Syfte: Att undersöka om anatomiska fynd återspeglas i funktionella tester; finns det något samband mellan temporala RNFL och kontrastseende hos friska personer? Material och metoder: Friska personer mellan 18-60 år inkluderades i denna studie. Mätningar gjordes på ögon som hade en refraktion inom ±6,00 DS och detta kontrollerades med en inledande synundersökning. Kontrastseende mättes med Pelli-Robson-testet på 1 m avstånd och testpersonen hade då på sig en provbåge med optimal korrektion samt +0,75 DS extra för att kompensera för testavståndet. Tjockleken på RNFL mättes med en OCT-SLO-mätare med inställningen RNFL. OCTn mäter ett cirkulärt område runt papillen, synnervsutträdet, som är 3,4 mm i diameter. Mätdatan analyserades i GraphPad Prism där statistiska analyser så som t-test och korrelation utfördes. Resultat: 34 personer medverkade i studien och hos samtliga kunde mätningar göras på båda ögonen. Medelåldern på gruppen var 24,3 ± 3,8 år med en spridning mellan 21-43 år. Medelvärdet på kontrastseendet för gruppen var 1,66 ± 0,05 logCS och medelvärdet på temporala RNFL-tjockleken var 76,6 ± 13,3 μm Det fanns inget statistiskt signifikant samband mellan tjockleken på temporala RNFL, och kontrastseende (r=0,05 p=0,68). Diskussion: I tidigare studier har det, i sjukdomsdrabbade ögon, funnits samband mellan tjockleken på RNFL och kontrastseende. Det sambandet går inte att finna i denna studie på friska ögon. När kontrastseendet mättes med Pelli-Robson-tavlan var kontrastkänsligheten nästan lika för samtliga ögon trots att RNFL-tjockleken varierade. Om ett känsligare kontrasttest använts i studien hade man förmodligen sett större variation i resultaten vilket i sin tur eventuellt kunnat visa på ett samband. Slutsats: I denna studie fanns inget statistiskt signifikant samband mellan temporala RNFL-tjockleken och kontrastseende hos friska personer. Därför kan mätningar av temporala RNFL-tjockleken inte förutspå om kontrastseendet, mätt med Pelli-Robson, blir bra eller dåligt. Studien visade också att friska ögon med normal RNFL-tjocklek har ett normalt kontrastseende.

Glaucoma is an ophthalmic pathology that is the second leading cause of blindness. The laboratory design of a Polarization Sensitive Spectral Domain Optical Coherence Tomographic System aims to detect early glaucoma symptoms and prevent vision loss that occurs due to late or no glaucoma diagnosis. In order to perform human clinical trials at partner hospitals across the country, a miniaturized and portable version of the laboratory system was developed. The system facilitates easy transportation and clinical testing of the otherwise voluminous laboratory system across different eye centers. Significant consideration was given for performance optimization, cost reduction, design improvements and providing a friendly user-patient interface. / text

The aim of the study was to evaluate the effect of human immunodeficiency virus infection (HIV) and antiretroviral treatment on the retinal nerve fibre layer (RNFL). The RNFL hickness defined by standard parameters(TSNIT average, Superior average and Inferior average) was assessed in 48 HIV positive patients using scanning laser polarimeter, GDx VCC device. Results were compared to normal values and tested against factors suspected to affect the RNFL thickness. The mean values of the RNFL standard parameters were for TSNIT average, Superior average and Inferior average, 57,65 ± 6,18  m, 69,38 ± 8,34  m, 68,89 ± 9,50  m respectively, in our cohort. The RNFL thinning was not confirmed in our HIV positive group compared to values on healthy population. No significant correlation between the RNFL thickness and the immune profile or antiretroviral therapy was detected. However, a significant negative correlation between the RNFL thickness with increasing duration of HIV infection was foundin our study that is hypothesized to be possibly on an immune pathological basis. Powered by TCPDF (www.tcpdf.org)

No / Purpose: To develop a perimetric test strategy, Structure Estimation of Minimum Uncertainty (SEMU), that uses structural information to drive stimulus choices. Methods: Structure Estimation of Minimum Uncertainty uses retinal nerve fiber layer (RNFL) thickness data as measured by optical coherence tomography to predict perimetric sensitivity. This prediction is used to set suprathreshold levels that then alter a prior probability distribution of the final test output. Using computer simulation, we studied SEMU’s performance under three different patient error response conditions: No Error, Typical False Positive errors, and Extremely Unreliable patients. In experiment 1, SEMU was compared with an existing suprathreshold cum thresholding combination test procedure, Estimation of Minimum Uncertainty (EMU), on single visual field locations. We used these results to finalize SEMU parameters. In experiment 2, SEMU was compared with full threshold (FT) on 163 glaucomatous visual fields. Results: On individual locations, SEMU has similar accuracy to EMU, but is, on average, one presentation faster than EMU. For the typical false-positive error condition, SEMU has significantly lower error compared with FT (SEMU average 0.33 dB lower; p < 0.001) and the 90% measured sensitivity range for SEMU is also smaller than that for FT. For unreliable patients, however, FT has lower mean and SD of error. Structure Estimation of Minimum Uncertainty makes significantly fewer presentations than FT (1.08 presentation on average fewer in a typical false-positive condition; p < 0.001). Assuming that a location in the field is marked abnormal if it falls below the 5th percentile of normal, SEMU has a false-positive rate of less than 10% for all error conditions compared with FT’s rate of 20% or more. Conclusions: On average, simulations show that using RNFL information to guide stimulus placement in a perimetric test procedure maintains accuracy, improves precision, and decreases test duration for patients with less than 15% false-positive rates.

Glaucoma is the second leading cause of blindness in the world. The disease is characterized by irreversible damage to retinal ganglion cells. Once glaucoma is detected, further vision loss can be prevented by pharmacological or surgical treatment. However, current diagnostic methods lack the necessary sensitivity and up to 40% of vision maybe irreversibly lost before detection occurs. A Swept Source Polarization-Sensitive Optical Coherence Tomography (SS-PSOCT) instrument for high sensitivity cross-sectional imaging of optical anisotropy in turbid media has been designed, constructed, and verified. A multiple-state nonlinear fitting algorithm was used to measure birefringence of the retinal nerve fiber layer with less than 1%± average uncertainty. To perform eye imaging efficiently a slit-lamp based interface for the SS-PSOCT instrument with a Line Scanning Laser Ophthalmoscope (LSLO) was used. This interface allowed for repeatable, stable, and registered measurements of the retina. A fixation target was used to stabilize the volunteer’s eye and image desired areas of the retina. The LSLO allowed for an optimization of the location of OCT scans on the retina and provided a fundus blood vessel signature for registration between different imaging sessions. The SS-PSOCT system was used to measure depth-resolved thickness, birefringence, phase retardation and optic axis orientation of the retinal nerve fiber layer in normal volunteers. The peripapillary area around the optic nerve head (ONH) is most sensitive to glaucoma changes and hence data was acquired as concentric ring scans about the ONH with increasing diameters from 2mm to 5mm. Imaging of normal patients showed that higher values of phase retardation occurred superior and inferior to the optic nerve head especially next to blood vessels and thicker parts of the retinal nerve fiber layer. / text

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.

Before year 1895, the doctors could only make a probable diagnosis based on what the patient could tell and it was hurt and there was no discernable change to the outside of the body. With X-ray, it was possible to see inside the patient without first cutting it, you can say that the X-ray was the starting point for diagnostic imaging.The further development of X-ray gave CT (Computed Tomography), where X-ray tubes and detectors rotate around the patient while the patient table moves. Besides CT also developed MRI (Magnetic Resonance Imaging), PET (Positron Emission Tomography) and Ultrasound. Common to these methods is that the produced 3D images.In 1990 a completely new approach for diagnostic imaging, OCT (optical coherence tomography), by measuring the phase shift and the intensity of reflected light, it provides real-time and non-destructive measurements (in vivo) a resolution of 1 to 15 microns, much higher than all other standard imaging techniques. You could say that OCT machine can be compared to ultrasound, which uses the reflection of sound waves to interpretation.The first OCT machines were of type TD (Time Domain), these had low resolution and low scanning speed. In 2005 came the SD-OCT, they had higher resolution and scanning speed, SD stands for spectral domain, SD-OCT is sometimes called FD-OCT as Fourier transformed signals and operating in the frequency domain.The development of OCT machines are only in their infancy, resolution, scanning speed and accuracy will increase all the time, this allows new uses and ways to diagnose developed. OCT can be used in such Oncology, MSD (Musculoskeletal disorders), cardiovascular medicine, teeth, nerves, but the largest field is the eye and then the back of the eye called the retina (retina).This thesis is limited to the eye, the purpose is to provide input to those who are likely to purchase an OCT-machine, but also show the measurement data OCT-machines are performing and how to use the OCT-machine more than to see age-related macular degeneration. Another aim is to increase understanding of the physics behind an OCT-machine for ease of understanding the output given.The manufacture/model that have selected for evaluation are Zeiss Cirrus 4000, Topcon 3D OCT-2000 and Heidelberg Spectralis, the reason is that there are only these three on the Swedish market and all are SD-OCT. The way to evaluate OCT-machines is to scan performance and what the various analysis programs can handle. Furthermore, each OCT-machine scans the macula and optic disk on a experimental person/ reference eye, in order to get the output of the precision, or if you want to call it repeatability, which is very important if one wants to follow a solitary disease course.The conclusion of this thesis is to OCT machines are quite similar. When it comes to ease of use when doing scans is the Cirrus is lightened by the use of the extra screen where you always look eye (iris camera), which makes it easy to adjust the sharpness and position of the mouse buttons. Topcon and Heidelberg is not difficult to use but requires more experience of the person making the OCT scans. Most measurement functions in the analysis program is Topcon and Heidelberg and best accuracy/repeatability is Heidelberg, both the macula and RFNL.OCT machine is a good tool to use on the anterior segment, but in the case the precision allows the precision used to monitor RNFL thickness changes in those with glaucoma. / <p>Validerat; 20131029 (global_studentproject_submitter)</p>