PURPOSE. To quantify the thickness of the outer retinal sublayers and choroid in pathological myopia and examine associations between these factors and best-corrected visual acuity (BCVA). METHODS. The cohort was composed of 21 eyes with emmetropia and 70 eyes with high myopia (49 simple high myopia; 21 pathological myopia). Optical coherence tomography images were segmented to determine macular thicknesses of the choroid and the following outer retinal sublayers: outer plexiform layer (OPL), Henle fiber layer and outer nuclear layer (HFL þ ONL), myoid and ellipsoid zone (MEZ), outer segment of photoreceptors (OS), and interdigitation zone and RPE/Bruch complex (IZ þ RPE). Correlations between BCVA and thickness of the outer retinal sublayers and choroid were determined. RESULTS. In pathological myopia, the choroid, HFL þ ONL, MEZ, and IZ þ RPE were thinner than in emmetropia and simple high myopia (P < 0.05). Simple and multiple regression models showed that MEZ thickness was correlated with BCVA (both P < 0.001). The relationship between MEZ thickness and BCVA varied with choroidal thickness (P ¼ 0.006). For a constant MEZ thickness, thinner choroids were associated with worse vision. In the final multiple regression predictive model, MEZ thickness, choroidal thickness, and interaction between MEZ and choroidal thickness (all P < 0.001) were predictors of BCVA. CONCLUSIONS. Outer retinal alterations, especially thinning of the MEZ, occurred in pathological myopia. The MEZ thickness was associated with BCVA, and this relationship was affected by choroidal thickness.

PURPOSE To investigate changes of whole eye axial biometry during accommodation using ultra-long scan depth optical coherence tomography (UL-OCT). DESIGN Prospective, observational case series. METHODS Twenty-one adult subjects were enrolled. Using UL-OCT, the left eye of each subject was imaged with relaxed (0 D) and accommodative stimuli (+6 D). Full eye biometry included central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness, vitreous length and axial length (AL). RESULTS During accommodation (+6 D), the axial biometry of the whole eye changed significantly. Compared to the rest state, ACD at the accommodative state decreased significantly from 3.128 ± 0.305 mm to 2.961 ± 0.298 mm (paired t-test, P < 0.001). The lens thickness increased significantly from 3.723 ± 0.237 mm to 3.963 ± 0.234 mm (P < 0.001). The vitreous length decreased significantly from 17.129 ± 0.864 mm to 17.057± 0.848 mm (P < 0.001). AL was 24.519 ± 0.917 mm at the rest state and increased to 24.545±0.915 mm with +6 D accommodation stimulus. The elongated AL of 26.1 ± 13.4 μm between the rest and accommodative states was significant (P < 0.001). CONCLUSIONS During accommodation, whole eye axial biometry changed, including a decrease in ACD and vitreous length, and an increase in lens thickness and AL. UL-OCT provides an alternative method that is suitable for full eye biometry during accommodation.

We demonstrated a novel approach of imaging the anterior segment including the ciliary muscle using combined and synchronized two spectral domain optical coherence tomography devices (SD-OCT). In one SD-OCT, a Complementary Metal-Oxide-Semiconductor Transistor (CMOS) camera and an alternating reference arm was used to image the anterior segment from the cornea to the lens. Another SD-OCT for imaging the ciliary muscle was equipped with a light source with a center wavelength of 1,310 nm and a bandwidth of 75 nm. Repeated measurements were performed under relaxed and 4.00 D accommodative stimulus states in six eyes from 6 subjects. We also imaged dynamic changes in the anterior segment in one eye during accommodation. The biometry of the anterior segment and the ciliary muscle was obtained. The combined system appeared to be capable to simultaneously real-time image the biometry of the anterior segment, including the ciliary muscle, in vivo during accommodation.

The purpose of this study was to measure alterations of inner retinal microvascular density and outer retinal sublayer thicknesses in pathological myopia, and to correlate the measured parameters with best corrected visual acuity (BCVA). METHODS. Optical coherence tomography (OCT) and OCT angiography (OCTA) images of 21 control, 48 simple high myopia, and 22 pathological myopia eyes were analyzed to quantify the thicknesses of the outer retinal sublayers and the density of the inner retinal microvascular network that includes the superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP). Retinal sublayer thicknesses and microvascular densities were compared among the three groups, and correlations of sublayer thicknesses and microvascular densities with BCVA were determined. RESULTS. In pathological myopia, density of the DRCP, thicknesses of myoid and ellipsoid zone (MEZ), interdigitation zone and retinal pigment epithelium/Bruch complex (IZ + RPE), and choroid were lower than in simple high myopia (P < 0.05). The decreased DRCP density was correlated with thinner MEZ and IZ+RPE in pathological myopia (P < 0.05), but not in simple high myopia (P > 0.05). Simple linear regression showed that axial length, female, thicknesses of outer plexiform layer (OPL), MEZ, IZ + RPE, choroid, and density of the SRCP and DRCP were correlated with BCVA. In multiple regression analysis, worse BCVA was associated only with thinner MEZ, thinner choroid, and decreased DRCP (P < 0.05). CONCLUSIONS. Alteration of inner retinal microvascular density and outer retinal sublayer thicknesses occurred in pathological myopia, especially decreased DRCP and thinner MEZ, which were significantly associated with worse BCVA.

We demonstrated the feasibility of a CMOS-based spectral domain OCT (SD-OCT) for versatile ophthalmic applications of imaging the corneal epithelium, limbus, ocular surface, contact lens, crystalline lens, retina, and full eye in vivo. The system was based on a single spectrometer and an alternating reference arm with four mirrors. A galvanometer scanner was used to switch the reference beam among the four mirrors, depending on the imaging application. An axial resolution of 7.7 μm in air, a scan depth of up to 37.7 mm in air, and a scan speed of up to 70,000 A-lines per second were achieved. The approach has the capability to provide high-resolution imaging of the corneal epithelium, contact lens, ocular surface, and tear meniscus. Using two reference mirrors, the zero delay lines were alternatively placed on the front cornea or on the back lens. The entire ocular anterior segment was imaged by registering and overlapping the two images. The full eye through the pupil was measured when the reference arm was switched among the four reference mirrors. After mounting a 60 D lens in the sample arm, this SD-OCT was used to image the retina, including the macula and optical nerve head. This system demonstrates versatility and simplicity for multi-purpose ophthalmic applications.

Age-related changes in the lens reshaping and ciliary muscle forward movement were found. Lens reshaping was much slower than the contraction of the ciliary muscle, especially in aging eyes, and this process required the ciliary muscle to contract more to reach a given response.

Purpose-To test the feasibility of measuring the entire thickness profiles of the epithelium and contact lens in vivo, using high speed and high resolution spectral domain optical coherence tomography (SD-OCT).Methods-A custom-built, long scan depth SD-OCT was developed based on a CMOS camera and the axial resolution was about 5.1 µm in tissue. Five eyes of 5 subjects were imaged twice across the horizontal meridian before and while wearing one contact lens (CL). Semi-automatic measurement was done to yield the entire thickness profiles of the epithelium, total cornea, and contact lens after correcting for optical distortion.Results-The full width and depth of the epithelium, ocular surface and contact lens were clearly visualized. The epithelial thickness (ET) at the center was 51.9 ± 3.5 µm, it remained at this thickness across the central 7 mm diameter and then increased at both temporal and nasal peripheries. The contact lens profile showed the thinnest point at the center with thickness of 100.3 ± 4.9 µm. The thickness increased towards the mid-periphery and then decreased at the edge.Conclusions-This pilot study demonstrated the feasibility of using high speed CMOS-based OCT to evaluate the entire thickness profiles of the epithelium and contact lens in vivo. Further development will be needed to extend the scanning from 2D to 3D with a robust automatic image processing ability.

PURPOSE. To investigate structural changes in the retinal outer layers and choroid using adaptive optics (AO) and optical coherence tomography (OCT) in eyes with myopia, and to correlate the changes with decreased macular light sensitivity (MLS). METHODS. This prospective study included 27 subjects with emmetropia and low myopia (EM/ LM), 25 with moderate myopia (MM), and 25 with high myopia (HM). Microperimetry was used to quantify MLS in each subject, while AO and OCT images of fundus were analyzed to quantify cone density and regularity and thickness of outer retinal sublayers and choroid. Differences of MLS, cone distribution, and chorioretinal thicknesses were compared among the three groups, and the associations among photoreceptor morphological alterations, MLS, and other parameters were analyzed. RESULTS. In HM, the MLS, cone density and regularity, and thicknesses of the myoid and ellipsoid zone (MEZ), Henle fiber layer and outer nuclear layer, interdigitation zone and RPE/ Bruch complex, and choroid were lower than in EM/LM. Decreased MLS was correlated with lower cone density and regularity, and thinner MEZ and choroid in the inner region, and with lower cone density, thinner MEZ and choroid, and longer axial length in the outer region. Multivariate regression showed that better MLS was correlated with thicker MEZ in the inner region and with higher cone density in the outer region. CONCLUSIONS. Altered cone distribution and outer retinal thickness, especially cone density and MEZ thickness, were significantly correlated with decline of MLS in HM, which may help to evaluate and monitor visual impairment in HM.