1. Articles from James G. Fujimoto

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    1. Geometric Perfusion Deficits: A Novel OCT Angiography Biomarker for Diabetic Retinopathy Based on Oxygen Diffusion

      Geometric Perfusion Deficits: A Novel OCT Angiography Biomarker for Diabetic Retinopathy Based on Oxygen Diffusion

      Purpose To develop geometric perfusion deficits (GPD), an optical coherence tomography angiography (OCTA) biomarker based on oxygen diffusion, and to evaluate its utility in a pilot study of healthy subjects and patients with diabetic retinopathy (DR). Design Retrospective cross-sectional study. Methods Commercial spectral-domain OCTA instruments were used to acquire repeated 3×3 mm 2 and 6×6 mm 2 motion-corrected macular OCTA volumes. En face OCTA images corresponding to the superficial capillary plexus (SCP), deep capillary plexus (DCP), and full retinal projections were obtained using automatic segmentation. For each projection, the GPD percentage and the vessel density percentage, the control ...

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    2. The long-term effects of anti-vascular endothelial growth factor therapy on the optical coherence tomography angiographic appearance of neovascularization in age-related macular degeneration

      The long-term effects of anti-vascular endothelial growth factor therapy on the optical coherence tomography angiographic appearance of neovascularization in age-related macular degeneration

      Background The short-term effects of anti-vascular endothelial growth factor (anti-VEGF) treatment on macular neovascularization (MNV) morphology is well described, but long-term studies on morphologic changes and correlation of such changes to the type of MNV have not been conducted. This study aims to determine if different types of MNVs in neovascular AMD (nAMD) behave differently with anti-VEGF treatment as visualized on optical coherence tomography angiography (OCTA). Methods Treatment-naïve nAMD patients were retrospectively screened for baseline and follow-up OCTA imaging 10 or more months after initial treatment. Images were graded for MNV type, area, activity, mature versus immature vessels, vessel ...

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    3. High-Speed, Ultrahigh-Resolution Spectral-Domain OCT with Extended Imaging Range Using Reference Arm Length Matching

      High-Speed, Ultrahigh-Resolution Spectral-Domain OCT with Extended Imaging Range Using Reference Arm Length Matching

      Purpose : To develop high-speed, extended-range, ultrahigh-resolution spectral-domain optical coherence tomography (UHR SD-OCT) and demonstrate scan protocols for clinical retinal imaging. Methods : A UHR SD-OCT operating at 840-nm with 150-nm bandwidths was developed. The axial imaging range was extended by dynamically matching reference arm length to the retinal contour during acquisition. Two scan protocols were demonstrated for imaging healthy participants and patients with dry age-related macular degeneration. A high-definition raster protocol with intra–B-scan reference arm length matching (ReALM) was used for high-quality cross-sectional imaging. A cube volume scan using horizontal and vertical rasters with inter–B-scan ReALM and software motion ...

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    4. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography

      Split-spectrum amplitude-decorrelation angiography with optical coherence tomography

      Amplitude decorrelation measurement is sensitive to transverse flow and immune to phase noise in comparison to Doppler and other phase-based approaches. However, the high axial resolution of OCT makes it very sensitive to the pulsatile bulk motion noise in the axial direction. To overcome this limitation, we developed split-spectrum amplitude-decorrelation angiography (SSADA) to improve the signal-to-noise ratio (SNR) of flow detection. The full OCT spectrum was split into several narrower bands. Inter-B-scan decorrelation was computed using the spectral bands separately and then averaged. The SSADA algorithm was tested on in vivo images of the human macula and optic nerve head ...

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    5. Analyzing Relative Flow Speeds in Diabetic Retinopathy Using Variable Interscan Time Analysis Optical Coherence Tomography Angiography

      Analyzing Relative Flow Speeds in Diabetic Retinopathy Using Variable Interscan Time Analysis Optical Coherence Tomography Angiography

      Objective Further insight into the flow characteristics of the vascular features associated with diabetic retinopathy (DR) may improve assessment and treatment of disease progression. The variable interscan time analysis (VISTA) algorithm is an extension of optical coherence tomography angiography (OCTA) that detects relative blood flow speeds which can then be depicted on a color-coded map. This study utilized VISTA to analyze relative blood flow speeds in the microvascular changes associated with DR. Design and Participants: In this cross-sectional study at New England Eye Center, Boston, Massachusetts, thirteen patients of varying severities of DR were enrolled. Methods OCTA images centered at ...

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    6. Macular and Peripapillary OCTA Metrics Predict Progression in Diabetic Retinopathy: A Sub-analysis of TIME-2b Study Data

      Macular and Peripapillary OCTA Metrics Predict Progression in Diabetic Retinopathy: A Sub-analysis of TIME-2b Study Data

      Purpose To identify optical coherence tomography angiography (OCTA) derived vessel metrics of the macula and optic nerve head (ONH) that predict diabetic retinopathy (DR) disease progression. Design Secondary analysis of clinical trial data Methods This was a sub-analysis of prospectively collected data from 73 subjects that participated in the TIME-2b Study (Aerpio Pharmaceuticals), a multi-center clinical trial for patients with moderate to severe DR treated with AKB-9778 and followed over a 12-month period. Eligible subjects were tested every 3 months with color fundus photography, spectral domain OCT and slit-lamp biomicroscopy. OCTA of the macula and ONH was obtained for a ...

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    7. Tethered capsule en face optical coherence tomography for imaging Barrett’s esophagus in unsedated patients

      Tethered capsule en face optical coherence tomography for imaging Barrett’s esophagus in unsedated patients

      Objective Detection of Barrett’s esophagus (BE) at points of care outside the endoscopy suite may improve screening access and reduce esophageal adenocarcinoma mortality. Tethered capsule optical coherence tomography (OCT) can volumetrically image esophageal mucosa and detect BE in unsedated patients. We investigated ultrahigh-speed tethered capsule, swept-source OCT (SS-OCT) in unsedated patients, improved device design, developed procedural techniques, measured how capsule contact and longitudinal pullback non-uniformity affect coverage, and assessed patient toleration. Design OCT was performed in 16 patients prior to endoscopic surveillance/treatment. Unsedated patients swallowed the capsule with small sips of water and the esophagus imaged by retracting ...

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    8. Correction propagation for user-assisted optical coherence tomography segmentation: general framework and application to Bruch’s membrane segmentation

      Correction propagation for user-assisted optical coherence tomography segmentation: general framework and application to Bruch’s membrane segmentation

      Optical coherence tomography (OCT) is a commonly used ophthalmic imaging modality. While OCT has traditionally been viewed cross-sectionally (i.e., as a sequence of B-scans), higher A-scan rates have increased interest in en face OCT visualization and analysis. The recent clinical introduction of OCT angiography (OCTA) has further spurred this interest, with chorioretinal OCTA being predominantly displayed via en face projections. Although en face visualization and quantitation are natural for many retinal features (e.g., drusen and vasculature), it requires segmentation. Because manual segmentation of volumetric OCT data is prohibitively laborious in many settings, there has been significant research and ...

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    9. Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept–source optical coherence tomography angiography

      Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept–source optical coherence tomography angiography

      Background The purpose of this study was to investigate the association between diabetic retinopathy (DR) severity and macular choriocapillaris (CC) flow deficit percentage (FD %) in different macular regions using swept-source optical coherence tomography angiography (SS-OCTA). Methods Diabetic patients with SS-OCTA images were graded by severity and retrospectively assessed. CC FD % was calculated in four different regions of the OCTA image: inner, middle, outer, and full-field region. The generalized estimating equations (GEE) approach for clustered eye data was used to determine effect size and significance of age and disease severity on FD % for each region. Results 160 eyes from 90 total ...

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    10. Compressed Sensing for Optical Coherence Tomography Angiography Volume Generation

      Compressed Sensing for Optical Coherence Tomography Angiography Volume Generation

      Optical coherence tomography angiography (OCTA) is an increasingly popular modality for imaging of the retinal vasculature. Repeated optical coherence tomography (OCT) scans of the retina allow the computation of motion contrast to display the retinal vasculature. To the best of our knowledge, we present the first application of compressed sensing for the generation of OCTA volumes. Using a probabilistic signal model for the computation of OCTA volumes and a 3D median filter, it is possible to perform compressed sensing reconstruction of OCTA volumes while suppressing noise. The presented approach was tested on a ground truth, averaged from ten individual OCTA ...

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    11. Deep OCT Angiography Image Generation for Motion Artifact Suppression

      Deep OCT Angiography Image Generation for Motion Artifact Suppression

      Eye movements, blinking and other motion during the acquisition of optical coherence tomography (OCT) can lead to artifacts, when processed to OCT angiography (OCTA) images. Affected scans emerge as high intensity (white) or missing (black) regions, resulting in lost information. The aim of this research is to fill these gaps using a deep generative model for OCT to OCTA image translation relying on a single intact OCT scan. Therefore, a U-Net is trained to extract the angiographic information from OCT patches. At inference, a detection algorithm finds outlier OCTA scans based on their surroundings, which are then replaced by the ...

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    12. Application of Corneal Optical Coherence Tomography Angiography for Assessment of Vessel Depth in Corneal Neovascularization

      Application of Corneal Optical Coherence Tomography Angiography for Assessment of Vessel Depth in Corneal Neovascularization

      Purpose: To map and measure the depths of corneal neovascularization (NV) using 3-dimensional optical coherence tomography angiography (OCTA) at 2 different wavelengths. Methods: Corneal NV of varying severity, distribution, and underlying etiology was examined. Average NV depth and vessel density were measured using 840-nm spectral-domain OCTA and 1050-nm swept-source OCTA. The OCTA results were compared with clinical slit-lamp estimation of NV depth. Results: Twelve eyes with corneal NV from 12 patients were imaged with OCTA. Clinically “superficial,” “midstromal,” and “deep” cases had an average vessel depth of 23%, 39%, and 66% on 1050-nm OCTA, respectively. Average vessel depth on OCTA ...

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    13. A Framework for Multiscale Quantitation of Relationships Between Choriocapillaris Flow Impairment and Geographic Atrophy Growth

      A Framework for Multiscale Quantitation of Relationships Between Choriocapillaris Flow Impairment and Geographic Atrophy Growth

      Purpose To develop a multiscale analysis framework for investigating the relationships between geographic atrophy (GA) growth rate and choriocapillaris (CC) blood flow impairment using optical coherence tomography (OCT) and OCT angiography (OCTA). Design Retrospective case series. Methods We developed an OCT/OCTA analysis framework that quantitatively measures GA growth rates at global and local scales, and CC impairment at global, zonal, and local scales. A geometric GA growth model was used to measure local GA growth rates. The utility of the framework was demonstrated on 7 eyes with GA imaged at two time points using a prototype 400 kHz, 1050 ...

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    14. Global Analysis of Macular Choriocapillaris Perfusion in Dry Age-Related Macular Degeneration using Swept-Source Optical Coherence Tomography Angiography

      Global Analysis of Macular Choriocapillaris Perfusion in Dry Age-Related Macular Degeneration using Swept-Source Optical Coherence Tomography Angiography

      Purpose : Swept-source optical coherence tomography angiography (SS-OCTA) was used to investigate if the clinical stage of dry age-related macular degeneration (AMD) was correlated with global and regional macular choriocapillaris (CC) perfusion. Methods : In this retrospective, cross-sectional study, 6 × 6-mm SS-OCTA images from eyes with early, intermediate, and advanced dry AMD (56 eyes, 41 patients) were analyzed using algorithms described in the literature to assess regional flow deficit percentage (FD%) and average flow deficit size. Regions were defined by concentric areas centered on the fovea: a 1-mm-diameter area, 3-mm-diameter ring, 5-mm-diameter area, 5-mm-diameter ring, and 6 × 6-mm whole image. Data were ...

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    15. Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

      Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

      Purpose : To evaluate whether retinal capillary nonperfusion is found predominantly adjacent to arteries or veins in eyes with diabetic retinopathy (DR). Methods : Sixty-three eyes from 44 patients with proliferative DR (PDR) or non-PDR (NPDR) were included. Images (12 × 12-mm) foveal-centered optical coherence tomography (OCT) angiography (OCTA) images were taken using the Zeiss Plex Elite 9000. In 37 eyes, widefield montages with five fixation points were also obtained. A semiautomatic algorithm that detects nonperfusion in full-retina OCT slabs was developed, and the percentages of capillary nonperfusion within the total image area were calculated. Retinal arteries and veins were manually traced. Based ...

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    16. Controlling for Artifacts in Widefield Optical Coherence Tomography Angiography Measurements of Non-Perfusion Area

      Controlling for Artifacts in Widefield Optical Coherence Tomography Angiography Measurements of Non-Perfusion Area

      The recent clinical adoption of optical coherence tomography (OCT) angiography (OCTA) has enabled non-invasive, volumetric visualization of ocular vasculature at micron-scale resolutions. Initially limited to 3 mm × 3 mm and 6 mm × 6 mm fields-of-view (FOV), commercial OCTA systems now offer 12 mm × 12 mm, or larger, imaging fields. While larger FOVs promise a more complete visualization of retinal disease, they also introduce new challenges to the accurate and reliable interpretation of OCTA data. In particular, because of vignetting, wide-field imaging increases occurrence of low-OCT-signal artifacts, which leads to thresholding and/or segmentation artifacts, complicating OCTA analysis. This study presents ...

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    17. QUANTIFICATION OF RETINAL CAPILLARY NONPERFUSION IN DIABETICS USING WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

      QUANTIFICATION OF RETINAL CAPILLARY NONPERFUSION IN DIABETICS USING WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

      Purpose: To combine advances in high-speed, wide-field optical coherence tomography angiography ( OCTA ) with image processing methods for semiautomatic quantitative analysis of capillary nonperfusion in patients with diabetic retinopathy (DR). Methods: Sixty-eight diabetic patients (73 eyes), either without retinopathy or with different degrees of retinopathy, were prospectively recruited for volumetric swept-source OCTA imaging using 12 mm × 12 mm fields centered at the fovea. A custom, semiautomatic software algorithm was used to quantify areas of capillary nonperfusion . Results: The mean percentage of nonperfused area was 0.1% (95% confidence interval: 0.0–0.4) in the eyes without DR; 2.1% (95 ...

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    18. Feature Of The Week 10/08/2018: Clinical Utility of Ultrahigh-Speed Endoscopic Optical Coherence Tomography in Gastroenterology

      Feature Of The Week 10/08/2018: Clinical Utility of Ultrahigh-Speed Endoscopic Optical Coherence Tomography in Gastroenterology

      Barrett’s esophagus (BE) surveillance is limited by biopsy sampling error. Optical coherence tomography (OCT) enables microscopic resolution, high speed, volumetric imaging and is commercially available as volumetric laser endomicroscopy (VLE, NinePoint Medical). Studies investigated cross-sectional OCT dysplasia features, including a diagnostic algorithm (VLE-DA), however, many VLE studies used ex vivo specimens due to challenges in registering biopsy with OCT. We previously demonstrated ultrahigh-speed endoscopic OCT >10x faster than commercial instruments, enabling depth-resolved en face and cross-sectional imaging. This study investigated volumetric en face and cross-sectional OCT for identifying neoplasia. 74 OCT datasets with correlated biopsy/endoscopic mucosal resection histology ...

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    19. Assessment of Barrett’s esophagus and dysplasia with ultrahigh-speed volumetric en face and cross-sectional optical coherence tomography

      Assessment of Barrett’s esophagus and dysplasia with ultrahigh-speed volumetric en face and cross-sectional optical coherence tomography

      Background  This study aimed to evaluate the use of ultrahigh-speed volumetric en face and cross-sectional optical coherence tomography (OCT) with micromotor catheters for the in vivo assessment of Barrett’s esophagus and dysplasia. Methods  74 OCT datasets with correlated biopsy/endoscopic mucosal resection histology (49 nondysplastic Barrett’s esophagus [NDBE], 25 neoplasia) were obtained from 14 patients with Barrett’s esophagus and a history of dysplasia and 30 with NDBE. The associations between irregular mucosal patterns on en face OCT, absence of mucosal layering, surface signal > subsurface, and > 5 atypical glands on cross-sectional OCT vs. histology and treatment history were ...

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    20. A Joint Probabilistic Model for Speckle Variance, Amplitude Decorrelation and Interframe Variance (IFV) Optical Coherence Tomography Angiography

      A Joint Probabilistic Model for Speckle Variance, Amplitude Decorrelation and Interframe Variance (IFV) Optical Coherence Tomography Angiography

      Optical Coherence Tomography Angiography (OCTA) is a general method to visualize blood flow in biological tissue. Despite its good results in practice, the commonly used Amplitude Decorrelation OCTA (AD-OCTA) measure suffers from a well-understood objective function, which makes it challenging to mathematically model post processing tasks like, e.g., denoising. In this paper, a probabilistic model is developed for the three OCTA measures Speckle Variance OCTA, ADOCTA and the newly proposed Interframe Variance OCTA (IFV-OCTA) to enable further tasks like regularization-based denoising. From a theoretical point of view, IFV-OCTA is shown to be in-between the other two methods and can ...

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    21. Microscope-Integrated Intraoperative Ultrahigh-Speed Swept-Source Optical Coherence Tomography for Widefield Retinal and Anterior Segment Imaging

      Microscope-Integrated Intraoperative Ultrahigh-Speed Swept-Source Optical Coherence Tomography for Widefield Retinal and Anterior Segment Imaging

      BACKGROUND AND OBJECTIVE: To demonstrate the feasibility of retinal and anterior segment intraoperative widefield imaging using an ultrahigh-speed, swept-source optical coherence tomography (SS-OCT) surgical microscope attachment. PATIENTS AND METHODS: A prototype post-objective SS-OCT using a 1,050-nm wavelength, 400 kHz A-scan rate, vertical cavity surface-emitting laser (VCSEL) light source was integrated to a commercial ophthalmic surgical microscope after the objective. Each widefield OCT data set was acquired in 3 seconds (1,000 × 1,000 A-scans, 12 × 12 mm 2 for retina and 10 × 10 mm 2 for anterior segment). RESULTS: Intraoperative SS-OCT was performed in 20 eyes of 20 patients ...

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    22. Temporal and Volumetric Denoising via Quantile Sparse Image (QuaSI) Prior in Optical Coherence Tomography and Beyond

      Temporal and Volumetric Denoising via Quantile Sparse Image (QuaSI) Prior in Optical Coherence Tomography and Beyond

      This paper introduces an universal and structure-preserving regularization term, called quantile sparse image (QuaSI) prior. The prior is suitable for denoising images from various medical image modalities. We demonstrate its effectivness on volumetric optical coherence tomography (OCT) and computed tomography (CT) data, which show differnt noise and image characteristics. OCT offers high-resolution scans of the human retina but is inherently impaired by speckle noise. CT on the other hand has a lower resolution and shows high-frequency noise. For purpose of denoising, we propose a variational framework based on the QuaSI prior and a Huber data fidelity model that can handle ...

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    23. Cycloid scanning for wide field optical coherence tomography endomicroscopy and angiography in vivo

      Cycloid scanning for wide field optical coherence tomography endomicroscopy and angiography in vivo

      Devices that perform wide field-of-view (FOV) precision optical scanning are important for endoscopic assessment and diagnosis of luminal organ disease such as in gastroenterology. Optical scanning for in vivo endoscopic imaging has traditionally relied on one or more proximal mechanical actuators, limiting scan accuracy and imaging speed. There is a need for rapid and precise two-dimensional (2D) microscanning technologies to enable the translation of benchtop scanning microscopies to in vivo endoscopic imaging. We demonstrate a new cycloid scanner in a tethered capsule for ultrahigh speed, side-viewing optical coherence tomography (OCT) endomicroscopy in vivo . The cycloid capsule incorporates two scanners: a ...

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    24. Ultrahigh-speed endoscopic optical coherence tomography and angiography enables delineation of lateral margins of endoscopic mucosal resection: a case report

      Ultrahigh-speed endoscopic optical coherence tomography and angiography enables delineation of lateral margins of endoscopic mucosal resection: a case report

      Endoscopic mucosal resection (EMR) is a common technique for resecting dysplastic lesions in Barrett’s esophagus (BE), stomach, and colon, 1 but precise delineation of dysplastic margins before resection and verification of complete removal after resection remain challenging. 2 , 3 Endoscopic optical coherence tomography (OCT) enables three-dimensional visualization of tissue microstructure and is commercially available as Volumetric Laser Endomicroscopy (NinePoint Medical, Bedford, MA, USA). 4 , 5 We recently developed an ultrahigh-speed endoscopic OCT system which operates more than 10 times faster than commercial instruments, generating volumetric images with higher transverse resolution and voxel density. 6 , 7 This allows visualization of ...

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    1. (236 articles) James G. Fujimoto
    2. (235 articles) Massachusetts Institute of Technology
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