This thesis forms part of an ongoing long-term project to investigate the suitability of Doppler optical coherence tomography (OCT) as a measurement tool to investigate skin thickness and blood flow in patients with systemic sclerosis. There is a discussion of the characterisation of an electro-optic phase modulator for use in a Doppler OCT imaging system which is being built for the purpose of clinical studies. In addition to this the development of software for the same system is described. The work includes a comparison of two methods of obtaining Doppler information that were tested with the system; a phase resolved method and a correlation mapping method. Initial structural and Doppler images obtained using the system are presented. In addition to this the development of semi-automated software to measure skin thickness from both OCT and high frequency ultrasound images is discussed. The results of a study, for which this software was developed, into skin thickness measurements using both techniques in both patients with systemic sclerosis and healthy controls are presented. Both OCT and high frequency ultrasound were able to measure a statistically significant difference in epidermal thickness at multiple locations on the body. Finally, the modification of a freely available Monte Carlo simulation for light propagation in multi-layered tissue (MCML) to enable the simulation of structural and Doppler OCT images is covered. The simulation was able to extract the magnitude of the simulated flow accurately to within an order of magnitude, and after a simple filter was applied to eliminate fluctuations in the data the structure of the Doppler image closely matched what was modelled.

This work describes optical coherence tomography, it's principle and methods for automatic segmentation intra-retinal layers in OCT images . There is proposed algorithm for boundary detection of two intra retinal layers, RFNL and RPE layer based on thresholding and second algorithm for detection of seven layers, which is based on graph search algorithm. In summary is compared accuracy against manualy segmented layers and there is also proposed solution for problematic parts.

La sclérose en plaques est une maladie dégénérative qui peut affecter la vision ainsi que différentes structures du système visuel afférent. La partie de l'oeil plus souvent affectée par la sclérose en plaques est le nerf optique, sous forme de névrite optique. Une technologie, nommée TCO (tomographie par cohérence optique), permet de prendre une image du nerf optique et de ses fibres nerveuses qui s'étendent sur la rétine. Dans cette thèse, la TCO a permis d’obtenir une épaisseur des fibres nerveuses autour du nerf optique, ainsi qu’une épaisseur totale de la macula et de la couche de cellules ganglionnaires chez les patients atteints de sclérose en plaques, avec et sans histoire de nérite optique, et chez un groupe de patients contrôle. Les résultats démontrent que seule l’épaisseur de la couche de cellules ganglionnaires permet de différentier les patients avec sclérose en plaques sans histoire de névrite optique des patients contrôle. Une deuxième étude a évalué la qualité visuelle en mesurant la sensibilité aux contrastes ainsi que la qualité de vie reliée à la vision avec un questionnaire de qualité de vie. Les résultats démontrent qu’une nouvelle charte de sensibilité aux contrastes, plus facile à administrer en clinique, permet aussi de différentier les patients sans névrite optique du groupe contrôle. De plus, la qualité de vie des patients ayant eu un épisode de névrite optique semble significativement affectée, même si le pronostic est considéré très favorable et que l’acuité visuelle est « bonne » suite à une névrite optique. En conclusion, l’utilisation de l’OCT en plus de mesures sensibles de fonction visuelle, telle la sensibilité aux contrastes, et de qualité de vié peuvent contribuer à mieux détecter des dysfonctions oculo-visuelles subtiles, mais importantes chez les patients atteints de sclérose en plaques. / Multiple sclerosis (MS) is the most common neurological condition causing disability in working-age adults. The hallmark of MS related disability is axonal loss. Through new technologies, such as optical coherence tomography (OCT), the retinal nerve fibre layer (RNFL), composed of ganglion cell axons, can be visualized and studied non-invasively in cross-section. Furthermore, recent OCT advances allow precise retinal layer segmentation and macular imaging of the ganglion cell layer. In this thesis, these different OCT parameters were measured to see which layers would be most affected in MS patients without previous optic neuritis. Results show that macular ganglion cell layer thickness is the only OCT parameter that can differentiate this sub-group of patients from healthy controls. Visual function was then assessed using a newly available, easy to use contrast sensitivity chart that can be self-administered by patients. Results show that this chart is also capable of differentiating MS patients without optic neuritis from controls, but usually gives better contrast sensitivity scores than the Mars chart. Lastly, vision-specific quality of life was assessed and proved to be reduced in MS patients with prior optic neuritis, despite supposed favorable recovery and good visual acuity in patients with this diagnosis. In sum, the use of OCT imaging, as well as sensitive visual function and quality of life measures, could help detect subtle, yet important structural or functional visual changes in patients with MS. This could ultimately help better screen, manage and counsel this subset of patients.