Adaptive Optics Retinal Imaging

National Eye Institute

Investigators

Linked publications & trials

Abstract

By the time diseases of the retina are detected, serious damage has often already been done. An advanced optical imaging instrument utilizing adaptive optics can be used to directly visualize the cellular structure of the retina in the living human eye. Adaptive optics is a technology for measuring and correcting the optical imperfections in the human eye. When adaptive optics is combined with an imaging platform, highly detailed images of the human retina can be acquired. Our research utilizes this technology to image cells in patients eyes through the Adaptive Optics Clinic within the NIH Clinical Center. Application of data science to rich adaptive optics imaging datasets can be greatly enhanced through artificial intelligence. We are continuing to explore the use of artificial intelligence as well as cloud based computing, not only for analysis of adaptive optics imaging data, but also for purposes of image enhancement. Leveraging artificial intelligence to link high resolution adaptive optics imaging datasets with established clinical imaging modalities is an important step towards improved detection of microscopic changes that are associated with disease onset and progression in patient eyes. One breakthrough area that we demonstrated recently is in how the outer retinal layers consisting of photoreceptors, retinal pigment epithelium, and choriocapillaris are affected in choroideremia, a rare inherited genetic eye disease. For the first time, we provide conclusive evidence of dramatic enlargement of the retinal pigment epithelial cells in patients with choroideremia. Interestingly, findings of enlarged retinal pigment epithelial cells were also observed in female carriers of choroideremia, who are often regarded to be relatively unaffected or mildly affected in most cases when compared to affected males with choroideremia. These findings were corroborated with clinical imaging which show a bidirectional link between the higher resolution adaptive optics indocyanine green (AO-ICG) imaging and lower resolution conventional clinical indocyanine green (ICG) imaging. In addition, we have demonstrated the first adaptive optics images of fluorescently labeled blood cells in the living human eye, through collaboration with the University of Maryland School of Medicine. These pilot studies have revealed a pattern of erythrocyte stasis in the outer retina that was previously unknown, with implications in glaucoma and potentially other neurodegenerative diseases. Studies to further characterize this phenomenon are ongoing. Activities to improve imaging technology are also ongoing, through the design and implementation of a next generation, custom-built adaptive optics instrument in the NEI eye clinic which integrates technological advancements related to adaptive optics imaging which were developed in collaboration with Stanford University through the Audacious Goals Initiative program at the National Eye Institute. Together, the synergistic activities in data science, clinical application, and instrumentation development pave a path forward toward new horizons in live cell imaging directly in the living human eye with the potential to reveal the pathophysiology of retinal and neurodegenerative diseases throughout the onset and progression of disease.