1. Articles from Cynthia A. Toth

    1-24 of 92 1 2 3 4 »
    1. Vascular Findings In A Small Retinoblastoma Tumor Using OCT-A

      Vascular Findings In A Small Retinoblastoma Tumor Using OCT-A

      Retinoblastoma (RB) is the most common primary intraocular malignancy of children. 1 Improvements in screening tactics and treatment methods have dramatically increased both patient and globe survival. 1,2 Imaging modalities such as fluorescein angiography (FA) have demonstrated retinal vascular abnormalities in both large and small caliber retinal vessels in eyes with retinoblastoma, 1 and optical coherence tomography (OCT) can reveal or confirm otherwise subclinical lesions. 2 OCT angiography (OCT-A) is a non-invasive imaging modality allowing for in vivo visualization of retinal and choroidal vasculature.

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    2. Imaging infant retinal vasculature with optical coherence tomography angiography

      Imaging infant retinal vasculature with optical coherence tomography angiography

      Study of infant retinal vascular development has been limited to histopathological reports. We report herein depth-resolved visualization of full-term infant parafoveal microvasculature and their similarity to that of young children using a portable optical coherence tomography angiography system.

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    3. Macular Features on Spectral-Domain Optical Coherence Tomography Imaging Associated With Visual Acuity in Coats' Disease

      Macular Features on Spectral-Domain Optical Coherence Tomography Imaging Associated With Visual Acuity in Coats' Disease

      Purpose : To investigate the association between macular features on spectral-domain optical coherence tomography (SD-OCT) and visual acuity (VA) in Coats' disease. Methods : Thirty-nine eyes (39 patients) with SD-OCT from January 1, 2008 to December 31, 2016 were reviewed for SD-OCT features. Central subfield (CSF) SD-OCT findings were analyzed relative to VA (logarithm of the minimum angle of resolution) at baseline and final visit (when follow-up ≥ 6 months) and across visits. Results : Mean VA ± standard deviation at baseline (37 eyes) was 0.92 ± 0.82. SD-OCT features associated with worse VA included, for treatment-naïve eyes ( n = 21), outer retinal atrophy ...

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    4. Volumetric Measurement of Subretinal Blebs Using Microscope-Integrated Optical Coherence Tomography

      Volumetric Measurement of Subretinal Blebs Using Microscope-Integrated Optical Coherence Tomography

      Purpose : We advance studies of subretinal treatments by developing a microscope-integrated optical coherence tomography (MIOCT) image-based method for measuring the volume of therapeutics delivered into the subretinal space. Methods : A MIOCT image-based volume measurement method was developed and assessed for accuracy and reproducibility by imaging an object of known size in model eyes. This method then was applied to subretinal blebs created by injection of diluted triamcinolone. Bleb volumes obtained from MIOCT were compared to the intended injection volume and the surgeon's estimation of leakage. Results : Validation of the image-based volume measurement method showed accuracy to ±1.0 μL ...

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    5. Characterization of Long Working Distance Optical Coherence Tomography for Imaging of Pediatric Retinal Pathology

      Characterization of Long Working Distance Optical Coherence Tomography for Imaging of Pediatric Retinal Pathology

      Purpose : We determined the feasibility of fovea and optic nerve head imaging with a long working distance (LWD) swept source optical coherence tomography (OCT) prototype in adults, teenagers, and young children. Methods : A prototype swept source OCT system with a LWD (defined as distance from the last optical element of the imaging system to the eye) of 350 mm with custom fixation targets was developed to facilitate imaging of children. Imaging was performed in 49 participants from three age groups: 26 adults, 16 children 13 to 18 years old (teenagers), and seven children under 6 years old (young children) under ...

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    6. Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

      Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

      Purpose Appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral-domain optical coherence tomography (SD OCT). We aimed to build SD OCT–based risk assessment models for 5-year new onset of GA and central GA on CP. Design Prospective, longitudinal study. Participants Age-Related Eye Disease Study 2 Ancillary SD OCT study participants with age-related macular degeneration (AMD) with bilateral large drusen or noncentral GA and at least 1 eye without advanced disease (n = 317). Methods For 1 eye per participant, qualitative and quantitative SD OCT variables were derived from standardized grading and semiautomated segmentation ...

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    7. HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING THROUGH THE UNDILATED PUPIL IN INFANTS BORN PRETERM OR WITH HYPOXIC INJURY OR HYDROCEPHALUS

      HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING THROUGH THE UNDILATED PUPIL IN INFANTS BORN PRETERM OR WITH HYPOXIC INJURY OR HYDROCEPHALUS

      Purpose: The authors investigated feasibility of undilated handheld spectral domain optical coherence tomography (SDOCT) retinal imaging in preterm infants and children with neurologic abnormalities. Methods: Under an institutional review board-approved protocol, the authors attempted handheld SDOCT imaging of the retina, choroid, and optic nerve in infants and young children without pupil dilation. Scans were analyzed for quality and successful capture of foveal, optic nerve, and retinal structural parameters and abnormalities. Results: The authors obtained images through an undilated pupil of 11 infants/children over 28 eye imaging sessions, 27 at the bedside without sedation, and one under anesthesia. Infants had ...

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    8. Optical Coherence Tomography and Wide-Field Fluorescein Angiography in Retinopathy of Prematurity (Book Chapter)

      Optical Coherence Tomography and Wide-Field Fluorescein Angiography in Retinopathy of Prematurity (Book Chapter)

      The advent and adaptation of many imaging modalities promise to revolutionize our understanding of retinopathy of prematurity (ROP) by improving the detection, diagnosis, and monitoring of response to treatment of this disease. Diagnosis and classification of ROP traditionally relies on an eye exam by an ophthalmologist expert in this area who characterizes extent and character of retinal vascularization via indirect ophthalmoscopy. Many tools now exist that allow for data acquisition by nurses, technicians, and other trained staff with the images analyzed in a more centralized location. We will focus on two rapidly evolving technologies, optical coherence tomography (OCT), and wide ...

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    9. Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease

      Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease

      Importance Intraoperative optical coherence tomography (OCT) has gained traction as an important adjunct for clinical decision making during vitreoretinal surgery, and OCT angiography (OCTA) has provided novel insights in clinical evaluation of retinal diseases. To date, these two technologies have not been applied in combination to evaluate retinal vascular disease in the operating suite. Objective To conduct microscope-integrated, swept-source OCTA (MIOCTA) in children with retinal vascular disease. Design, Setting, and Participants In this case report analysis, OCT imaging in pediatric patients, MIOCTA images were obtained during examination under anesthesia from a young boy with a history of idiopathic vitreous hemorrhage ...

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    10. Review of intraoperative optical coherence tomography: technology and applications [Invited]

      Review of intraoperative optical coherence tomography: technology and applications [Invited]

      During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon’s depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld ...

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    11. History of Intraoperative OCT

      History of Intraoperative OCT

      Pars plana vitrectomy is almost a half-century old, and the earliest probes were powered by batteries, said Cynthia A. Toth, MD, the Joseph A.C. Wadsworth professor of ophthalmology at Duke University Medical Center. OCT imaging has “revolutionized our pre- and postoperative assessment,” she said, “but while our tools have advanced, our microscopes have not.” Although OCT granted surgeons the ability to visualize anatomical abnormalities in the retina, surgeons returned to en face OCT-free views during surgery. Dr. Toth noted there are “three staged developments in OCT – stage A was intraoperative OCT,” where a two-dimensional view outside the microscope gave ...

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    12. Four-dimensional Microscope-Integrated Optical Coherence Tomography to Visualize Suture Depth in Strabismus Surgery

      Four-dimensional Microscope-Integrated Optical Coherence Tomography to Visualize Suture Depth in Strabismus Surgery

      The authors report the use of swept-source microscope-integrated optical coherence tomography (SS-MIOCT), capable of live four-dimensional (three-dimensional across time) intraoperative imaging, to directly visualize suture depth during lateral rectus resection. Key surgical steps visualized in this report included needle depth during partial and full-thickness muscle passes along with scleral passes.

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    13. Long working distance OCT with a compact 2f retinal scanning configuration for pediatric imaging

      Long working distance OCT with a compact 2f retinal scanning configuration for pediatric imaging

      Young and/or autistic children cannot be imaged with tabletop or handheld optical coherence tomography (OCT) because of their lack of attention and fear of large objects close to their face. We demonstrate a prototype retinal swept-source OCT system with a long working distance (from the last optical element to the subject’s eye) to facilitate pediatric imaging. To reduce the number of optical elements and axial length compared to the traditional 4

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    14. Optical Coherence Tomography Reflective Drusen Substructures Predict Progression to Geographic Atrophy in Age-related Macular Degeneration

      Optical Coherence Tomography Reflective Drusen Substructures Predict Progression to Geographic Atrophy in Age-related Macular Degeneration

      Purpose Structural and compositional heterogeneity within drusen comprising lipids, carbohydrates, and proteins have been previously described. We sought to detect and define phenotypic patterns of drusen heterogeneity in the form of optical coherence tomography–reflective drusen substructures (ODS) and examine their associations with age-related macular degeneration (AMD)–related features and AMD progression. Design Retrospective analysis in a prospective study. Participants Patients with intermediate AMD (n = 349) enrolled in the multicenter Age-Related Eye Disease Study 2 (AREDS2) ancillary spectral-domain optical coherence tomography (SD OCT) study. Methods Baseline SD OCT scans of 1 eye per patient were analyzed for the presence of ...

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    15. Spectral domain optical coherence tomography (SD-OCT) Imaging of the Vascular-Avascular junction in the nursery in infants with retinopathy of prematurity

      Spectral domain optical coherence tomography (SD-OCT) Imaging of the Vascular-Avascular junction in the nursery in infants with retinopathy of prematurity

      Since the publication of Foos, there has been little additional microanatomic data on the vascular-avascular junction in retinopathy of prematurity (ROP) in infants. We hypothesize that one could view retinal development across the vascular-avascular (V-AV) junction in infants with ROP using portable bedside SDOCT imaging and novel image analysis.

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    16. Impact of Microscope-Integrated OCT on Ophthalmology Resident Performance of Anterior Segment Surgical Maneuvers in Model Eyes

      Impact of Microscope-Integrated OCT on Ophthalmology Resident Performance of Anterior Segment Surgical Maneuvers in Model Eyes

      Purpose : The integration of swept-source optical coherence tomography (SS-OCT) into the operating microscope enables real-time, tissue-level three-dimensional (3D) imaging to aid in ophthalmic microsurgery. In this prospective randomized controlled study, we evaluated the impact of SS microscope-integrated OCT (MI-OCT) on ophthalmology residents' performance of ophthalmic microsurgical maneuvers. Methods : Fourteen ophthalmology residents from a single institution were stratified by year of training and randomized to perform four anterior segment surgical maneuvers on porcine eyes with (MI-OCT+) or without (MI-OCT−) direct intraoperative OCT guidance. Subsequently, both groups repeated the same maneuvers without MI-OCT feedback to test whether initial MI-OCT experience affected subsequent ...

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    17. Optical Coherence Tomography for Retinal Surgery: Perioperative Analysis to Real-Time Four-Dimensional Image-Guided Surgery

      Optical Coherence Tomography for Retinal Surgery: Perioperative Analysis to Real-Time Four-Dimensional Image-Guided Surgery

      Magnification of the surgical field using the operating microscope facilitated profound innovations in retinal surgery in the 1970s, such as pars plana vitrectomy. Although surgical instrumentation and illumination techniques are continually developing, the operating microscope for vitreoretinal procedures has remained essentially unchanged and currently limits the surgeon's depth perception and assessment of subtle microanatomy. Optical coherence tomography (OCT) has revolutionized clinical management of retinal pathology, and its introduction into the operating suite may have a similar impact on surgical visualization and treatment. In this article, we review the evolution of OCT for retinal surgery, from perioperative analysis to live ...

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    18. Optical coherence tomography of the preterm eye: from retinopathy of prematurity to brain development

      Optical coherence tomography of the preterm eye: from retinopathy of prematurity to brain development

      Preterm infants with retinopathy of prematurity are at increased risk of poor neurodevelopmental outcomes. Because the neurosensory retina is an extension of the central nervous system, anatomic abnormalities in the anterior visual pathway often relate to system and central nervous system health. We describe optical coherence tomography as a powerful imaging modality that has recently been adapted to the infant population and provides noninvasive, high-resolution, cross-sectional imaging of the infant eye at the bedside. Optical coherence tomography has increased understanding of normal eye development and has identified several potential biomarkers of brain abnormalities and poorer neurodevelopment.

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    19. Novel microscope-integrated stereoscopic heads-up display for intrasurgical optical coherence tomography

      Novel microscope-integrated stereoscopic heads-up display for intrasurgical optical coherence tomography

      Intra-operative optical coherence tomography (OCT) requires a display technology which allows surgeons to visualize OCT data without disrupting surgery. Previous research and commercial intrasurgical OCT systems have integrated heads-up display (HUD) systems into surgical microscopes to provide monoscopic viewing of OCT data through one microscope ocular. To take full advantage of our previously reported real-time volumetric microscope-integrated OCT (4D MIOCT) system, we describe a stereoscopic HUD which projects a stereo pair of OCT volume renderings into both oculars simultaneously. The stereoscopic HUD uses a novel optical design employing spatial multiplexing to project dual OCT volume renderings utilizing a single micro-display ...

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    20. MACULAR PSEUDO-HOLE IN SHAKEN BABY SYNDROME: UNDERSCORING THE UTILITY OF OPTICAL COHERENCE TOMOGRAPHY UNDER ANESTHESIA

      MACULAR PSEUDO-HOLE IN SHAKEN BABY SYNDROME: UNDERSCORING THE UTILITY OF OPTICAL COHERENCE TOMOGRAPHY UNDER ANESTHESIA

      Purpose: To describe a case of vitrectomy for nonclearing vitreous hemorrhage in shaken baby syndrome and the utility of intraoperative hand-held optical coherence tomography to distinguish a macular hole from a pseudo-hole. Methods: Case report of a 4-month-old girl. Results: After clearing of media opacity by vitrectomy, an apparent macular hole was seen with the operating microscope. However, this was shown to be only a pseudo-hole by intraoperative hand-held optical coherence tomography, requiring no further treatment. Conclusion: Intraoperative hand-held optical coherence tomography may be important when performing vitrectomy for nonclearing vitreous hemorrhage in shaken baby syndrome.

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    21. Real-Time Microscope-Integrated OCT to Improve Visualization in DSAEK for Advanced Bullous Keratopathy

      Real-Time Microscope-Integrated OCT to Improve Visualization in DSAEK for Advanced Bullous Keratopathy

      Purpose: To report the intraoperative use of microscope-integrated optical coherence tomography (MIOCT) to enable visualization for Descemet's stripping automated endothelial keratoplasty (DSAEK) in 2 patients with advanced bullous keratopathy. Methods: Patient 1 was an 83-year-old female and patient 2 was a 28-year-old male both with limited vision and significant pain from bullous keratopathy who underwent palliative DSAEK. Because of the severity and chronicity of the corneal decompensation in both patients, the view past the anterior cornea was negligible using standard microscope illumination techniques. We used spectral-domain (Patient 1) and swept-source (Patient 2) MIOCT, both of which rely on infrared ...

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    22. Retinal Imaging of Infants on Spectral Domain Optical Coherence Tomography

      Retinal Imaging of Infants on Spectral Domain Optical Coherence Tomography

      Spectral domain coherence tomography (SD OCT) has become an important tool in the management of pediatric retinal diseases. It is a noncontact imaging device that provides detailed assessment of the microanatomy and pathology of the infant retina with a short acquisition time allowing office examination without the requirement of anesthesia. Our understanding of the development and maturation of the infant fovea has been enhanced by SD OCT allowing an in vivo assessment that correlates with histopathology. This has helped us understand the critical correlation of foveal development with visual potential in the first year of life and beyond. In this ...

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    1-24 of 92 1 2 3 4 »
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