From Clinical Examination of the Optic Disc to Clinical Assessment of the Optic Nerve Head: A Paradigm Change

doi:10.1016/J.AJO.2013.04.016

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From Clinical Examination of the Optic Disc to Clinical Assessment of the Optic Nerve Head: A Paradigm Change

Journal Article•DOI•

From Clinical Examination of the Optic Disc to Clinical Assessment of the Optic Nerve Head: A Paradigm Change

Balwantray C. Chauhan¹, Claude F. Burgoyne•Institutions (1)

Dalhousie University¹

01 Aug 2013-American Journal of Ophthalmology (Elsevier)-Vol. 156, Iss: 2, pp 218-227

TL;DR: The proposed 4-point paradigm change for clinical assessment of the ONH is designed to enhance the accuracy and consistency of rim width, as well as of peripapillary and macular intraretinal thickness measurements.

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About: This article is published in American Journal of Ophthalmology.The article was published on 2013-08-01 and is currently open access. It has received 229 citations till now. The article focuses on the topics: Optic disc & Optic nerve.

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Journal Article•DOI•

Deep learning in ophthalmology: The technical and clinical considerations.

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Daniel Shu Wei Ting¹, Lily Peng², Avinash V. Varadarajan², Pearse A. Keane³, Philippe Burlina⁴, Michael F. Chiang⁵, Leopold Schmetterer⁶, Louis R. Pasquale⁷, Neil M. Bressler⁴, Dale R. Webster², Michael D. Abràmoff⁸, Tien Yin Wong¹ - Show less +8 more•Institutions (8)

National University of Singapore¹, Google², Moorfields Eye Hospital³, Johns Hopkins University School of Medicine⁴, Oregon Health & Science University⁵, Nanyang Technological University⁶, Icahn School of Medicine at Mount Sinai⁷, University of Iowa⁸

01 Sep 2019-Progress in Retinal and Eye Research

TL;DR: Global eye disease burden, unmet needs and common conditions of public health importance for which AI and DL systems may be applicable are described and the potential challenges for clinical adoption are discussed.

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274 citations

Journal Article•DOI•

Bruch's Membrane Opening Minimum Rim Width and Retinal Nerve Fiber Layer Thickness in a Normal White Population: A Multicenter Study

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Balwantray C. Chauhan¹, Vishva M Danthurebandara¹, Glen P. Sharpe¹, Shaban Demirel, Christopher A. Girkin², Christian Y. Mardin³, Alexander F. Scheuerle⁴, Claude F. Burgoyne - Show less +4 more•Institutions (4)

Dalhousie University¹, University of Alabama at Birmingham², University of Erlangen-Nuremberg³, Heidelberg University⁴

01 Sep 2015-Ophthalmology

TL;DR: There was significant age-related loss of BMO-MRW in healthy subjects and notable differences between BMO -MRW and RNFLT in their relationship with age and between each other, and adjustment for age and sector is important in ensuring optimal diagnostics for glaucoma.

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134 citations

Cites background or methods from "From Clinical Examination of the Op..."

...The BMO points were fitted with a spline to derive a closed curve to represent the BMO around the ONH....
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...A scan pattern containing 24 radially equidistant Bscans, each subtending 15 , was centered first on the ONH....
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...Our findings re-emphasize that the FoBMO axis in individual subjects should be the reference axis for image acquisition and sectorization of all ONH, RNFL, and retinal thickness measurements.(9) There are a limited number of studies with actual longitudinal ONH or RNFLT data in healthy subjects, most with relatively small sample sizes and short followup periods....
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...The current study is important because it characterizes for the first time, to the best of our knowledge, indices based on BMO in a normal population acquired and analyzed with respect to the eye-specific orientation of the fovea relative to the ONH....
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...Furthermore, OCT has permitted important anatomic insights into the optic nerve head (ONH) structures that correspond to the clinically perceived optic disc margin1,2 and visualization of deep ONH structures, such as the anterior laminar surface3,4 and the termination of the Bruch’s membraneeretinal pigment epithelium complex within the ONH.2e4 1786 2015 by the American Academy of Ophthalmology Published by Elsevier Inc. Optic disc margin-based indices that quantify the neuroretinal rim, such as cup-to-disc ratio and rim area, lack a solid anatomic and geometrical rationale.2,5 Conventional funduscopy and disc photography do not permit clinicians to visualize critical anatomic features that delineate the outer edge of the rim, principally because of extensions of Bruch’s membrane well inside the clinical disc margin that are present in variable amounts in all eyes2 and that yield critical errors in rim estimates.5 http://dx.doi.org/10.1016/j.ophtha.2015.06.001 ISSN 0161-6420/15 Recently, we and other investigators5e8 have proposed an anatomically and geometrically accurate neuroretinal rim parameter, which is one aspect of an OCT-based paradigm change in the clinical assessment of the ONH.9 This parameter, Bruch’s membrane opening minimum rim width (BMO-MRW),5 measures the rim from a logical outer border of the neuroretinal rim, that is, BMO, which represents the maximum aperture at the level of the ONH through which retinal ganglion cell axons can pass....
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Journal Article•DOI•

Diagnosing glaucoma progression with optical coherence tomography.

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Christopher Kai-Shun Leung¹•Institutions (1)

The Chinese University of Hong Kong¹

01 Mar 2014-Current Opinion in Ophthalmology

TL;DR: The analyses of the RNFL thickness map, lamina cribrosa displacement and inner macular thickness have provided a new paradigm to evaluate glaucomatous damage and its progression.

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Abstract: Purpose of reviewOptical coherence tomography (OCT) imaging of the retinal nerve fiber layer (RNFL), optic nerve head (ONH) and macula has gained popularity in recent years to detect and monitor glaucoma. With significant improvement in scan speed and scan resolution, spectral-domain OCT has become

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124 citations

Journal Article•DOI•

The aqueous humor outflow pathways in glaucoma: A unifying concept of disease mechanisms and causative treatment.

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Barbara M. Braunger¹, Rudolf Fuchshofer¹, Ernst R. Tamm¹•Institutions (1)

University of Regensburg¹

01 Sep 2015-European Journal of Pharmaceutics and Biopharmaceutics

TL;DR: Causative therapy concepts targeting the aqueous outflow pathways in glaucoma should aim at interfering with this process either by attenuating TM or SC stiffness, and/or by modulating TGF-β/CTGF signaling.

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123 citations

Cites background from "From Clinical Examination of the Op..."

...It is generally assumed that an IOP level, which is too high for the health of the optic nerve initiates events that result in a chronic and progressive deformation of the optic nerve head [16], a scenario that is observed by examining ophthalmologists as excavation or cupping of the optic disc [6, 8, 17]....
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...[17] B....
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Journal Article•DOI•

A method to estimate the amount of neuroretinal rim tissue in glaucoma: comparison with current methods for measuring rim area.

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Stuart K. Gardiner, Ruojin Ren¹, Hongli Yang, Brad Fortune, Claude F. Burgoyne, Shaban Demirel - Show less +2 more•Institutions (1)

New York Eye and Ear Infirmary¹

01 Mar 2014-American Journal of Ophthalmology

TL;DR: Minimum rim measurements from SD-OCT are significantly better correlated to both RNFL thickness and MD than rim measurements within the BMO plane or based on the clinical disc margin.

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117 citations

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References

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Journal Article•DOI•

Histology of the Human Eye.

[...]

David M. Worthen

01 Aug 1972-Archives of Ophthalmology

TL;DR: A classic is born that will most likely become a standard reference and teaching text throughout the world after an introductory chapter on cell structure and 11 chapters approach the human eye from the viewpoint of gross anatomy, physiology, biochemistry, embryology, light and electron microscopy.

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Abstract: A classic is born that will most likely become a standard reference and teaching text throughout the world. It is the result of a symbiosis between a distinguished clinician and pathologist, an excellent electron microscopist and a medical illustrator with a unique ability to represent tissue in three dimensions. The industry of assembling a textbook and atlas of this size is to be admired. After an introductory chapter on cell structure, 11 chapters approach the human eye from the viewpoint of gross anatomy, physiology, biochemistry, embryology, light and electron microscopy. The photomicrographs are numerous, as if each was dear to the heart of the authors. The drawings by Weddell are themselves worth the purchase price of the book. The publisher has also made available a set of 200 35-mm slides of selected figures in the book. The presentation is clear, logical, and few mistakes are present. The blend of

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992 citations

"From Clinical Examination of the Op..." refers background or methods in this paper

...Modified from Hogan, Alvarado Wedell.(15) ANATOMIC ERRORS IN THE CURRENT EVALUATION OF THE NEURORETINAL RIM...
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...traditionally is defined to be the inner edge of the scleral lip or crescent (Figure 1).(15) Within this conceptual framework, the disc margin is assumed to be a single and consistent anatomic structure around the entire ONH and a true outer border of the neuroretinal rim, and therefore the landmark from which the width of the rim can be measured....
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Journal Article•DOI•

Deformation of the lamina cribrosa and anterior scleral canal wall in early experimental glaucoma.

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Anthony J. Bellezza¹, Christopher J. Rintalan¹, Hilary W. Thompson², J. Crawford Downs¹, Richard T. Hart¹, Claude F. Burgoyne², Claude F. Burgoyne¹ - Show less +3 more•Institutions (2)

Tulane University¹, LSU Health Sciences Center New Orleans²

01 Feb 2003-Investigative Ophthalmology & Visual Science

TL;DR: Findings suggest that damage to the ONH connective tissues occurs early in the monkey model of experimental glaucoma, and both plastic (permanent) and hypercompliant deformation of the lamina cribrosa and anterior scleral canal wall are present in young adult monkey eyes with early experimental glAUcoma.

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Abstract: Purpose To test the hypothesis that pathophysiologic deformation of the lamina cribrosa and anterior scleral canal wall underlies the onset of confocal scanning laser tomography (CSLT)-detected optic nerve head (ONH) surface change in early experimental glaucoma. Methods Both eyes of four normal (two normal eyes) monkeys and four with early glaucoma (one eye with laser-induced IOP elevation, observed until the onset of CSLT-detected ONH surface change) were enucleated immediately after death and immersion fixed at IOP 0 mm Hg. In an additional four normal monkeys and five with early glaucoma, both eyes were cannulated, and IOP set to 10 mm Hg in one normal eye and either 30 or 45 mm Hg in the other (normal or early-glaucoma) eye. After 15 to 80 minutes of acute IOP elevation, these nine monkeys were perfusion-fixed. Within images of serial sagittal sections of the ONH tissues in all 17 monkeys, anterior lamina cribrosa position, laminar thickness, and scleral canal diameter were measured. For each parameter, differences between the two eyes of each monkey and between treatment groups were assessed by ANOVA. Results Within the eyes of the eight monkeys with IOP 0 mm Hg, the lamina cribrosa was posteriorly displaced and thicker and the scleral canal was enlarged at Bruch's membrane and at the anterior laminar insertion in the early-glaucoma eyes compared with the contralateral normal eyes (plastic deformation). Within the high-IOP normal eyes, the lamina cribrosa was posteriorly displaced compared with that in the low-IOP normal eyes, but there were no significant differences in laminar thickness or scleral canal diameter (normal compliance). Within the high-IOP early-glaucoma eyes, the lamina cribrosa was posteriorly displaced and thicker and the scleral canal enlarged, compared with both low-IOP normal eyes and high-IOP normal eyes (hypercompliant deformation). Differences in laminar position between the high-IOP early-glaucoma eyes and the contralateral low-IOP normal eyes (hypercompliant plus plastic deformation) were more than eight times greater than the differences between the high-IOP normal eyes and the contralateral low-IOP normal eyes (normal compliance). Conclusions Both plastic (permanent) and hypercompliant deformation of the lamina cribrosa and anterior scleral canal wall are present in young adult monkey eyes with early experimental glaucoma. These findings suggest that damage to the ONH connective tissues occurs early in the monkey model of experimental glaucoma.

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377 citations

"From Clinical Examination of the Op..." refers background in this paper

...There is no published evidence yet on the stability of BMO with glaucoma progression; however, in experimental glaucoma in monkeys, BMO position in 3-dimensional histomorphometry of the ONH seems to be unaltered despite changes in the neural component of the ONH and in the positions of the anterior and posterior scleral canal opening.(19)...
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Journal Article•DOI•

Enhanced Detection of Open-angle Glaucoma with an Anatomically Accurate Optical Coherence Tomography–Derived Neuroretinal Rim Parameter

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Balwantray C. Chauhan¹, Neil O'Leary¹, Faisal A. Almobarak², Faisal A. Almobarak¹, Alexandre S C Reis³, Alexandre S C Reis¹, Hongli Yang, Glen P. Sharpe¹, Donna M. Hutchison¹, Marcelo T. Nicolela¹, Claude F. Burgoyne - Show less +7 more•Institutions (3)

Dalhousie University¹, King Saud University², University of São Paulo³

01 Mar 2013-Ophthalmology

TL;DR: The higher sensitivity at 95% specificity in early glaucoma of BMO-MRW compared with current BMO methods is significant, indicating a new structural marker for the detection and risk profiling of glau coma.

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315 citations

"From Clinical Examination of the Op..." refers background in this paper

...Currently, BMO is the most consistent SD OCT-detected outer border of the neuroretinal rim and a stable landmark that is visible readily in all but a few exceptional B-scans.(9,22) The minimum distance from BMO to the internal limiting membrane represents the geometrically correct width of the neuroretinal rim....
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...Currently, BMO is the most consistent SD OCT-detected outer border of the neuroretinal rim and a stable landmark that is visible readily in all but a few exceptional B-scans.9,22 The minimum distance from BMO to the internal limiting membrane represents the geometrically correct width of the neuroretinal rim....
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...Most recently, we showed that BMO-MRW significantly enhanced the ability to detect glaucomatous optic neuropathy compared with current confocal scanning laser tomography and current SD OCT analyses.(22) Automated algorithms for identifying (segmenting) BMO inB-scans of SDOCT images have been described and incorporated into commercial software....
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...The immediate consequence of the new quantitative measures proposed is that our ability to detect glaucoma is enhanced.(22) We anticipate that as data acquisition and analysis takes place according to the specific fovea-BMO center axis of an individual eye, interindividual variation in several important quantitative measures, including thickness of the peripapillary and macular RNFL and other segmented layers of the retina, will decrease and further will enhance detection of glaucoma....
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Journal Article•DOI•

Reproducibility of Peripapillary Retinal Nerve Fiber Layer Thickness and Optic Nerve Head Parameters Measured with Cirrus HD-OCT in Glaucomatous Eyes

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Jean-Claude Mwanza¹, Robert T. Chang¹, Donald L. Budenz¹, Mary K Durbin², Mohamed G. Gendy¹, Wei Shi¹, William J. Feuer¹ - Show less +3 more•Institutions (2)

Bascom Palmer Eye Institute¹, Carl Zeiss AG²

01 Nov 2010-Investigative Ophthalmology & Visual Science

TL;DR: Intravisit and intervisit measurements of peripapillary RNFL thickness and ONH parameters with Cirrus HD-OCT showed excellent reproducibility, indicating that this instrument may be useful in monitoring glaucoma progression.

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Abstract: Progressive death of retinal ganglion cells and their axons is the hallmark of glaucomatous optic neuropathy. There is evidence that these structural changes precede visual field (VF) deficits as measured by standard automated perimetry.1 The ability to detect subtle changes in the retinal nerve fiber layer (RNFL) and optic nerve head (ONH) over time is critical in the management of glaucoma. Until very recently, glaucomatous structural changes have been assessed through ophthalmoscopic examination and fundus photography, but small changes are difficult to detect with these techniques and their interpretation is entirely subjective. To provide more accurate, quantitative, and reproducible methods of detecting and following glaucoma-related structural changes, new computerized imaging methods of assessing the RNFL have been developed. Optical coherence tomography (OCT) is a noncontact, noninvasive imaging technique that exploits the property of coherence interferometry and optical back-scattered light to obtain in vivo, high-resolution, cross-sectional images of microstructure in biological tissues. Until recently, retinal and ONH measurements were acquired with time-domain (TD) OCT (Stratus OCT; Carl Zeiss Meditec, Inc., Dublin, CA). The reproducibility of RNFL thickness with TD-OCT has been extensively investigated. Only a few reports are available on the reproducibility of TD-OCT ONH measurements, and they have yielded variable results.2–6 Several OCT devices that use spectral domain (SD) technology, one of which is Cirrus HD-OCT (Carl Zeiss Meditec), are commercially available and in their early stage of clinical use. Because both early diagnosis of glaucoma and detection of its progression through subtle changes in RNFL and ONH measurements may be useful for glaucoma diagnosis and management, reproducibility of such measurements must be demonstrated before this technique can be used successfully. Several studies have examined the reproducibility of peripapillary RNFL thickness measurements with different SD-OCT systems.7–12 Only one study has reported on the repeatability of ONH measurements obtained with SD-OCT (RTVue; Optovue, Inc., Freemont, CA).8 The purpose of the present study was to assess the intravisit and intervisit reproducibility of peripapillary RNFL thickness and ONH parameters measured with Cirrus HD-OCT in glaucomatous eyes.

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278 citations

Journal Article•DOI•

Ultrahigh-speed optical coherence tomography for three-dimensional and en face imaging of the retina and optic nerve head.

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Vivek J. Srinivasan¹, Desmond C. Adler¹, Yueli Chen², Yueli Chen¹, Iwona Gorczynska², Iwona Gorczynska¹, Robert Huber³, Robert Huber¹, Jay S. Duker², Joel S. Schuman⁴, James G. Fujimoto¹ - Show less +7 more•Institutions (4)

Massachusetts Institute of Technology¹, Tufts University², Ludwig Maximilian University of Munich³, University of Pittsburgh⁴

01 Nov 2008-Investigative Ophthalmology & Visual Science

TL;DR: Ultrahigh-speed OCT imaging of the retina and optic nerve head at 249,000 axial scans per second is possible and the combination of the longer wavelength and ultrahigh imaging speed enables excellent visualization of the choroid, sclera, and lamina cribrosa.

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Abstract: Optical coherence tomography (OCT) is an emerging optical imaging modality for biomedical research and clinical medicine.1 In the eye, OCT can provide detailed images of retinal diseases including diabetic retinopathy, age-related macular degeneration, and glaucoma.2,3 The commercial StratusOCT instrument (Carl Zeiss Meditec, Inc., Dublin, CA), with 8- to 10-μm axial image resolution, has become a standard in the diagnosis and monitoring of diseases such as wet age-related macular degeneration, diabetic macular edema, and glaucoma. Recent work in the field of ophthalmic OCT has demonstrated that spectral/Fourier domain detection methods4–7 enable OCT imaging with dramatically improved speed and sensitivity over conventional time domain methods.8–10 Spectral/Fourier domain OCT uses a broadband light source and a spectrometer to measure the interference spectrum. Light backscattered or backreflected from different positions in the sample is measured simultaneously, rather than sequentially, improving the imaging speed. The improved speed enables three-dimensional (3D) and high-definition imaging of the retina and enhanced visualization of retinal diseases.11–14 Several companies have developed clinical spectral/Fourier domain OCT instruments for retinal imaging. These instruments operate at speeds of 20,000 to 40,000 axial scans per second, 50 to 100 times faster than previous OCT instruments. Despite the dramatically improved performance of spectral/Fourier domain OCT, there are several important limitations. First, spectral/Fourier domain detection utilizes a high-speed camera and spectrometer for detection, which increases system size and complexity. Second, because of spectrometer and camera resolution limits, detection sensitivity and axial resolution change as a function of axial position or imaging depth.7,8,15 This sensitivity decrease may adversely affect the reproducibility of quantitative measurements. Finally, spectrometer losses and camera read out rates limit the maximum imaging speed. Therefore, although 3D imaging with spectral/Fourier domain OCT is possible, motion artifacts prevent reliable acquisition of 3D data sets when high sampling density is desired. For example, at an acquisition speed of 25,000 axial scans per second, a raster scan of the macula consisting of 512 × 512 axial scans would require >10 seconds. Current ophthalmic systems solve this problem by sacrificing sampling density along one axis of the raster scan or individually acquiring densely sampled data sets from different portions of the retina. The first approach does not adequately sample the retina, and the second approach requires the precise acquisition and registration of multiple data sets, which may be time-consuming and cumbersome in subjects with poor fixation. Some commercially available, high-end OCT instruments provide active eye motion tracking that enables long acquisition times and high-density data sets. However, eye tracking requires an additional optical system to determine eye motion and actuators to correct for eye motion, both of which increase system complexity and cost. Swept-source OCT10,16–19 is another approach for high-speed OCT imaging which possesses speed and sensitivity advantages similar to those of spectral/Fourier domain OCT. Both methods measure interference as a function of optical frequency or wavelength. However, swept-source OCT uses a frequency swept laser that enables measurement of interference at different optical frequencies or wavelengths sequentially over time. Swept-source OCT imaging of the retina was first demonstrated in 2006 at 18,800 axial scans per second and 14-μm axial resolution in air, using a 1050-nm frequency swept laser.20 Swept-source OCT imaging of the human retina was also demonstrated at 43,200 axial scans per second and 13 μm axial resolution in air, using an 850-nm frequency swept laser,21 and 16,000 axial scans per second and 9.5-μm axial resolution in air using an 850-nm frequency swept laser.22 Recently, swept-source OCT imaging of the human retina was demonstrated at 28,000 axial scans per second and 14.4-μm axial resolution in air with a 1050-nm frequency swept laser.23 Our group previously demonstrated swept-source OCT imaging at 236,000 axial scans per second and 19-μm axial resolution in air with a 1060-nm Fourier domain mode locked (FDML) frequency swept laser.24 In this article, OCT imaging of the retina and optic nerve head at 249,000 axial scans per second and 11-μm axial resolution in air (8 μm in the retina) are demonstrated.

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276 citations