The utility of anterior segment optical coherence tomography angiography for the assessment of limbal stem cell deficiency

Binotti, William; Nosé, Ricardo Menon; Koseoglu, Neslihan Dilruba; Dieckmann, G; Kenyon, Kenneth R.; Hamrah, Pedram

doi:10.1016/j.jtos.2020.04.007

Cited by 22 publications

(9 citation statements)

References 38 publications

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“…The application of OCTA to investigate vessel morphology has been demonstrated for monitoring inflammation 38 , corneal neovascularization 39 , 40 , limbal stem cell deficiency 41 , and tumor growth 42 . Thus, anterior eye OCTA may serve as a non-invasive alternative to fluorescein angiography for assessing vascular morphology to determine malignancy.…”

Section: Discussionmentioning

confidence: 99%

High speed, long range, deep penetration swept source OCT for structural and angiographic imaging of the anterior eye

Chen

Potsaid

et al. 2022

Sci Rep

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This study reports the development of prototype swept-source optical coherence tomography (SS-OCT) technology for imaging the anterior eye. Advances in vertical-cavity surface-emitting laser (VCSEL) light sources, signal processing, optics and mechanical designs, enable a unique combination of high speed, long range, and deep penetration that addresses the challenges of anterior eye imaging. We demonstrate SS-OCT with a 325 kHz A-scan rate, 12.2 µm axial resolution (in air), and 15.5 mm depth range (in air) at 1310 nm wavelength. The ultrahigh 325 kHz A-scan rate not only facilitates biometry measurements by minimizing acquisition time and thus reducing motion, but also enables volumetric OCT for comprehensive structural analysis and OCT angiography (OCTA) for visualizing vasculature. The 15.5 mm (~ 11.6 mm in tissue) depth range spans all optical surfaces from the anterior cornea to the posterior lens capsule. The 1310 nm wavelength range enables structural OCT and OCTA deep in the sclera and through the iris. Achieving high speed and long range requires linearizing the VCSEL wavenumber sweep to efficiently utilize analog-to-digital conversion bandwidth. Dual channel recording of the OCT and calibration interferometer fringe signals, as well as sweep to sweep wavenumber compensation, is used to achieve invariant 12.2 µm (~ 9.1 µm in tissue) axial resolution and optimum point spread function throughout the depth range. Dynamic focusing using a tunable liquid lens extends the effective depth of field while preserving the lateral resolution. Improved optical and mechanical design, including parallax “split view” iris cameras and stable, ergonomic patient interface, facilitates accurate instrument positioning, reduces patient motion, and leads to improved imaging data yield and measurement accuracy. We present structural and angiographic OCT images of the anterior eye, demonstrating the unique imaging capabilities using representative scanning protocols which may be relevant to future research and clinical applications.

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Section: Discussionmentioning

confidence: 99%

High speed, long range, deep penetration swept source OCT for structural and angiographic imaging of the anterior eye

Chen

Potsaid

et al. 2022

Sci Rep

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“…However, epithelial thickness parameters depend on stage and chronicity of LSCD, hence could be useful for quantitatively staging LSCD but may not be a reliable criterion for diagnosis of LSCD. Binotti et al described the use of OCT angiography for assessing eyes with LSCD by analysing changes in vascular parameters such as the maximum corneal vascular extension from the limbus to the furthest vessel over the cornea, and corneal vascular thickness from the most superficial to the deepest corneal vessel [ 25 ]. However, in the study by Binotti et al, the aetiology for LSCD was LSCD secondary to contact lens wear, herpetic keratitis, or chronic allergic keratitis, in contrast to our study where the aetiology for a majority of cases was LSCD secondary to ocular chemical injuries.…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Optical Coherence Tomography Angiography Characteristics of Limbal Stem Cell Deficiency

et al. 2021

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This study aimed to identify the anterior segment high-resolution optical coherence tomography (HR-OCT) and HR-OCT angiography (HR-OCTA) features suggestive of limbal stem cell deficiency (LSCD) as confirmed by both impression cytology (IC) and in vivo confocal microscopy (IVCM). This was a single-centre prospective cross-sectional study including 24 eyes of 22 patients with clinical suspicion of LSCD based on peripheral superficial corneal vascularisation and scarring. On IC and IVCM, performed and interpreted by blinded observers, 12 eyes each were diagnosed with and without LSCD. Additionally, 10 eyes of 5 healthy volunteers with no ocular pathology were also imaged. The 136 HR-OCT/A images of these 34 eyes were analysed with respect to 12 imaging parameters; the parameters most suggestive of LSCD were identified and the sensitivity and specificity were calculated. In the LSCD group, the most common aetiology was ocular chemical burns (83%), whereas in the non-LSCD group, the most common aetiology was viral keratitis (67%). Multiple logistic regression analysis revealed that mean epithelial reflectivity, mean stromal reflectivity, and mean superficial vascular density were the parameters that were diagnostic of LSCD on HR-OCT/A (p < 0.0001). A ratio of the mean epithelial reflectivity to stromal reflectivity of >1.29 corresponded with a high sensitivity (91.7%) and specificity (98.75%); while a mean superficial vascular density score of >0.38 corresponded with a sensitivity of 97.9% and specificity of 73.8%. In conclusion, HR-OCT/A as a non-invasive imaging modality could prove to be a useful tool for confirming the diagnosis of LSCD, with potential clinical and research applications.

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“…Central corneal epithelial thickness and limbal epithelial thickness on AS-OCT appear to correlate with LCSD disease, making these measurements a potentially useful diagnostic aid. 44 , 45 In addition to providing 3-dimensional cross-sectional images of the limbal niche, 44 , 46 AS-OCTA provides a volumetric analysis of microvasculature by identifying the change in signal produced by red blood cell motion through sequential scans at the same site. 44 Recently, it has been reported as a diagnostic tool of LSCD via assessing limbal vessel architecture, limbal vessel density measurements and quantifying extension and depth of corneal vascularization.…”

Section: Limbal Stem Cell Deficiency (Lscd)mentioning

confidence: 99%

Current and Emerging Therapies for Limbal Stem Cell Deficiency

Elhusseiny

Soleimani

Eleiwa

et al. 2022

Stem Cells Translational Medicine

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The corneal epithelium serves to protect the underlying cornea from the external environment and is essential for corneal transparency and optimal visual function. Regeneration of this epithelium is dependent on a population of stem cells residing in the basal layer of the limbus, the junction between the cornea and the sclera. The limbus provides the limbal epithelial stem cells (LESCs) with an optimal microenvironment, the limbal niche, which strictly regulates their proliferation and differentiation. Disturbances to the LESCs and/or their niche can lead to the pathologic condition known as limbal stem cell deficiency (LSCD) whereby the corneal epithelium is not generated effectively. This has deleterious effects on the corneal and visual function, due to impaired healing and secondary corneal opacification. In this concise review, we summarize the characteristics of LESCs and their niche, and present the current and future perspectives in the management of LSCD with an emphasis on restoring the function of the limbal niche.

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The utility of anterior segment optical coherence tomography angiography for the assessment of limbal stem cell deficiency

Cited by 22 publications

References 38 publications

High speed, long range, deep penetration swept source OCT for structural and angiographic imaging of the anterior eye

High speed, long range, deep penetration swept source OCT for structural and angiographic imaging of the anterior eye

High-Resolution Optical Coherence Tomography Angiography Characteristics of Limbal Stem Cell Deficiency

Current and Emerging Therapies for Limbal Stem Cell Deficiency

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