. Micieli, MD Valérie Biousse, MD

Fundus Autofluorescence. Jonathan A. Micieli, MD Valérie Biousse, MD Fundus Autofluorescence Jonathan A. Micieli, MD Valérie Biousse, MD The retinal pigment epithelium (RPE) has many important functions including phagocytosis of the photoreceptor outer segments Cone Rod