Objetivo: Comparar o efeito da terapia da fotocoagulação panretiniana (PFC) associada à injeção intravítrea de Ranibizumabe (RBZ) versus terapia isolada com PFC em pacientes com retinopatia diabética proliferativa (RDP) precoce, virgens de tratamento, com ou sem edema macular diabético (DME) durante 6 meses de acompanhamento. Projeto: Estudo prospectivo intervencionista, randomizado e controlado. Métodos: Sessenta olhos de 30 pacientes com RDP bilateral precoce foram randomizados para o grupo de estudo (GE) que foram tratados com PFC associado a duas injeções de RBZ intravítreo (0.5mg/0.05ml) ou para o grupo controle (GC) tratados apenas com PFC. Mudanças na acuidade visual (AV) corrigida, na sensibilidade ao contraste (SC) e na espessura foveal (EF) foram comparados no início, e nos 1, 3 e 6 meses após o tratamento. Resultados: No GE, a diferença na média da AV do baseline para o mês 6 teve um aumento significativo de + 3,4 letras (p = 0,006) e uma diminuição significativa na EF de - 47.6um (p < 0,001). No GC, a diferença na média da AV teve uma diminuição de - 3,4 letras (p = 0,04) e uma mudança na EF de -3.8 um (p = 0,96). Com relação ao teste de SC dentre os 28 olhos do GE, houve uma melhora no mês 6 em relação ao baseline nos ciclos: 1,5 (p < 0.001) e 3,0 ciclo (p=0.023). Dentre os 30 olhos do GC, não houve uma diferença estatística nos momentos estudados. Conclusão: A injeção intravítrea de RBZ associado com PFC pode ser um tratamento eficaz em olhos de pacientes com RDP precoce e EMD / Purpose: To compare the efficacy of therapy with panretinal photocoagulation (PRP) and intravitreal ranibizumab (RBZ) injection versus PRP alone in patients with treatment-naive bilateral non-high risk proliferative diabetic retinopathy (PDR) with and without diabetic macular edema (DME) with a 6-month follow-up. Design: Prospective, interventional, randomized controlled trial. Methods: Sixty eyes of 30 patients with bilateral non-high risk PDR were randomized either to the study group (SG) receiving PRP plus two intravitreal ranibizumab injections (0.5mg/0.05ml), the first one week before and the second four weeks after the PRP or to the control group (CG) receiving PRP alone. Mean change in best-corrected visual acuity (BCVA), contrast sensitivity (CS) and central macular thickness (CMT) were compared at baseline and 1, 3 and 6 months after treatment. Results: Changes from baseline to 6 months showed in the SG an increased in the BCVA by + 3.4 letters (p= 0.006) with a decrease in CMT by - 47.6um (p < 0.001). In the CG, a decrease by - 3.4 letters (p = 0.04) and an decrease by -3.8um (p= 0.96). Regarding the CS in the SG, there was an improvement compared to baseline for the sixth month in the 1.5 (p < 0.001) and 3.0 cycles (p = 0.023). The CG did not show significant results from baseline to month 6. Conclusion: Intravitreal RBZ associated with PRP can be an effective treatment in eyes with non-high risk PDR and DME

Objetivos: Determinar o efeito da panfotocoagulação retiniana (PFC) nos parâmetros topográficos do disco óptico e na camada de fibras nervosas da retina (CFNR) peripapilar em pacientes com retinopatia diabética proliferativa (RDP). Métodos: Este é um estudo observacional prospectivo, de centro único. Trinta e oito olhos de 26 pacientes diabéticos foram submetidos a PFC para retinopatia diabética proliferativa. As estereofotografias (EFs) e os parâmetros do disco óptico foram avaliados usando o retinógrafo Visucam da Zeiss e a Tomografia de varredura a laser (TVL), respectivamente. A espessura da CFNR peripapilar foi medida por tomografia de coerência óptica (OCT) e polarimetria de varredura a laser (PVL). Todas as medições foram realizadas no início e 12 meses após a conclusão da PFC. Resultados: Trinta e oito olhos de 26 pacientes (15 mulheres) com média de idade de 53,7 anos (faixa etária de 26 a 74 anos) foram recrutados. Nenhuma diferença significativa foi encontrada entre a média horizontal e vertical para relação escavação/disco óptico (E/D) determinadas pelas EFs antes e após o tratamento com PFC (P = 0,461 e 0,839, respectivamente). Os valores globais dos parâmetros do disco óptico analisados com a TVL não mostraram nenhuma mudança significativa entre o baseline e 12 meses após o tratamento (área do disco, área da escavação, área da rima, volume da escavação, volume da rima, relação área da escavação/área do disco, relação linear do tamanho da escavação/disco, profundidade média da escavação, profundidade máxima da escavação, medida do formato da escavação, variação na altura do contorno, espessura média da CFNR e área transversal da CFNR). O OCT e o PVL não encontraram diferença significativa entre a CFNR peripapilar antes e após a PFC (P = 0,114 e P = 0,813, respectivamente). Conclusões: Nossos resultados sugerem que a PFC nos padrões realizados no presente estudo não causa significantes alterações morfológicas no disco óptico em pacientes diabéticos com RDP após um ano de acompanhamento / Purpose: To determine the effect of panretinal photocoagulation (PRP) on optic disc topographic parameters and peripapillary retinal nerve fiber layer (RNFL) in nonglaucomatous patients with proliferative diabetic retinopathy (PDR). Methods: This is a prospective, single center, observational study. Thirty-eight eyes of 26 diabetic patients underwent PRP for proliferative diabetic retinopathy. Stereoscopic disc photographs and optic nerve head (ONH) parameters were evaluated using the Zeiss fundus camera and the confocal scanning laser ophthalmoscopy (CSLO), respectively. The peripapillary RNFL thickness was measured by optical coherence tomography (OCT) and scanning laser polarimetry (SLP). All measurements were performed at baseline and 12 months after completion of PRP. Results: Thirty-eight eyes of 26 patients (15 female) with a mean age of 53.7 years (range 26 to 74 years) were recruited. No significant difference was found between mean horizontal and vertical cup to disc (C/D) ratio determined by stereoscopic disc photographs before and after PRP treatment (P=0.461 and 0.839, respectively). The global values of ONH parameters analyzed with the CSLO showed no significant change from baseline to 12 months (disc area, cup area, rim area, cup volume, rim volume, C/D area ratio, linear C/D ratio, mean cup depth, maximum cup depth, cup shape measure, height variation contour, mean retinal nerve fiber layer thickness and cross-sectional area). The OCT and SLP did not find significant difference between peripapillary RNFL before and after PRP (P=0.114 and P=0.813, respectively). Conclusion: Our results suggest that PRP as performed in this study does not cause significant morphological optic disk changes in diabetic PDR patients after one year of follow-up

Ce manuscrit de thèse présente l’étude des techniques de super-résolution latérale en nanoscopie optique, qui est une des nouvelles techniques d'imagerie haute résolution, aujourd'hui largement utilisée en biophysique et en imagerie médicale, pour imager et caractériser des nanostructures, tout en conservant les avantages de l'imagerie optique en champ lointain comme un vaste champ, la visualisation et l’analyse en temps réel…Un des défis futurs de la microscopie 3D super-résolue est d’éviter l’utilisation des marqueurs fluorescents. La microscopie interférométrique fait partie des techniques d’imagerie 3D sans marquage permettant la détection de nanostructures. Pour améliorer le pouvoir de détection de ce système optique, un premier protocole de traitement d’images a été développé et implémenté, permettant ainsi de révéler des structures initialement non mesurables. Puis, pour améliorer la résolution latérale du système, une nouvelle technique combinant l’interférométrie et le principe du nano-jet photonique a été développée permettant l’observation d’objets de taille inférieure à la limite de diffraction de l’instrument optique. / This manuscript presents the study of the lateral super-resolution techniques in optical nanoscopy, which is a new high-resolution imaging method now widely used in biophysics and medical imaging, to observe and measure nanostructures, with the advantages of far field optical imaging, such as a large field of view, visualization and analysis in real time…One of the future challenges of 3D super resolution microscopy is to avoid the use of fluorescent markers. Interferometric microscopy is a 3D label-free imaging technique enabling the detection of nanostructures. To improve the detection capability of this optical system, a first version of a protocol composed of image processing methods was developed and implemented, revealing structures initially unmeasurable. Then, to improve the lateral resolution of the system, a new technique combining interferometry and the principle of the photonic nano-jet has been developed, thus allowing the observation of objects of a size smaller than the diffraction limit of the optical instrument.

Objetivo: Comparar o efeito da terapia da fotocoagulação panretiniana (PFC) associada à injeção intravítrea de Ranibizumabe (RBZ) versus terapia isolada com PFC em pacientes com retinopatia diabética proliferativa (RDP) precoce, virgens de tratamento, com ou sem edema macular diabético (DME) durante 6 meses de acompanhamento. Projeto: Estudo prospectivo intervencionista, randomizado e controlado. Métodos: Sessenta olhos de 30 pacientes com RDP bilateral precoce foram randomizados para o grupo de estudo (GE) que foram tratados com PFC associado a duas injeções de RBZ intravítreo (0.5mg/0.05ml) ou para o grupo controle (GC) tratados apenas com PFC. Mudanças na acuidade visual (AV) corrigida, na sensibilidade ao contraste (SC) e na espessura foveal (EF) foram comparados no início, e nos 1, 3 e 6 meses após o tratamento. Resultados: No GE, a diferença na média da AV do baseline para o mês 6 teve um aumento significativo de + 3,4 letras (p = 0,006) e uma diminuição significativa na EF de - 47.6um (p < 0,001). No GC, a diferença na média da AV teve uma diminuição de - 3,4 letras (p = 0,04) e uma mudança na EF de -3.8 um (p = 0,96). Com relação ao teste de SC dentre os 28 olhos do GE, houve uma melhora no mês 6 em relação ao baseline nos ciclos: 1,5 (p < 0.001) e 3,0 ciclo (p=0.023). Dentre os 30 olhos do GC, não houve uma diferença estatística nos momentos estudados. Conclusão: A injeção intravítrea de RBZ associado com PFC pode ser um tratamento eficaz em olhos de pacientes com RDP precoce e EMD / Purpose: To compare the efficacy of therapy with panretinal photocoagulation (PRP) and intravitreal ranibizumab (RBZ) injection versus PRP alone in patients with treatment-naive bilateral non-high risk proliferative diabetic retinopathy (PDR) with and without diabetic macular edema (DME) with a 6-month follow-up. Design: Prospective, interventional, randomized controlled trial. Methods: Sixty eyes of 30 patients with bilateral non-high risk PDR were randomized either to the study group (SG) receiving PRP plus two intravitreal ranibizumab injections (0.5mg/0.05ml), the first one week before and the second four weeks after the PRP or to the control group (CG) receiving PRP alone. Mean change in best-corrected visual acuity (BCVA), contrast sensitivity (CS) and central macular thickness (CMT) were compared at baseline and 1, 3 and 6 months after treatment. Results: Changes from baseline to 6 months showed in the SG an increased in the BCVA by + 3.4 letters (p= 0.006) with a decrease in CMT by - 47.6um (p < 0.001). In the CG, a decrease by - 3.4 letters (p = 0.04) and an decrease by -3.8um (p= 0.96). Regarding the CS in the SG, there was an improvement compared to baseline for the sixth month in the 1.5 (p < 0.001) and 3.0 cycles (p = 0.023). The CG did not show significant results from baseline to month 6. Conclusion: Intravitreal RBZ associated with PRP can be an effective treatment in eyes with non-high risk PDR and DME

Les technologies d'imagerie intravasculaire c’est à dire l’échographie endo-coronaire (IVUS)et la tomographie par cohérence optique (IV-OCT) sont des outils précieux pour aider audiagnostic de la plaque d’athérosclérose et guider les gestes thérapeutiques.Le chapitre 1 présente les inconvénients de la coronarographie dans la pratique clinique.Dans plusieurs circonstances, l’IVUS et l’OCT ont clairement une valeur supplémentaire quandils sont utilisés comme un outil diagnostique en cas d'ambiguïtés angiographiques. Nousavons récemment rapporté la première observation utilisant l’OCT pour décrire une dissectioncoronaire d'une branche septale perforante responsable d’un infarctus du myocarde.Le chapitre 2 porte sur la reproductibilité de I’OCT entre différents instituts concernant denombreux paramètres qualitatifs et quantitatifs de la plaque d'athérome. Le but de notre étudeétait d'étudier en plus de la reproductibilité inter- et intra-observateur, la variabilité inter-institutsde I’OCT concernant les mesures quantitatives et qualitatives et de la comparer à celle del’IVUS. Dans ce travail, nous avons observé que, dans la mesure de la surface de la lumièreendocoronaire, des diamètres minimum et maximum de cette même lumière endocoronaire,de la surface endo-luminale du stent, des diamètres minimum et maximum endo-luminaux dustent, par des analystes provenant de 2 laboratoires différents, la reproductibilité inter-institutsde I’OCT était nettement supérieure à celle de l’IVUS. Le Chapitre 3 présente 2 nouvelles technologies robustes d'imagerie intravasculaire hybridesdéveloppées dans le laboratoire du Professeur Guillermo J. Tearney: l’OCT couplée à laspectroscopie dans le proche infra-rouge (OFDI-NIRS) et l’OCT couplée à l’autofluorescencedans le proche infra-rouge (OFDI-NIRAF). Les premières procédures d’OFDI-NIRS chezl’homme sont prévues dans un avenir proche. Les premières procédures chez l’homme ontété réalisées chez 12 patients porteurs d’un angor stable entre Juillet 2014 et Janvier 2015.Les résultats de cette étude pilote ont montré que le signal d’autofluorescence recueilli(NIRAF) a été focalement trés élevé dans des endroits de la plaque d’athérome où la plupartdes phénotypes morphologiques en OCT d’une plaque à haut risque de rupture étaientévidents. Les substrats biochimiques de ce signal d’autofluorescence (NIRAF) sont encore àélucider. / Intravascular imaging technologies i.e. IVUS and IV-OCT are valuable tools for interventionguidance and diagnostic plaque imaging.Chapter 1 introduces the drawbacks of coronary angiography in the clinical practice. In severalcircumstances, IVUS and IV-OCT have clearly an additional value when they are used as adiagnosis tool in case of angiographic ambiguities. We recently reported the first observationusing IV-OCT to describe a coronary dissection of a septal perforating branch causing AMI.Chapter 2 focuses on the inter-institute reliability of IV-OCT to determine qualitative andquantitative parameters of atherosclerotic plaque. The purpose of our study was to investigatefurther inter- and intra-observer reproducibility, the inter-institute variability for IV-OCT (OFDI)quantitative and qualitative measurements vs. IVUS measurements using publishedconsensus document definitions. In our work, we observed that in the measurement of lumenCSA, maximum and minimum lumen diameters, stent CSA, maximum and minimum stentdiameters by analysts from 2 different laboratories, inter-institute reproducibility of OFDI wasfound to be more consistent than IVUS.Chapter 3 present 2 new robust hybrid intravascular imaging technologies developed in Dr.Tearney’s laboratory i.e. OFDI-NIRS and OFDI-NIRAF, which may offer supplementary criteriafor plaque vulnerability. First-in-human OFDI-NIRS imaging procedures are anticipated in thenear future. First-in-human OFDI-NIRAF imaging procedures have been performed in a firstpioneering series of 12 stable patients between July 2014 and January 2015. Findings of thispilot study showed that NIRAF was focally elevated in plaque locations where most high-riskmorphologic phenotypes were evident. The biochemical substrates of the NIRAF signal stillhave to be elucidated.

Ce manuscrit de thèse de doctorat présente la conception et la réalisation d’un système d’imageriepour le diagnostic précoce des pathologies de la peau. Un diagnostic précoce permet de réduire lesactes chirurgicaux inutiles. Il est important de mettre en avant que seulement 20% des pathologiesfaisant office d’une opération chirurgicale, sont malignes. De plus, les pronostics de l’année 2015avançaient trois millions de nouveaux cas de cancer de la peau diagnostiqués aux ´ Etats-Unis. Basésur la tomographie par cohérence optique à balayage en longueur d’onde et une configuration pleinchamp et multi-canaux, le système d’imagerie médicale est capable d’imager en volume les couchesinternes de la peau et donc de fournir un diagnostic médical pour le professionnel de santé. Pourune fabrication en série du système portatif, les composants optiques sont micro-fabriqués sur dessubstrats et assemblés verticalement. Ces micro-composants optiques requièrent une caractérisationspécifique. Pour cela, deux systèmes ont ainsi été développés pour estimer leurs performancesoptiques. Ce travail a été réalisé dans le cadre du projet Européen VIAMOS (Vertically IntegratedArray-type Mirau-based OCT System). / The manuscript concerns the optical design and the development of a non-invasive new imagingsystem for the early diagnosis of skin pathologies. Indeed, an early diagnosis can make the differencebetween malignant and benign skin lesion in order to minimize unnecessary surgical procedure.Furthermore, prognosis for the year 2015 was that more than three millions new skin cancer caseswill be diagnosed in the United States. Based on the swept source optical coherence tomographytechnique in full-field and multiple channels configuration, the imaging system is able to perform avolumetric image of the subsurface of the skin, and thus can help in taking a better medical decision.Furthermore, for a batch-fabrication of the hand-held device, micro-optical components were made atwafer-level and vertically assembled using multi-wafer bonding. This miniaturized system requiresspecific characterization. Thus, two systems were also developed for imaging quality evaluation ofmicro-optical elements. This work has been supported by the VIAMOS (Vertically Integrated ArraytypeMirau-based OCT System) European project.

Le glaucome est la première cause de cécité irréversible dans le monde. Bien que sa pathogenèse demeure encore nébuleuse, les propriétés biomécaniques de l’oeil sembleraient jouer un rôle important dans le développement et la progression de cette maladie. Il est stipulé que la rigidité oculaire (RO) est altérée au travers les divers stades de la maladie et qu’elle serait le facteur le plus influent sur la réponse du nerf optique aux variations de la pression intraoculaire (PIO) au sein du glaucome. Pour permettre l’investigation du rôle de la RO dans le glaucome primaire à angle ouvert (GPAO), la capacité de quantifier la RO in vivo par l’entremise d’une méthode fiable et non-invasive est essentielle. Une telle méthode n’est disponible que depuis 2015. Basée sur l'équation de Friedenwald, cette approche combine l'imagerie par tomographie par cohérence optique (TCO) et la segmentation choroïdienne automatisée afin de mesurer le changement de volume choroïdien pulsatile (ΔV), ainsi que la tonométrie dynamique de contour Pascal pour mesurer le changement de pression pulsatile correspondant. L’objectif de cette thèse est d’évaluer la validité de cette méthode, et d’en faire usage afin d’investiguer le rôle de la RO dans les maladies oculaires, particulièrement le GPAO. Plus spécifiquement, cette thèse vise à : 1) améliorer la méthode proposée et évaluer sa validité ainsi que sa répétabilité, 2) investiguer l’association entre la RO et le dommage neuro-rétinien chez les patients glaucomateux, et ceux atteints d’un syndrome de vasospasticité, 3) évaluer l’association entre la RO et les paramètres biomécaniques de la cornée, 4) évaluer l’association entre la RO et les pics de PIO survenant suite aux thérapies par injections intravitréennes (IIV), afin de les prédire et de les prévenir chez les patients à haut risque, et 5) confirmer que la RO est réduite dans les yeux myopes. D’abord, nous avons amélioré le modèle mathématique de l’oeil utilisé pour dériver ΔV en le rendant plus précis anatomiquement et en tenant compte de la choroïde périphérique. Nous avons démontré la validité et la bonne répétabilité de cette méthodologie. Puis, nous avons effectué la mesure des coefficients de RO sur un large éventail de sujets sains et glaucomateux en utilisant notre méthode non-invasive, et avons démontré, pour la première fois, qu'une RO basse est corrélée aux dommages glaucomateux. Les corrélations observées étaient comparables à celles obtenues avec des facteurs de risque reconnus tels que la PIO maximale. Une forte corrélation entre la RO et les dommages neuro-rétiniens a été observée chez les patients vasospastiques, mais pas chez ceux atteints d'une maladie vasculaire ischémique. Cela pourrait potentiellement indiquer une plus grande susceptibilité au glaucome due à la biomécanique oculaire chez les patients vasospastiques. Bien que les paramètres biomécaniques cornéens aient été largement adoptés dans la pratique clinique en tant que substitut pour la RO, propriété biomécanique globale de l'oeil, nous avons démontré une association limitée entre la RO et ces paramètres, offrant une nouvelle perspective sur la relation entre les propriétés biomécaniques cornéennes et globales de l’oeil. Seule une faible corrélation entre le facteur de résistance cornéenne et la RO demeure après ajustement pour les facteurs de confusion dans le groupe des patients glaucomateux. Ensuite, nous avons présenté un modèle pour prédire l'amplitude des pics de PIO après IIV à partir de la mesure non-invasive de la RO. Ceci est particulièrement utile pour les patients à haut risque atteints de maladies rétiniennes exsudatives et de glaucome qui nécessiteraient des IIV thérapeutiques, et pourrait permettre aux cliniciens d'ajuster ou de personnaliser le traitement pour éviter toute perte de vision additionnelle. Enfin, nous avons étudié les différences de RO entre les yeux myopes et les non-myopes en utilisant cette technique, et avons démontré une RO inférieure dans la myopie axiale, facteur de risque du GPAO. Dans l'ensemble, ces résultats contribuent à l’avancement des connaissances sur la physiopathologie du GPAO. Le développement de notre méthode permettra non seulement de mieux explorer le rôle de la RO dans les maladies oculaires, mais contribuera également à élucider les mécanismes et développer de nouveaux traitements ciblant la RO pour contrer la déficience visuelle liée à ces maladies. / Glaucoma is the leading cause of irreversible blindness worldwide. While its pathogenesis is yet to be fully understood, the biomechanical properties of the eye are thought to be involved in the development and progression of this disease. Ocular rigidity (OR) is thought to be altered through disease processes and has been suggested to be the most influential factor on the optic nerve head’s response to variations in intraocular pressure (IOP) in glaucoma. To further investigate the role of OR in open-angle glaucoma (OAG) and other ocular diseases such as myopia, the ability to quantify OR in living human eyes using a reliable and non-invasive method is essential. Such a method has only become available in 2015. Based on the Friedenwald equation, the method uses time-lapse optical coherence tomography (OCT) imaging and automated choroidal segmentation to measure the pulsatile choroidal volume change (ΔV), and Pascal dynamic contour tonometry to measure the corresponding pulsatile pressure change. The purpose of this thesis work was to assess the validity of the methodology, then use it to investigate the role of OR in ocular diseases, particularly in OAG. More specifically, the objectives were: 1) To improve the extrapolation of ΔV and evaluate the method’s validity and repeatability, 2) To investigate the association between OR and neuro-retinal damage in glaucomatous patients, as well as those with concomitant vasospasticity, 3) To evaluate the association between OR and corneal biomechanical parameters, 4) To assess the association between OR and IOP spikes following therapeutic intravitreal injections (IVIs), to predict and prevent them in high-risk patients, and 5) To confirm that OR is lower in myopia. First, we improved the mathematical model of the eye used to derive ΔV by rendering it more anatomically accurate and accounting for the peripheral choroid. We also confirmed the validity and good repeatability of the method. We carried out the measurement of OR coefficients on a wide range of healthy and glaucomatous subjects using this non-invasive method, and were able to show, for the first time, that lower OR is correlated with more glaucomatous damage. The correlations observed were comparable to those obtained with recognized risk factors such as maximum IOP. A strong correlation between OR and neuro-retinal damage was found in patients with concurrent vasospastic syndrome, but not in those with ischemic vascular disease. This could perhaps indicate a greater susceptibility to glaucoma due to ocular biomechanics in vasospastic patients. While corneal biomechanical parameters have been widely adopted in clinical practice as surrogate measurements for the eye’s overall biomechanical properties represented by OR, we have shown a limited association between these parameters, bringing new insight unto the relationship between corneal and global biomechanical properties. Only a weak correlation between the corneal resistance factor and OR remained in glaucomatous eyes after adjusting for confounding factors. In addition, we presented a model to predict the magnitude of IOP spikes following IVIs from the non-invasive measurement of OR. This is particularly useful for high-risk patients with exudative retinal diseases and glaucoma that require therapeutic IVIs, and could provide the clinician an opportunity to adjust or customize treatment to prevent further vision loss. Finally, we investigated OR differences between non-myopic and myopic eyes using this technique, and demonstrated lower OR in axial myopia, a risk factor for OAG. Overall, these findings provide new insights unto the pathophysiology of glaucomatous optic neuropathy. The development of our method will permit further investigation of the role of OR in ocular diseases, contributing to elucidate mechanisms and provide novel management options to counter vision impairment caused by these diseases.

In this work is describe anatomy and physiology of the cornea. The following are the primary non-inflamatory degeneration of the cornea. Then describe the physical principles diagnostic devices for cornea – keratometer, pachymeter, Michelson interferometr and optical coherence tomography (OCT). At the end of the theoretical introduction is describes the principle of laser correction surgery – LASIK. The practical part is divided into two main objectives. The first task is propose an algorithm for automatic detection of corneal surface and then calculation of corneal thickness and size of the chamber angle in Matlab. The aim of the second task is image flap analysis for boundary detection.

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.

Indiana University-Purdue University Indianapolis (IUPUI) / Adaptive optics-optical coherence tomography (AO-OCT) is a non-invasive method of imaging the human retina in vivo. It can be used to visualize microscopic structures, making it incredibly useful for the early detection and diagnosis of retinal disease. The research group at Indiana University has a novel multi-camera AO-OCT system capable of 1 MHz acquisition rates. Until this point, a method has not existed to process data from such a novel system quickly and accurately enough on a CPU, a GPU, or one that can scale to multiple GPUs automatically in an efficient manner. This is a barrier to using a MHz AO-OCT system in a clinical environment. A novel approach to processing AO-OCT data from the unique multi-camera optics system is tested on multiple graphics processing units (GPUs) in parallel with one, two, and four camera combinations. The design and results demonstrate a scalable, reusable, extensible method of computing AO-OCT output. This approach can either achieve real time results with an AO-OCT system capable of 1 MHz acquisition rates or be scaled to a higher accuracy mode with a fast Fourier transform of 16,384 complex values.