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Biomedical subjects

J W Berger

Publications and source records attributed to J W Berger.

At least 19 recordsLinked to original sources
PubMed2001

Augmented reality fundus biomicroscopy: a working clinical prototype.

BACKGROUND: To guide treatment for macular diseases and to facilitate real-time image correlation, measurement, and comparison, we developed a method for direct overlay of previously stored photographic and angiographic images onto the real-time slitlamp fundus view. METHODS: Previously acquired fundus photographs and angiography images were digitized. A slitlamp interfaced to a charge-coupled device camera, framegrabber, and computer allowed for real-time acquisition and digitization of slitlamp fundus images that was synchronous with posterior segment examination. Custom-developed video injectors containing a miniature cathode ray tube display allowed for real-time superposition of angiographic images to the fundus view. Registration and tracking algorithms were developed and deployed in C++. The feasibility of this approach was demonstrated in 5 human subjects. RESULTS: The computer-vision algorithms provided robust registration, tracking, and image overlay of previously stored photographic and angiographic images directly onto the real-time fundus view. Accurate tracking was demonstrated with updates at 3 to 5 Hz. Direct overlay of previously stored images confirmed registration accuracy, but examiners preferred a more simple rendering that included only relevant information and eliminated extraneous, potentially confusing image data. CONCLUSIONS: Slitlamp-based video injection of previously stored images allows for accurate, robust, real-time correlation and comparison to the biomicroscopic fundus view in human subjects.

Algorithms↗
PubMed2001

Laser burn intensity and the risk for choroidal neovascularization in the CNVPT Fellow Eye Study.

OBJECTIVE: To explore the relationship between laser burn intensity and the subsequent risk for development of choroidal neovascularization (CNV) in eyes assigned to the treatment group of the Fellow Eye Study (FES) of the Choroidal Neovascularization Prevention Trial (CNVPT), using computerized methods for laser burn quantitation, and to examine the association between laser burn intensity and (1) drusen reduction and (2) visual acuity. METHODS: Color fundus images before and immediately after laser treatment in the CNVPT FES were available for 53 of 59 eyes. Prelaser and postlaser treatment images were analyzed using custom-developed computer software, allowing for laser burn identification and quantitation. As measures of laser burn intensity, we derived integrated burn rating (IBR) (the integral of the normalized intensity difference divided by the burn pixels), and the maximum burn intensity (MAX). We identified CNV using fluorescein angiography. A Cox proportional hazards model was fit to the time to development of CNV. Baseline and 6-month color photographs were used to determine reduction in drusen. Visual acuity was measured using a standardized protocol. RESULTS: The IBR and MAX spanned 4.5 logarithm units. After adjusting for smoking history and predominant drusen size, the risk ratio for CNV per logarithm unit of increasing laser burn intensity for each measure was 2.0 (P =.05) for MAX and 1.7 (P =.07) for IBR. When patients were divided into high- and low-intensity treatment groups of equal size, the high-intensity group had more drusen reduction (57% vs 32%; P =.14). There was no effect of laser intensity on change in visual acuity at 6 months. CONCLUSION: Higher-intensity prophylactic laser applications appear to be associated with a greater risk for development of CNV and with more extensive drusen reduction.

Choroidal Neovascularization↗
PubMed2001

Mosaicking and enhancement of slit lamp biomicroscopic fundus images.

AIMS: To process video slit lamp biomicroscopic fundus image sequences in order to generate wide field, high quality fundus image montages which might be suitable for photodocumentation. METHODS: Slit lamp biomicroscopic fundus examination was performed on human volunteers with a contact or non-contact lens. A stock, charge coupled device camera permitted image capture and storage of the image sequence at 30 frames per second. Acquisition time was approximately 30 seconds. Individual slit lamp biomicroscope fundus image frames were aligned and blended with custom developed software. RESULTS: The developed algorithms allowed for highly accurate alignment and blending of partially overlapping slit lamp biomicroscopic fundus images to generate a seamless, high quality, wide field montage. CONCLUSIONS: Video image acquisition and processing algorithms allow for mosaicking and enhancement of slit lamp biomicroscopic fundus images. The improved quality and wide field of view may confer suitability for inexpensive, real time photodocumentation of disc and macular abnormalities.

Algorithms↗
PubMed2000

Computerized stereochronoscopy and alternation flicker to detect optic nerve head contour change.

PURPOSE/BACKGROUND: Stereochronoscopy, a technique previously explored but abandoned for glaucoma diagnosis, viewed optic nerve images acquired at separate points in time as if a stereo pair. Prior efforts to exploit this technique were impaired by a lack of superimposability for sequential optic nerve images. We investigated computerized registration techniques for aligning sequential, monoscopic optic disc images to facilitate sensitive detection of optic nerve head contour changes in glaucoma. DESIGN: Algorithm and software development. Comparisons with standard techniques. MATERIALS: Existing patient records from the Glaucoma Service, Scheie Eye Institute, University of Pennsylvania. METHODS: Two sets of optic disc photographs, separated in time by 1 to 18 years, of 25 eyes with and without glaucomatous optic disc progression were digitized. We developed custom software for accurate image alignment. Change in disc morphology was then judged by digital stereochronoscopy and user-controlled alternation flicker of superimposed, time-separated images on a computer monitor. Comparisons were made with standard stereoscopic comparison. MAIN OUTCOME MEASURE: Identification of change or no change in optic nerve head contour for images acquired at separate points in time. RESULTS: Image processing and registration permits accurate alignment of optic disc photographs. Alternation flicker of superimposed, sequential images facilitates image comparison and detection of change as indicated by change in vessel position, color, and other cues for contour change. A high concordance was found between standard stereoscopic comparison and alternation flicker. In several cases, reinspection of stereo comparison led to a revised judgment on the basis of disc changes rendered more obvious with alternation flicker. Digital stereochronoscopy was less concordant with standard techniques. CONCLUSIONS: Digital image processing techniques and alternation flicker provide a simple, sensitive, software-based method for detecting glaucomatous optic disc change.

Algorithms↗
PubMed2000

Automated, real time extraction of fundus images from slit lamp fundus biomicroscope video image sequences.

AIMS: Slit lamp fundus biomicroscopy allows for high magnification, stereoscopic diagnosis, and treatment of macular diseases. Variable contrast, narrow field of view, and specular reflections arising from the cornea, sclera, and examining lens reduce image quality; these images are of limited clinical utility for diagnosis, treatment planning, and photodocumentation when compared with fundus camera images. Algorithms are being developed to segment fundus imagery from slit lamp biomicroscopic video image sequences in order to improve clinical utility. METHODS: Video fundus image sequences of human volunteers were acquired with a video equipped, Nikon NS-1V slit lamp biomicroscope. Custom developed software identified specular reflections based on brightness and colour content, and extracted the illuminated fundus image based on colour image analysis and size constraints. RESULTS: In five subjects with variable image quality, the approach allowed for automatic, robust, accurate extraction of that portion of the video image corresponding to the illuminated portion of the fundus. Non-real time analysis allowed for fundus image segmentation for each frame of the image sequence. In real time, segmentation occurs at 2 Hz, and improvements are being implemented for video rate performance. CONCLUSIONS: Computer vision algorithms allow for real time extraction of fundus imagery from marginal quality, slit lamp fundus biomicroscope image sequences.

Algorithms↗
PubMed2000

Grading, image analysis, and stereopsis of digitally compressed fundus images.

PURPOSE: To investigate the effects of image digitization and compression on the ability to identify and quantify features in color fundus photographs. METHODS: Color fundus photographs were digitized as tagged image file format (TIFF) and high-compression (80:1) and low-compression (30:1) joint photographic experts group (JPEG) images. Rerendered images were subjected to standard grading protocols developed for a clinical trial, and digitized images were subjected to image analysis software for drusen identification and quantitation. Re-created stereoscopic images were compared subjectively with originals. RESULTS: Original, TIFF, and low-compression (30:1) JPEG images were virtually indistinguishable when subjected to close scrutiny with magnification. The overall quality of high-compression (80:1) JPEG images and images digitized at 500 dots per inch was markedly reduced. Protocol grading of original and digitized images was highly concordant within the repeatability of multiple grading of original images. The area subtended by drusen differed by less than 1.0% for all uncompressed and compressed image pairs quantified. Stereoscopic information was accurately preserved when compared with originals for TIFF and low-compression JPEG images. CONCLUSIONS: Fundus images can be digitized and stored with significant compression while preserving stereopsis and image quality suitable for quantitative image analysis and semiquantitative grading. Low-compression (30:1) JPEG images may be suitable for archiving and telemedical applications.

Depth Perception↗
PubMed2000

Computer-assisted quantitation of choroidal neovascularization for clinical trials.

PURPOSE: To develop a computer-assisted method for the quantitation of choroidal neovascularization (CNV) for the support of clinical trials. METHODS: Fluorescein angiographic images were selected from 5 patients enrolled in a clinical trial for which three follow-up visits were available. Thirty- and 600-second images were digitized at 1000 dots/in and registered (aligned) with polynomial warping algorithms. Custom-developed software allowed for coarse, automated identification of CNV. An easy-to-use graphical user interface facilitated supervision and refinement of the lesion boundaries by a skilled reader based on standard stereoscopic viewing of the fluorescein angiography study. Capabilities for boundary delineation in both early and late phases, and animation to allow for image correlation and evaluation of temporal changes in fluorescence of spatially corresponding pixels, were included. Two metrics for CNV characterization were generated. First, the lesion area based on the lesion boundaries was identified after supervision. Second, an integrated lesion intensity (ILI) reflecting the integrated, normalized lesion hyperfluorescence was calculated. RESULTS: Area and ILI measures were calculated for each of 5 patients for three or more visits. Facile supervision based on the stereoscopic angiogram permitted arbitrarily close concordance with CNV identification using standard methods. Changes in area and ILI measurements between visits correlated closely with clinically observed changes in each case. CONCLUSIONS: Interactive image processing permits efficient, accurate, computer-assisted CNV quantitation that may be useful for the support of clinical trials and preclinical studies.

Choroid↗
PubMed1999

Computer-assisted, interactive fundus image processing for macular drusen quantitation.

PURPOSE: To design and validate a software package to quantitate the area subtended by drusen in color fundus photographs for the conduct of efficient, accurate clinical trials in age-related macular degeneration. DESIGN: Algorithm and software development. Comparisons with manual methodologies. PARTICIPANTS: Evaluation and testing on color fundus photographs from patient records and from eyes enrolled in the Choroidal Neovascularization Prevention Trial. METHODS: Fundus photographs of eyes with drusen were digitized. The green channel was selected for maximum contrast and preprocessed with filtering and shade correction to minimize noise, improve contrast, and correct for illumination and background inhomogeneities. Local thresholding and region-growing algorithms identified drusen. Multiple levels of supervision were incorporated to maximize robustness, accuracy, and validity. Validation studies compared computer-assisted with manual grading by an experienced grader. Intraclass correlation coefficients were calculated as a measure of the concordance between manual and computer-assisted fundus gradings. MAIN OUTCOME MEASURES: Drusen area and concordance with manual grading. RESULTS: Automated supervised image analysis offers extreme robustness and accuracy. Most images were segmented with little or no supervision, with processing times on the order of 5 seconds. More complicated images required supervision and a total analysis time varying from 20 seconds to 5 minutes, with most of this time devoted to inspection and comparison. Interactive image processing affords arbitrarily close concordance with manual drusen identification, with calculated intraclass correlation coefficients of 0.92 and 0.93 for comparison of manual with automated, supervised grading by two observers. CONCLUSIONS: Automated supervised fundus image analysis is an efficient, robust, valid technique for drusen quantitation from color fundus photographs. This approach should prove useful in the conduct of efficient accurate clinical trials for age-related macular degeneration.

Algorithms↗
PubMed1999

Computer-vision-enabled augmented reality fundus biomicroscopy.

PURPOSE: To guide treatment for macular diseases and to facilitate real-time image measurement and comparison, investigations were initiated to permit overlay of previously stored photographic and angiographic images directly onto the real-time slit-lamp biomicroscopic fundus image. DESIGN: Experimental study in model eyes, and preliminary observations in human subjects. METHODS: A modified, binocular video slit lamp interfaced to a personal computer and framegrabber allows for image acquisition and rendering of stored images overlaid onto the real-time slit-lamp biomicroscopic fundus image. Development proceeds with rendering on a computer monitor, while construction is completed on a miniature display interfaced directly with one of the slit-lamp oculars. Registration and tracking are performed with in-house-developed software. MAIN OUTCOME MEASURES: Tracking speed and accuracy, ergonomic acceptability. RESULTS: Computer-vision algorithms permit robust montaging, tracking, registration, and rendering of previously stored photographic and angiographic images onto the real-time slit-lamp fundus biomicroscopic image. In model eyes and in preliminary studies in a human eye, optimized registration permits near-video-rate image overlay with updates at 3 to 10 Hz and misregistration errors on the order of 1 to 5 pixels. CONCLUSIONS: A prototype for ophthalmic augmented reality (image overlay) is presented. The current hardware/software implementation allows for robust performance.

Algorithms↗
PubMed1999

An intelligent, interactive platform for ophthalmic teaching, telemedicine, and telecollaboration: design considerations and prototype construction.

The development of technologies permitting processing, compression, and transmission of digital images and image sequences enables powerful methodologies for local and remote medical teleconsultation. We are developing a slit-lamp-based ophthalmic augmented reality (image overlay) environment incorporating features to permit real-time, interactive teaching, telemedicine, and telecollaboration. A binocular slit-lamp biomicroscope interfaced to a CCD camera, framegrabber board, and PC permits acquisition and rendering of anterior segment and retinal images. Computer-vision algorithms facilitate robust tracking, registration, and near-video-rate image overlay of previously stored retinal photographic and angiographic images onto the real-time fundus image. Our algorithms facilitate shared control of pointing, drawing, and measuring functions registered with the retinal image video stream and direct audio communication between an examiner (student, generalist) and remote observer (instructor, specialist). Bandwidth and video compression considerations limit the frame rate and latency for video stream transmission. Excellent and acceptable performance are demonstrated in model eyes over a local area network and through a modem connection, respectively. These studies represent the first investigations towards the design and implementation of an intelligent platform for ophthalmic telemedicine and telecollaboration.

Algorithms↗
PubMed1999

Quantitative image sequence analysis of fundus fluorescein angiography.

Interpretation of retinal angiographic studies has heretofore been largely qualitative. The temporal properties associated with fluorescein fluorescence of normal and pathologic fundus features are quantified to potentiate pixel assignment and fundus feature quantitation for clinical studies where precise image metrology is vital. Fluorescein angiography studies were digitized, and temporally sequential images were spatially registered with polynomial warping algorithms, allowing for the construction of a three-dimensional angiogram vector. Temporal profiles through spatially registered, temporally sequential pixels were computed. Fundus feature fluorescence behavior was quantified. Fundus features may be discriminated on the basis of spatio-temporal fluorescein fluorescence properties. Pixel assignment based on spatio-temporal relationships will facilitate fundus feature quantitation.

Choroidal Neovascularization↗
PubMed1997

Thermal modelling of micropulsed diode laser retinal photocoagulation.

BACKGROUND AND OBJECTIVE: Recent studies have sought to utilize diode laser "micropulsing" in order to preserve therapeutic efficacy of retinal photocoagulation while minimizing pain and subjacent tissue injury. A model for the transient thermal tissue response to continuous and micropulsed diode laser output is presented in order to understand the laser-tissue interactions and to generate optimum parameters for exploiting potential advantages of micropulsed application. STUDY DESIGN/MATERIALS AND METHODS: The tissue thermal response was calculated by convolving the analytical solution to the three-dimensional, isotropic heat conduction equation with a source term corresponding to the spot size of the laser incident on the absorbing retinal pigment epithelium (RPE) and choroid layers of the ocular fundus. Thermal localization is quantitated by comparing the temperature rise in the RPE (T(RPE) and deep choroid (T(Ch). A 1-watt (average power), 20-microns diameter, 100 ms pulse (continuous or micropulsed) of 810 nm radiation was modelled to be incident on a geometric idealization of the human retina and choroid. RESULTS: A temperature gradient is rapidly established with only modest temperature augmentation between 10 and 100 ms. At 100 ms T(RPE) and T(Ch) are 32 and 23 C, respectively, for continuous application, and 41 and 27 C for 2 ms on/off micropulsed application. For a duty factor (total laser "on" time divided by pulse length) of 50%, T(RPE)/T(Ch) is maximal for a micropulse on/off duration of 2 ms; however, the variation over micropulse durations from 200 microseconds to 50 ms is small. In addition, whereas end-pulse T(RPE)/T(Ch) is greater for 2 ms on/off application when compared with continuous delivery (1.53 vs. 1.39), thermal relaxation during pulse quiescence in the micropulsed mode allows for an early increase in deep choroidal temperature with respect to T(RPE). For ten 200 microseconds pulses equally separated over 100 ms (duty factor = 2%), T(RPE)/T(Ch) = 3.2. With more numerous, lower power micropulses, T(RPE)/T(Ch) decreases monotonically to 1.39 as the duty factor is increased to 100%. CONCLUSION: These modelling studies provide the first quantitative predictions of thermal localization achieved with diode laser micropulsing and demonstrate that short pulse lengths and low duty factors allow for maximum thermal localization. These studies will potentiate pulse-shape optimization strategies for diode laser retinal photocoagulation applications.

Body Temperature↗
PubMed1997

Modeling of erbium: YAG laser-mediated explosive photovaporization: implications for vitreoretinal surgery.

BACKGROUND AND OBJECTIVE: Motivated by the potential for highly precise tissue removal, investigators are exploring fiberoptic microsurgical maneuvers with the erbium:YAG (Er:YAG) laser. Tissue is disrupted and removed by direct ablation and the acousto-mechanical sequelae of explosive vaporization of the tissue water. The authors investigated the scaling laws for photoablative and photodisruptive interactions and interpreted these results to optimize energy delivery for vitreoretinal surgical maneuvers. MATERIALS AND METHODS: A model for laser-generated-bubble expansion is presented based on energy principles and adiabatic gas expansion. Comparisons are made with the authors' previous studies of ablation rate and thermometry. RESULTS: The authors' modeling studies generated predictions similar to experimental data. The maximum bubble diameter increases as the cube root of the pulse energy. At constant radiant exposure, the maximum bubble diameter increases as the probe tip diameter raised to the two-thirds power. The authors demonstrated that tissue ablation depends on radiant exposure (J/cm2), whereas temperature increases, bubble size, and peak pressure depend on total pulse energy. CONCLUSIONS: Mechanical injury should be minimized and efficient ablation preserved by delivering low-pulse energy through small-diameter probe tips at high repetition rates.

Laser Therapy↗
PubMed1996

Measurement and modeling of thermal transients during Er:YAG laser irradiation of vitreous.

BACKGROUND AND OBJECTIVE: We investigated the transient thermal behavior of vitreous in order to understand the local thermal effects of laser output, and to predict the potential for unintentional injury during Er:YAG laser vitreoretinal surgery. STUDY DESIGN/MATERIALS AND METHODS: The output of a free-running Er:YAG laser (2.94 microns, 300 microseconds FWHM) was delivered through a fiberoptic and applied to en bloc samples of bovine vitreous. Temperature was measured with ultrafine thermocouples. RESULTS: For 6 mJ pulse energy at 10 Hz, a temperature rise of 20 degrees C is measured 500 microns from the laser tip. The temperature rise is localized with a rapid fall-off greater than 1 mm from the energy source. At constant time-averaged laser power, the temperature profile is independent of repetition rate. Our finite-difference model generates results qualitatively consistent with measured data and allows for investigation of the influence of thermophysical parameters on heat transfer. CONCLUSION: Thermal injury to ocular structures should be limited during intravitreal application of Er:YAG laser energy.

Animals↗