U.S. patent application number 11/416915 was filed with the patent office on 2006-11-02 for imaging of macular pigment distributions.
Invention is credited to Werner Gellermann, Moshen Sharifzadeh.
Application Number | 20060244913 11/416915 |
Document ID | / |
Family ID | 46324405 |
Filed Date | 2006-11-02 |
United States Patent
Application |
20060244913 |
Kind Code |
A1 |
Gellermann; Werner ; et
al. |
November 2, 2006 |
Imaging of macular pigment distributions
Abstract
Macular pigments are measured by spectrally selective lipofuscin
detection. Light from a light source that emits light at a selected
range of wavelengths that overlap the absorption band of macular
carotenoids is directed onto macular tissue of an eye for which
macular pigment levels are to be measured. Emitted light is then
collected from the macular tissue. The collected light is filtered
so that the collected light includes lipofuscin emission from the
macular tissue at an excitation wavelength that lies outside the
macular pigment absorption range and outside the excitation range
of interfering fluorophores. The collected light is quantified at
each of a plurality of locations in the macular tissue and the
macular pigment levels in the macular tissue are determined from
the differing lipofuscin emission intensities in the macula and
peripheral retina.
Inventors: |
Gellermann; Werner; (Salt
Lake City, UT) ; Sharifzadeh; Moshen; (Salt Lake
City, UT) |
Correspondence
Address: |
HOLME ROBERTS & OWEN, LLP
299 SOUTH MAIN
SUITE 1800
SALT LAKE CITY
UT
84111
US
|
Family ID: |
46324405 |
Appl. No.: |
11/416915 |
Filed: |
May 3, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
11018403 |
Dec 21, 2004 |
|
|
|
11416915 |
May 3, 2006 |
|
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Current U.S.
Class: |
351/205 ;
600/315 |
Current CPC
Class: |
A61B 3/10 20130101; A61B
5/0059 20130101; A61B 3/1225 20130101 |
Class at
Publication: |
351/205 ;
600/315 |
International
Class: |
A61B 3/10 20060101
A61B003/10 |
Claims
1. A method for measuring macular pigments, comprising:
illuminating the macular tissue of an eye with light at a
wavelength that overlaps the absorption band of macular carotenoids
and the absorption band of lipofuscin, quantifying the light
emission from each of the macula and peripheral retina of the eye
at an excitation wavelength that lies outside the macular pigment
absorption range and outside the excitation range of interfering
fluorophores, and determining the spatial extent and topographic
concentration distribution of macular pigments in the macular
tissue from the differing light intensities in the macula and
peripheral retina.
2. A method as defined in claim 1, wherein the act of illuminating
the macula and peripheral retina of an eye with light is performed
with light at a wavelength of from about 450 nm to about 550 nm at
an exposure on the eye below about 10 mJ/cm.sup.2 and for less than
about 1 second.
3. A method as defined in claim 1, wherein the act of illuminating
the macula and peripheral retina of an eye with light comprises
illuminating the macula and peripheral retina of an undilated
eye.
4. A method for diagnosing a subject, comprising: performing a
method as defined in claim 1 upon the eye of a subject, comparing
the macular pigment levels to correlative data indicative of one or
more pathologies or symptoms, and based upon the comparison,
determining the presence, absence, or degree of one or more
pathologies or symptoms.
5. A method for measuring macular pigments, comprising: providing a
light source that emits light at at least one wavelength that
overlaps the absorption band of macular carotenoids and the
absorption band of lipofuscin, directing light from the light
source onto macular tissue of an eye for which macular pigment
levels are to be measured, collecting light emitted from the
macular tissue, the collected light comprising lipofuscin emission
from the macular tissue at an excitation wavelength that lies
outside the macular pigment absorption range and outside the
excitation range of interfering fluorophores, quantifying the
collected light from each of a plurality of locations in the
macular tissue and thereby quantifying the lipofuscin emission
intensities from each of a plurality of locations, and determining
the macular pigment levels in the macular tissue from the differing
lipofuscin emission intensities in the macula and peripheral
retina.
6. A method as defined in claim 5, wherein the collected light is
filtered such that only light above about 700 nm is quantified.
7. A method as defined in claim 5, wherein the light from the light
source has an intensity that does not substantially alter macular
pigment levels in the macular tissue;
8. A method as defined in claim 5, wherein the light source
generates coherent light at a wavelength of from about 450 nm to
about 550 nm.
9. A method as defined in claim 5, wherein the light source
generates laser light at a wavelength of about 488 nm.
10. A method as defined in claim 5, wherein the light source is a
light emitting diode.
11. A method as defined in claim 5, wherein the light exposure from
the light source on the eye is below about 10 mJ/cm.sup.2.
12. A method as defined in claim 5, wherein the light exposure from
the light source on the eye is for less than about 1 second.
13. A method as defined in claim 5, wherein the collected light is
used to produce digital macular pigment images of the macular
tissue.
14. A method as defined in claim 5, wherein the lipofuscin emission
is from fluorescence of the retinal pigment epithelium of the eye
upon excitation with the light from the light source.
15. A method as defined in claim 14, wherein the fluorescence of
the retinal pigment epithelium is used to produce digital macular
pigment images of the macular tissue.
16. A method as defined in claim 15, further comprising determining
spatial extent and topographic concentration distribution of the
macular pigments by digital image subtraction.
17. A method for diagnosing a subject, comprising: performing a
method as defined in claim 5 upon the eye of the subject; comparing
the macular pigment levels to correlative data indicative of one or
more pathologies or symptoms; and based upon the comparison,
determining the presence, absence, or degree of one or more
pathologies or symptoms.
18. An apparatus for measuring macular pigments, comprising: a
light source that generates light at a wavelength that is absorbed
by macular pigment and lipofuscin and that produces an
autofluorescence lipofuscin emission; at least one optical filter
configured for receiving, directly or indirectly, light that is
emitted from macular tissue of an eye that has been illuminated
with light from the light source, the optical filter being
selective for passing light at a selected wavelength range such
that fluorescence contributions from ocular media besides the
macula are substantially blocked; and an optical detector
configured for receiving the passed light from the optical filter
and generating a signal indicative of the fluorescence intensities
of the lipofuscin emission at the macula and peripheral retina of a
subject's eye; and a computing device for determining macular
pigment concentrations from the fluorescence intensities of the
lipofuscin emission at the macula and peripheral retina.
19. An apparatus as defined in claim 18, further comprising: one or
more light delivery optical components for directing light from the
light source to a subject's eye; and one or more light collection
optical components for receiving an autofluorescence lipofuscin
emission from the subject's eye and routing the autofluorescence
lipofuscin emission from the eye.
20. An apparatus as defined in claim 18, wherein the light source
comprises a light emitting diode.
21. An apparatus as defined in claim 18, wherein the light source
generates coherent light at a wavelength of about 488 nm.
22. An apparatus as defined in claim 18, wherein the optical filter
blocks light at wavelengths of less than about 700 nm.
23. An apparatus as defined in claim 18, wherein the optical
detector is selected from the group consisting of a CCD camera, a
CCD detector array, an intensified CCD detector array, a
photomultiplier apparatus, and photodiodes.
24. An apparatus as defined in claim 18, wherein the computing
device uses the fluorescence intensities of the lipofuscin emission
to produce digital macular pigment images of the macular
tissue.
25. An apparatus as defined in claim 18, wherein the computing
device uses the fluorescence intensities of the lipofuscin emission
to obtain spatial extent and topographic concentration distribution
of the macular pigments by digital image subtraction.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of U.S. patent
application Ser. No. 11/018,403, filed Dec. 21, 2004, entitled
"Methods and Apparatus for Detection of Carotenoids for Macular
Tissue, which is incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0002] 1. The Field of the Invention
[0003] The present invention relates to techniques for optically
measuring levels of chemical compounds in biological tissues. More
particularly, the invention relates to the noninvasive optical
detection and measurement of levels of macular carotenoids and
related chemical substances using spectrally selective fluorescence
spectroscopy of lipofuscin.
[0004] 2. The Relevant Technology
[0005] Macular pigment ("MP") is a collection of biological
compounds concentrated in a small region in the center of the
retina that provides high-acuity vision. Comprised of the
carotenoid compounds lutein and zeaxanthin, MP is thought to play a
protective role in the prevention or delay of age-related macular
degeneration ("AMD"), the leading cause of irreversible blindness
in the elderly in the Western world. Epidemiological studies
analyzing carotenoid levels via dietary surveys and serum assays
have shown that there is an inverse correlation between high
dietary intakes and blood levels of lutein and zeaxanthin and risk
of advanced AMD. Furthermore, several studies, including resonance
Raman clinical studies and a high performance liquid chromatography
("HPLC") analysis of human cadaver eyes with and without a known
history of AMD, have demonstrated a correlation between levels of
lutein and zeaxanthin and AMD.
[0006] The standard methods that have been used for measuring
carotenoids are through high-performance liquid chromatography
(HPLC) techniques. Such techniques require that large amounts of
tissue sample be removed from the patient for subsequent analysis
and processing, which typically takes at least 24 hours to
complete. In the course of these types of analyses, the tissue is
damaged, if not completely destroyed. As a result, there is a
strong interest to develop non-invasive detection techniques for MP
in the living human retina. Such techniques could be used, for
example, in large-scale monitoring studies of dietary and/or
nutritional interventions designed to raise MP levels, and
potentially help protect a large fraction of the population from
developing this debilitating disease.
[0007] Currently, the most commonly used noninvasive method for
measuring human MP levels is a subjective psychophysical
heterochromatic flicker photometry test involving color intensity
matching of a light beam aimed at the fovea and another aimed at
the perifoveal area. However, this method is rather time consuming
and requires an alert, cooperative subject with good visual acuity.
This method can also exhibit a high intrasubject variability when
macular pigment densities are low or if significant macular
pathology is present. Thus, the usefulness of this method for
assessing macular pigment levels in the elderly population most at
risk for AMD is severely limited. Nevertheless, researchers have
used flicker photometry to investigate important questions such as
variation of macular pigment density with age and diet.
[0008] A number of objective techniques for the measurement of MP
in the human retina have been explored recently as alternatives to
the subjective psychophysical tests. The underlying optics
principles of these techniques are either based on fundus
reflection or fundus fluorescence (autofluorescence)
spectroscopy.
[0009] One of the MP imaging approaches is based on fundus
reflectance techniques. There are two variants in which this method
is implemented. In one variant, the reflectance of a broad band
light source from the sclera is compared for a foveal and
perifoveal spot and the spectral contribution of the absorbance by
MP is calculated. In a second variant, no reference at a peripheral
site is needed. Only a foveal field is used, and MP levels are
derived from a model fit that takes into account the absorption and
scattering coefficients of all retinal layers traversed in a
double-path succession by the light.
[0010] Some reflectance based imaging variants are based on
scanning laser ophthalmoscopes (SLOs). Argon laser lines at 488 and
514 nm are used to generate monochromatic digital reflection images
from the retina at MP "on peak" and "off peak" spectral absorption
positions, which are then digitally subtracted to display the MP
absorption distribution. While reflectance based MP imaging is
evolving as a viable clinical technique for subjects, a drawback of
the technology is seen in the need for eyes in mydriasis (dilation
of the pupil).
[0011] In autofluorescence spectroscopy, lipofuscin in the retinal
pigment epithelium is excited with light within and outside the
wavelength range of macular pigment absorption, but within the
absorption range of lipofuscin. This can be realized, for example,
with 488 nm and 532 nm light sources, respectively. The blue (488
nm) wavelength is absorbed both by macular pigment and lipofuscin;
the green (532 nm) wavelength is absorbed only by lipofuscin. By
measuring the lipofuscin fluorescence intensity levels for the
foveal and peripheral retina regions, I.sub.min and I.sub.max,
respectively, for both excitation wavelengths, an estimate of the
single-pass absorption of MP can be obtained. A disadvantage of the
autofluoresecence technique is its low specificity. In principle,
any absorber absorbing in the same wavelength range as the MP can
artifactually attenuate the lipofuscin excitation, and thus lead to
an erroneous mapping of the MP distribution and its concentration
levels. This could be a serious drawback, particularly in the
presence of retinal pathology (e.g. drusen, bleeding vessels, etc).
Similarly, fluorescence from other compounds than lipofuscin could
confound the results.
[0012] MP usually peaks in the center of the macula, the foveola,
and drops off rapidly with increasing eccentricity. Absolute
concentrations of MP are very high compared to other tissue sites,
corresponding typically to 10-30 ng per macular punch biopsy (about
5 mm diameter). FIG. 1 illustrates the absorption spectrum of an
excised, flat-mounted, human retina in the blue/green wavelength
region, showing typical absorption characteristics of carotenoid
macular pigment (solid curve at left). The retinal pigment
epithelium of the retina was removed for this measurement, and the
spectrum was measured through a 1 mm aperture. In spite of the very
thin retinal tissue layer, the optical density reaches an average
value of about 0.3 above background, which explains the origin of
the strong yellow coloration of the macula. Comparing the optical
absorption of the macula with lutein and zeaxanthin solutions, one
finds that the absorption behavior is remarkably similar, including
the appearance of vibronic substructure, and that there is little
overlap with potentially confounding other chromophores in the
intact retina. The solid curve at right shows the fluorescence
spectrum of a solution of lutein, obtained under excitation at 488
nm.
[0013] Optical excitation of MP leads to only very weak
fluorescence since the excited lutein and zeaxanthin molecules
relax very rapidly (within 200-250 fsec) to a lower lying excited
state from which emission of light is parity forbidden (see FIG.
1C). The unusual ordering of the energy states is a unique feature
of the polyene-like, .pi.-conjugated carotenoids having a large
number of conjugated C.dbd.C double bonds (10 and 11 in lutein and
zeaxanthin, respectively, see FIG. 1B). In fact, the quantum
efficiency for a radiative transition from the 2 .sup.1Ag excited
state to the 1 .sup.1Ag ground state is estimated to be as low as
10.sup.-5 to 10.sup.-4. Therefore, relaxation of the excited
molecule back to the ground state occurs mostly via non-radiative
transitions. The weak emission, observable only with very sensitive
detection, has a small Stokes shift, and occurs in the green
wavelength range centered at about 530 nm, as shown in FIG. 1
(solid curve at right).
[0014] Due to the weak fluorescence transitions, direct detection
of MP using lutein or zeaxanthin fluorescence has not been realized
to date. However, the virtual absence of intrinsic MP fluorescence
makes it possible to detect instead the resonance Raman transitions
of MP, even in living human eyes, which would otherwise be masked
beyond detection by the fluorescence background. As a result, one
method for the measurement of carotenoids and related chemical
substances in biological tissue is by resonance Raman spectroscopy,
for example as disclosed in U.S. Pat. No. 6,205,354, the disclosure
of which is incorporated by reference herein in its entirety.
Generally, Raman spectroscopy is a highly specific form of
vibrational spectroscopy that identifies a Raman shift, which
corresponds to an energy which is the fingerprint of the
vibrational or rotational energy state of certain molecules.
Typically, a molecule exhibits several characteristic Raman active
vibrational or rotational energy states, and the measurement of the
molecule's Raman spectrum thus provides a fingerprint of the
molecule, i.e., it provides a molecule-specific series of
spectrally sharp vibration or rotation peaks. The intensity of the
Raman scattered light corresponds directly to the concentration of
the molecule(s) of interest. In the case of Raman spectroscopy as
applied to MP, this method detects the light that is Raman
scattered from the MP carotenoid molecules at their 1525 cm.sup.-1
carbon-carbon double bond stretch frequency under resonant
excitation in the MP absorption band. The Raman method measures the
response of MP directly and has a very high molecule
specificity.
[0015] Raman detection methods have the benefit of extremely high
specificity for lutein and zeaxanthin, and therefore for MP.
However, detecting only the absolute amount of MP, the Raman
response is attenuated to some degree by the combined absorption
and scattering of anterior ocular media, predominantly the
lens.
[0016] Accordingly, improved methods and apparatus that quickly,
safely, and accurately measure a human's macular carotenoid levels
are needed.
BRIEF SUMMARY OF THE INVENTION
[0017] According to the invention, macular pigment ("MP") imaging
based on lipofuscin fluorescence detection is useful as a
relatively simple, objective and quantitative noninvasive optical
technique suitable to rapidly screen MP levels and distributions in
healthy humans with undilated pupils. The invention can be used in
a direct and quantitative optical diagnostic technique, which uses
low intensity illumination of intact tissue and provides high
spatial resolution, allowing for precise quantification of the
carotenoid levels in the tissue.
[0018] The detection of lipofuscin fluorescence, in combination
with suitable signal processing, can be used to indirectly derive
the concentrations and spatial distributions of MP in living human
subjects. Particularly, the invention enables the elimination of
the confounding effects of fluorophores, found mainly in the lens,
in detected intensity maps. The confounding effect on the optically
detected MP levels can be avoided by using a transmission filter in
the fluorescence detection channel that limits the detection to
wavelengths on the long-wavelength shoulder of the lipofuscin
fluorescence spectrum. Using a direct, CCD based fluorescence
imaging setup with suitable light excitation sources, like lasers,
light emitting diodes (LEDs), or conventional light sources with
suitable filters, and filtered signal detection, MP distributions
can be measured within a fraction of a second through undilated
eyes with high reproducibility.
[0019] The spatial and quantitative information of retinal MP
levels simultaneously measurable with the lipofuscin-based
technique without pupil dilation can be expected to be of
tremendous value in screening of large populations. It can be a
tool in studies investigating the influence of dietary supplements
on MP levels and their distributions, and in research investigating
the link between MP levels and retinal pathologies. Since the
fluorescence based MP detection method is not influenced, in first
order, by anterior media opacities, it could have a particular
advantage over the Raman method in elderly subjects, which in
general have higher lens opacities, and often reduced MP
levels.
[0020] Accordingly, a first example embodiment of the invention is
a method for measuring macular pigments. The method generally
includes first providing a light source that emits light at a
selected range of wavelengths that simultaneously overlaps the
absorption band of macular carotenoids and the absorption band of
lipofuscin. The light is directed from the light source onto
macular tissue of an eye for which macular pigment levels are to be
measured, light emitted from the macular tissue is collected, the
collected light comprising lipofuscin emission from the macular
tissue at an excitation wavelength that lies outside the macular
pigment absorption range and outside the excitation range of
interfering fluorophores. The collected light is quantified for
each of a plurality of locations in the macular tissue and the
lipofuscin emission intensities from each of a plurality of
locations is thereby determined as well. Finally, the macular
pigment levels in the macular tissue are determined from the
differing lipofuscin emission intensities in the macula and
peripheral retina. Further details and variants on this method are
described elsewhere herein.
[0021] Another example method of the invention is also a method for
measuring macular pigments. This method generally includes:
providing a light source that emits light at a selected range of
wavelengths that overlap the absorption band of macular
carotenoids; directing light from the light source at an intensity
of less than about 10 mJ/cm.sup.2 for less than 500 msec onto
macular tissue of an undilated eye for which macular pigment levels
are to be measured; collecting light emitted from the macular
tissue, the collected light comprising lipofuscin emission from the
macular tissue at an excitation wavelength that lies outside the
macular pigment absorption range and outside the excitation range
of interfering fluorophores in the lens; quantifying the collected
light from each of a plurality of locations in the macular tissue
and thereby quantifying the lipofuscin emission intensities from
each of a plurality of locations; determining the macular pigment
levels in the macular tissue from the differing lipofuscin emission
intensities in the macula and peripheral retina; and determining
spatial extent and topographic concentration distribution of the
macular pigments.
[0022] Yet another non limiting example embodiment of the invention
is an apparatus for measuring macular pigments. The apparatus
includes a light source that generates light at a wavelength that
produces an autofluorescence lipofuscin emission. One or more light
delivery optical components such as fibers, a shutter, lens
filters, etc. are used for directing light from the light source to
a subject's eye. Light collection optical components are used for
receiving an autofluorescence lipofuscin emission from the
subject's eye and routing the autofluorescence lipofuscin emission
from the eye. An optical filter is configured for receiving the
autofluorescence lipofuscin emission and is selective for passing
light at a selected wavelength range such that fluorescence
contributions from ocular media besides the macula are
substantially blocked. An optical detector is configured for
receiving the passed light from the optical filter and generating a
signal indicative of the fluorescence intensities of the lipofuscin
emission at a plurality of points on the subject's eye. A computing
device can be used to determine intensities of the lipofuscin
emission from the passed light at a plurality of points.
[0023] These and other features of the present invention will
become more fully apparent from the following description and
appended claims, or may be learned by the practice of the invention
as set forth hereinafter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0024] To further clarify the above and other advantages and
features of the present invention, a more particular description of
the invention will be rendered by reference to specific embodiments
thereof which are illustrated in the appended drawings. It is
appreciated that these drawings depict only typical embodiments of
the invention and are therefore not to be considered limiting of
its scope. The invention will be described and explained with
additional specificity and detail through the use of the
accompanying drawings in which:
[0025] FIG. 1a illustrates the absorption spectrum of an excised,
flat-mounted, human retina in the blue/green wavelength region,
showing typical absorption characteristics of carotenoid macular
pigment (solid curve at left) and the very weak fluorescence of
macular pigment (solid curve at right) obtained when exciting them
in their absorption band;
[0026] FIG. 1b illustrates the molecular structure of lutein and
zeaxanthin;
[0027] FIG. 1c is an energy level diagram of long-chain conjugated
carotenoids like lutein or zeaxanthin, with optical and
non-radiative transitions like excitation, Raman, and fluorescence,
indicated as arrows;
[0028] FIG. 2a illustrates the absorption and emission spectra of a
methanolic solution of A2E, the main fluorophore of lipofuscin,
shown as solid curves at left and right side of panel,
respectively. The absorption spectrum of macular pigment is
indicated as a dashed curve;
[0029] FIG. 2b illustrates molecular structures of A2E (left) and
iso-A2E;
[0030] FIG. 2c is an energy level diagram for lipofuscin with
optical transitions shown as arrows;
[0031] FIG. 3a is a schematic representation of retinal layers
participating in light absorption, transmission, and scattering of
excitation and emission light in the macular region;
[0032] FIG. 3b is the schematics of anterior optical media and
retinal layers traversed by excitation laser light, fluorescence
from anterior optical media and fluorescence from lipofuscin;
[0033] FIG. 4 illustrates schematics of an apparatus used for
imaging MP distributions in living human subjects according to the
invention;
[0034] FIG. 5 illustrates the removal of laser speckle effects in
fluorescence imaging;
[0035] FIG. 6 illustrates the determination of a spatial correction
factor for image processing due to spatially varying intensity
profiles in laser excitation and lipofuscin fluorescence disks;
[0036] FIG. 7 is a white-light fundus camera image of a healthy
subject (image a), and lipofuscin fluorescence images of the fundus
obtained at near infrared wavelengths with 488 nm (image b) and 532
mn (image c) laser excitation, respectively;
[0037] FIG. 8 illustrates schematics showing processing of CCD
pixel intensity regions to derive optical density values of MP
absorption at any desired location in the retina;
[0038] FIG. 9a is a top view schematic illustration of a setup used
in the measurement of lutein concentrations in a tissue phantom
consisting of a dried lutein spot located on the side wall of a
thin cuvette filled with an optically thin A2E solution (O.D. about
0.35);
[0039] FIG. 9b is a side view schematic illustration of a setup
used in the measurement of lutein concentrations in a tissue
phantom consisting of a dried lutein spot located on the side wall
of a thin cuvette filled with an optically thin A2E solution (O.D.
about 0.35);
[0040] FIG. 9c is a plot illustrating optical densities of lutein
concentrations measured for several dozen positions within the
dried lutein spot, using simultaneous lipofuscin fluorescence
attenuation and transmission measurements of the individual spots,
showing excellent correlation (correlation coefficient R=0.96);
[0041] FIG. 10 illustrates the wavelength dependence of MP optical
density obtained when successively limiting the detected
fluorescence range to longer wavelength, using long-wavelength pass
filters with suitable cut-on wavelengths, .lamda.c;
[0042] FIG. 11 displays lipofuscin fluorescence images of four
volunteer subjects (a-d), obtained under 488 nm excitation, with
intensity levels coded in gray scale;
[0043] FIG. 12 shows lipofuscin fluorescence intensity profiles,
derived from FIG. 11, along nasal-temporal meridans (solid curves)
and inferior-superior meridians (dashed curves), all running
through the center of the macula (see insert);
[0044] FIG. 13 shows MP optical density plot profiles along the
nasal-temporal meridian, derived from FIG. 11 for each subject;
[0045] FIG. 14 shows pseudo-color scaled, 3-d, MP distributions
derived from the 2-d lipofuscin fluorescence pixel intensity maps
of FIG. 11;
[0046] FIG. 15 illustrates the effect of blood vessels on
transmission line plots derived from gray-scale lipofuscin
fluorescence intensity maps;
[0047] FIG. 16a illustrates categories of MP distributions observed
in clinical measurements of 70 subjects (total of 122 eyes);
[0048] FIG. 16b illustrates the distribution of 122 measured eyes
among categories A to E. A large fraction of subjects, 28%, has a
sharp, central MP distribution;
[0049] FIG. 17 illustrates the macular pigment levels measured in
90 eyes of a clinical population of 70 volunteer subjects,
displayed as a function of age. Each data point corresponds to the
maximum MP level determined from lipofuscin fluorescence images;
and
[0050] FIG. 18 illustrates the correlation between MP levels
determined by lipofuscin fluorescence based imaging and resonance
Raman spectroscopy.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0051] According to the invention, lipofuscin fluorescence
spectroscopy ("autofluorescence or AF spectroscopy") can be used to
noninvasively and indirectly derive the concentrations and spatial
distributions of MP in living mammals, e.g. human subjects.
Conventional approaches suffer from the effects of fluorophores in
the living human lens that have previously confounded lipofuscin
fluorescence techniques. The fluorophores in the living human lens
are simultaneously excited with the lipofuscin molecules to
generate a strong fluorescence in the green/yellow wavelength
range. According to one aspect of the invention, the confounding
effect on the optically detected MP levels can be avoided by using
a transmission filter in the fluorescence detection channel that
limits the detection to wavelengths on the long-wavelength shoulder
of the lipofuscin fluorescence spectrum. For example, using a
direct, CCD based fluorescence imaging setup with laser excitation
and filtered signal detection, the invention makes it possible to
measure MP distributions within a fraction of a second with high
reproducibility, while avoiding confounding effects of lens
fluorescence.
[0052] Embodiments of the invention can be performed or used
quickly in non-mydriatic conditions. A mydriatic is an agent which
induces dilation of the pupil. Normally, mydriatic drugs such as
tropicamide are used in ophthalmology to permit examination of the
retina and other deep structures of the eye. Applying a mydriatic
to examine the retina is inherently risky because it removes a
protective defense of the body. The non-mydriatic uses of the
invention can therefore provide a significant advantage by
increasing the safety, speed, and frequency with which the tests
can be performed.
[0053] Reference will now be made to the drawings to describe
various aspects of exemplary embodiments of the invention. It is to
be understood that the drawings are diagrammatic and schematic
representations of such exemplary embodiments, and are not limiting
of the present invention, nor are they necessarily drawn to
scale.
[0054] In the following description, numerous specific details are
set forth in order to provide a thorough understanding of the
present invention. It will be obvious, however, to one skilled in
the art that the present invention may be practiced without these
specific details. In other instances, well-known aspects of the
molecules and compositions discussed herein, the physics of light,
and optical systems in general have not been described in
particular detail in order to avoid unnecessarily obscuring the
present invention.
[0055] Human retinal pigment epithelium contains the age pigment
lipofuscin which accumulates in the lysosomal body of the RPE
cells. Two components of lipofuscin exist that absorb strongly in
the blue wavelength region and emit strongly in the orange-red
region. They are two isomers of a bis-substituted pyridinium ring,
and are termed A2E and iso-A2E, respectively. The structure of the
molecules, their optical transitions, and their associated energy
level scheme are shown in FIGS. 2a, 2b, and 2c.
[0056] The absorption spectrum of A2E partially overlaps with the
absorption spectrum of the macular carotenoids, and its emission
spectrum is broad, extending to wavelengths well beyond the
absorption of carotenoids, as shown in FIG. 2a. Particularly, FIG.
2a is a graph of the absorption (solid curve at left) and emission
spectra (solid curve at right) of A2E, the main fluorophore of
lipofuscin, dissolved in methanol. The absorption peaks in the blue
spectral range at about 430 nm, and the emission in the red
spectral range at about 640 nm. The absorption of the macular
pigments lutein and zeaxanthin is also indicated, as a dotted line,
and shows that it essentially occurs in the same spectral range as
that of lipofuscin, with the important exception that lipofuscin
absorbs also to longer wavelengths compared to the macular
pigments, so that a wavelength range exists on the long-wavelength
shoulder of the lipofuscin absorption band where lipofuscin can
excited exclusively without being attenuated by the macular pigment
absorption. Two spectral positions of laser excitation lines, 488
nm and 532 nm, respectively, are shown as arrows. The 488 nm line
is seen to overlap both the lipofuscin and the MP absorption on the
long wavelength shoulder. The 532 nm line is outside the spectral
absorption range of MP but overlaps that of lipofuscin.
[0057] It is possible, therefore, to excite the A2E emission within
and outside the absorption range of MP. Similar to lutein and
zeaxanthin, A2E has a conjugated carbon backbone. However, the
conjugation length is shorter, interrupted by the central
pyridinium ring, which shortens the conjugated carbon bond chain to
two smaller chains with five double bonds each. This leads to an
emission with a quantum efficiency of 10.sup.-2, which is about
three orders of magnitude stronger than that reported for lutein
and zeaxanthin. The in-vivo excitation spectrum of fundus
autofluorescence is much broader than that of A2E, suggesting that
other lipofuscin fluorophores contribute to fundus
autofluorescence. Regarding its spatial distribution, it is known
that the lipofuscin fluorescence at 15.degree. from the fovea is
1.4-1.7 times higher than at the fovea and that there is a gradual
increase in lipofuscin fluorescence with increasing
eccentricity.
[0058] As will be described in greater detail elsewhere herein, the
shading to the right of about 700 nm indicates the wavelength range
where a long-wavelength pass filter used for the measurement of
lipofuscin emission has reached transparency, limiting the
detection of the lipofuscin emission intentionally only to
wavelengths beyond about 700 nm.
[0059] With reference to FIG. 3a, excitation light, indicated by
shaded arrows, is shown reaching a retina, where the MP levels are
generally depicted as shaded areas. In MP Raman detection, which
uses backscattering of excitation light from the MP-containing
Henle fiber layer, detection is not influenced by deeper retinal
layers as indicated by the limited depth of the filled arrows. In
contrast, emission of lipofuscin used in autofluorescence-based
measurements of MP has to traverse the photoreceptor (PhR) layer,
and also deeper layers of the retina. Therefore, it has to take
into account additional absorption and emission effects of these
layers and their fluorophores.
[0060] As seen in resonance Raman detection experiments of MP, that
detect the spectrally sharp C.dbd.C double bond 1525 cm.sup.-1
stretching vibration Raman response of lutein and zeaxanthin (M),
which occur at 527 nm under 488 nm excitation, a strong
fluorescence background is superimposed on the Raman response in
the 530 nm region. This fluorescence background varies strongly
from subject to subject and exceeds in strength the background
level expected from intrinsic lutein or zeaxanthin (MP)
fluorescence. This background is a combination of lipofuscin
fluorescence and fluorescence from anterior ocular media. In Raman
detection, the broad fluorescence background can be easily fitted
with a higher order polynomial and subtracted from the measured
spectra.
[0061] In lipofuscin-based MP measurements, however, the extra
fluorescence responses can be expected to play an interfering role.
Methods of handling these extra fluorescence responses are
therefore described below.
[0062] The optical layers of interest traversed by the excitation
light and the lipofuscin fluorescence are sketched in FIG. 3b. The
fluorescence intensity in 180 degree detection geometry, I.sub.Det,
measured at a selected wavelength, .lamda., in the visible/near IR
wavelength range, is in general given by
I.sub.Det(.lamda.)=I.sub.L(.lamda.)T.sub.PR(.lamda.)T.sub.MP(.lamda.)T.su-
b.OM(.lamda.)+I.sub.OM(.lamda.), (Eq. 1) where T(.lamda.) is the
transmission of the respective layer corresponding to
photoreceptors, PR, macular pigment, MP, and anterior ocular media,
OM, at the fluorescence wavelength, .lamda.. I.sub.L is the
lipofuscin fluorescence originating in the fovea, and
I.sub.OM(.lamda.) is the potentially overlapping fluorescence
intensity of the OM layer at .lamda..
[0063] It is safe to assume that the photoreceptors do not generate
any fluorescence, but their absorption can not be neglected, in
general. Under excitation with I.sub.exc at wavelength
.lamda..sub.exc, the lipofuscin fluorescence intensity
I.sub.L(.lamda.) is correlated with I.sub.exc according to
I.sub.L(.lamda..sub.exc,.lamda.)=.eta..sub.L(.lamda..sub.exc,.lamda.)I.su-
b.exc(.lamda..sub.exc)T.sub.OM(.lamda..sub.exc)T.sub.MP(.lamda..sub.exc)T.-
sub.PR(.lamda.), (Eq. 2) and I.sub.OM is correlated with I.sub.exc
according to
I.sub.OM(.lamda..sub.exc,.lamda.)=.eta..sub.OM(.lamda..sub.exc,.lamda.)I.-
sub.exc(.lamda..sub.exc)(1-T.sub.OM), (Eq. 3) where
.eta..sub.L(.lamda.,.lamda..sub.exc) and
.eta..sub.OM(.lamda.,.lamda..sub.exc) are the fluorescence quantum
efficiencies, respectively, of lipofuscin and the anterior ocular
media.
[0064] Inserting equations (2) and (3) into (1), one obtains I Det
.function. ( .lamda. exc , .lamda. ) = .eta. MP .function. (
.lamda. exc , .lamda. ) I exc .function. ( .lamda. exc ) T OM
.function. ( .lamda. exc ) T MP .function. ( .lamda. exc ) T PR
.function. ( .lamda. exc ) T OM .function. ( .lamda. ) T MP
.function. ( .lamda. ) T PR .function. ( .lamda. ) + .eta. OM
.function. ( .lamda. exc , .lamda. ) I exc .function. ( .lamda. exc
) [ 1 - T OM .function. ( .lamda. ) ] . ( Eq . .times. 4 )
##EQU1##
[0065] In general, it is impossible to extract the isolated MP
transmission (absorption) from this complex relation between
detector intensity and transmission/fluorescence terms of all
layers. However, adopting a string of assumptions and
approximations, it becomes possible to eliminate, in first order,
several unwanted terms in (4), and to derive an approximation for
the MP transmission (absorption) difference between fovea and
perifovea.
[0066] First, as substantiated below (section 3), it is possible to
largely block the detection of OM fluorescence by limiting the
detection of lipofuscin fluorescence to near IR wavelengths. Only
under this condition can the second term in (Eq. 4) can be ignored.
Second, it is useful to reference the detected luminescence in the
fovea to a measurement in the perifovea, and to determine this
ratio for two excitation wavelengths .lamda..sub.1 and
.lamda..sub.2 near the peak and just outside the MP absorption
band, respectively. For the ratios of the MP transmissions in
perifovea and fovea at the two wavelengths one then obtains I Det P
.function. ( .lamda. exc , .lamda. ) I Det F .function. ( .lamda.
exc , .lamda. ) = .times. .eta. MP P .function. ( .lamda. exc ,
.lamda. ) .eta. MP F .function. ( .lamda. exc , .lamda. ) T OM P
.function. ( .lamda. exc ) .times. T OM P .function. ( .lamda. ) T
OM F .function. ( .lamda. exc ) .times. T OM F .function. ( .lamda.
) .times. T MP P .function. ( .lamda. exc ) .times. T MP P
.function. ( .lamda. ) T MP F .function. ( .lamda. exc ) .times. T
MP F .function. ( .lamda. ) T PR P .function. ( .lamda. exc )
.times. T PR P .function. ( .lamda. ) T PR F .function. ( .lamda.
exc ) .times. T PR F .function. ( .lamda. ) ( Eq . .times. 5 )
##EQU2## If one assumes that the lipofuscin composition is constant
across the posterior pole, the quantum efficiency ratio term (
.eta. MP P .function. ( .lamda. 1 , .lamda. ) .eta. MP F .function.
( .lamda. 1 , .lamda. ) / .eta. MP P .times. ( .lamda. 2 , .lamda.
) .eta. MP F .times. ( .lamda. 2 , .lamda. ) ) ##EQU3## is
eliminated. If one further assumes that there is no difference
between foveal and perifoveal lens transmission terms cancel out.
Furthermore, if one insures that the excitation light beam profiles
are identical for the two wavelengths, they cancel out, too. One
then obtains the much simplified expression ( I Det P .function. (
.lamda. 1 , .lamda. ) I Det F .function. ( .lamda. 1 , .lamda. ) )
/ ( I Det P .times. ( .lamda. 2 , .lamda. ) I Det F .times. (
.lamda. 2 , .lamda. ) ) = .times. ( T MP P .function. ( .lamda. 1 )
T MP F .function. ( .lamda. 1 ) / T MP P .function. ( .lamda. 2 ) T
MP F .function. ( .lamda. 2 ) ) .times. ( T PR P .function. (
.lamda. 1 ) T PR F .function. ( .lamda. 1 ) / T PR P .function. (
.lamda. 2 ) T PR F .function. ( .lamda. 2 ) ) . ( Eq . .times. 6 )
##EQU4##
[0067] Referencing the transmissions of the excitation light at the
.lamda..sub.1 and .lamda..sub.2 positions to the transmission
values in the peak of the MP absorption band, 460 nm, with
respective extinction coefficients K.sub.MP(.lamda..sub.1) and
K.sub.MP(.lamda..sub.2), where
T.sub.MP.sup.P,F(.lamda..sub.1)=T.sub.MP.sup.P,F(460).sup.K(.lamda..sup.1-
.sup.),
T.sub.MP.sup.P,F(.lamda..sub.2)=T.sub.MP.sup.P,F(460).sup.K(.lamda-
..sup.2.sup.), the right side of (Eq. 6) reduces to
[T.sub.MP.sup.P(460)/T.sub.MP.sup.F(460)].sup.[K.sup.MP.sup.(.lamda..sup.-
1.sup.)-K.sup.MP.sup.(.lamda..sup.2.sup.)]. With O.D.=log (1/T),
and solving for the MP optical density difference, this can be
written as O . D .times. . MP .times. F .times. ( .lamda. .times.
460 ) - O . D .times. . MP .times. P .times. ( .lamda. .times. 460
) = .times. 1 .DELTA. .times. .times. K .times. { log .function. (
I Det P .function. ( .lamda. 1 , .lamda. ) I Det F .function. (
.lamda. 1 , .lamda. ) ) - .times. log .times. ( .times. I .times.
Det .times. P .times. .times. ( .times. .lamda. .times. 2 , .times.
.lamda. ) .times. I .times. Det .times. F .times. .times. ( .times.
.lamda. .times. 2 , .times. .lamda. ) ) } - .times. 1 .times.
.DELTA. .times. .times. K .times. log .function. ( T PR P
.function. ( .lamda. 1 ) T PR F .function. ( .lamda. 1 ) / T PR P
.function. ( .lamda. 2 ) T PR F .function. ( .lamda. 2 ) ) . ( Eq .
.times. 7 ) ##EQU5##
[0068] If one assumes in addition that the photoreceptors can be
completely bleached in the measurements (T.sub.PR=100%), the second
term can be neglected. Then the MP optical density difference
between fovea and perifovea is given by O . D .times. . MP .times.
F .times. ( .lamda. .times. 460 ) - O . D .times. . MP .times. P
.times. ( .lamda. .times. 460 ) = .times. 1 .DELTA. .times. .times.
K .times. { log .times. ( I Det P .times. ( .lamda. 1 , .lamda. ) I
Det F .times. ( .lamda. 1 , .lamda. ) ) - .times. log .times. (
.times. I .times. Det .times. P .times. .times. ( .times. .lamda.
.times. 2 , .times. .lamda. ) .times. I .times. Det .times. F
.times. .times. ( .times. .lamda. .times. 2 , .times. .lamda. ) ) }
, ( Eq . .times. 8 ) ##EQU6## i.e. it can be approximated by the
log differences of foveal and perifoveal fluorescence
intensities.
[0069] It should be mentioned that besides lipofuscin detection at
near infrared wavelength other approaches are possible to minimize
the effects of media fluorescence. These include confocal optics,
separation of excitation and detection beams through the lens, and
correction for lens fluorescence.
[0070] It is instructive to compare the derived expressions with
the expression for the MP signal intensity obtained with the Raman
method. Since the Raman response originates directly in the MP
layer, deeper layers do not play a role in the excitation and
emission paths. Only the anterior optical media are traversed,
resulting in I S = T OM .function. ( .lamda. exc ) T OM .function.
( .lamda. Raman ) N .function. ( E I ) .sigma. R I exc .function. (
.lamda. exc ) + .eta. OM .function. ( .lamda. exc , .lamda. Raman )
I exc .function. ( .lamda. exc ) [ 1 - T OM .function. ( .lamda.
Raman ) ] . ( Eq . .times. 9 ) ##EQU7##
[0071] Here, I.sub.S is the Raman scattered light intensity,
N(E.sub.I) is the concentration of MP molecules, .sigma..sub.R is
the Raman scattering cross section, and I.sub.exc is the laser
excitation intensity. No assumptions regarding photoreceptor
bleaching have to be made, and since the fluorescence of the lens
is easily distinguishable from the spectrally sharp Raman response
of MP, it can be easily subtracted. On the other hand, since very
little MP exists outside the macula area, foveal Raman measurements
can not be referenced to perifoveal levels, and lens absorptions as
well as all anterior media scattering will reduce the observed
Raman intensities.
[0072] An example of an inventive apparatus 100 where it can be
employed for measuring macular pigments using autofluorescence
spectroscopy, is schematically depicted in FIG. 4. This system is
configured for obtaining MP measurements by direct, large diameter,
laser or non-laser light excitation of a foveal and peripheral
macular area, spectrally isolating the captured fluorescence, and
using an imaging CCD camera for fluorescence detection. As
described below, the system is designed to maximize the throughput
for fluorescence originating from the retina.
[0073] The depicted apparatus 100 includes a light source(s) that
emits light at a wavelength or wavelength range that overlaps the
absorption band of both macular carotenoids and the absorption band
of lipofuscin, for example a first coherent, or non-coherent
conventional light source 102 and an optional second coherent light
source 104, for example 488 nm and 532 nm fiber-coupled solid state
lasers. Alternatively, light sources 102 and 104 may comprise other
devices, such as light emitting diodes (LEDs) for generating nearly
monochromatic light, or suitably filtered, i.e. spectrally
narrowed, conventional light sources. It is because of the other
inventive aspects of the system and methods described herein that
relatively low power and low cost LEDs can be used.
[0074] The light sources 102 and 104 are in optical communication
with one or more light delivery optical components, which direct
laser light to the macular tissue to be measured. The laser beams
are combined in an optical beam combining cube 106, sent into an
optical fiber 122, expanded at the output end of fiber 122 with an
achromatic lens 124, and filtered by a narrow-band interference
filter 126. The light is then projected onto the retina using
focusing lens 128, a dichroic holographic beam splitter 30 and the
combination of the human cornea and eye lens 133 (eye lens is not
shown). The resulting excitation disk on the retina is preferably
about 3.5 mm in diameter. The excitation disk has an intermediate
focus at the position of an aperture 132 that is positioned in
front of the eye (about 1 cm distance), and that effectively blocks
spurious reflections originating from beam splitter 130.
[0075] To ensure steady fixation of the eye during measurements, a
red aiming laser 136 is used as the fixation target. It is routed
into the setup with an uncoated quartz beam splitter 138. The
fixation light is directed either to the fovea, for measurements
centered on the fovea of the macular region, or to the peripheral
macula (about 7 degrees eccentricity). The fixation laser beam
diameter on the retina is about 200 microns. The optical shutter
120 is designed such that it transmits a small portion of the
excitation light even when it is closed. This allows the subject to
view both the red fixation target and the superimposed laser
excitation disk for optimum head alignment, which is further
facilitated by an adjustable chin rest.
[0076] At prolonged viewing, the leaked excitation light (6.9 log
trolands) effectively bleaches more than 90% of the photoreceptor
pigments of the macula. This establishes uniform background
absorption throughout the exposed retina.
[0077] The lipofuscin fluorescence is captured by one or more light
collection optical components, which direct laser light to the
macular tissue to be measured. As depicted in FIG. 4, light is thus
routed back through beam splitter 130, which is transparent for
wavelengths above about 580 nm, through holographic notch filter
140, which blocks excitation light wavelengths, and through a
long-pass filter, 142, which is transmissive above 700 nm.
Limitation of the fluorescence to wavelengths above 700 nm insures
rejection of light from unwanted fluorophores like the lens, and
provides optimum contrast between peripheral and macular
fluorescence intensities, as shown below.
[0078] The light beam delivery system is in optical communication
with a an optical detector such as a light detection system 146,
that is used to measure the intensity of the scattered light over
the target area of interest. The light detection system 146 may
include, but is not limited to, devices such as a CCD (charge
coupled device) camera or detector array, an intensified CCD
detector array, a photomultiplier apparatus, photodiodes, or the
like. For example, the light can be collected by a 50 mm focal
length achromat 144 and imaged onto the pixel array of a CCD camera
(e.g. a 512.times.512 pixel array of a CCD camera Model ST-9 XE,
available from the Santa Barbara Instrument Group, Inc.). For the
Model ST-9 XE camera, individual pixel dimensions are 20 micron
height by 20 micron width; quantum efficiency in the red/near IR
drops slowly from 60% at 650 nm to 40% at 800.
[0079] The detected light is converted by light detection system
146 into an electronic signal, typically processed by software
associated with the detection system, and sent to a computing
device such as a microprocessor or personal computer 142 or the
like. The computer 148 can control the shutter 120 as well. For
data analysis, the pixel intensity maps can be converted to
proportional files, and further processed using suitable image
processing software (available, e.g. from The MathWorks, Inc.).
[0080] The signal is then analyzed and visually displayed on the
monitor of computer 148. It should be understood that the light
detection system 146 may also convert the light signal into other
digital or numerical formats, if desired. The resultant signal
intensities may be calibrated by comparison with chemically
measured carotenoid levels from other experiments. The computer 148
preferably has data acquisition software installed that is capable
of spectral manipulations.
[0081] During operation of apparatus 100, laser excitation light
from either light source 102 or 104 is routed via optical beam
combining cube 106, mechanical shutter 120, optical fiber 122, and
dichroic beam splitter 130 to the retina of the eye to be measured.
The lenses 124 and 128 image the output face of the optical fiber
delivering the laser excitation light onto the retina of the eye to
be measured. The notch filter 126 transmits only the laser
excitation light. The lipofuscin emission from the retina of the
measured eye is transmitted by dichroic beam splitters 130 and 138
and detected by light detection system, 146 such as a CCD camera,
after traversing filter 140, 142 and lens 144. A red aiming light
136, serving as a fixation target during the measurement, is
projected onto the retina of the eye via dichroic beam splitter
138. The pass filter 142 transmits only the long-wavelength
emission of lipofuscin (e.g., at wavelengths larger than about
700). The light detection system 146 then converts the signal into
a form suitable for visual display such as on a computer monitor or
the like. For example, spatial digital MP images of a subject are
recorded by detecting the lipofuscin fluorescence of the retinal
pigment epithelium in its long-wavelength emission range upon
sequential excitation with 488 nm and 532 nm light, and the spatial
extent of MP and its topographic concentration distribution is
obtained by digital image processing according to equation (8),
which under these wavelength conditions reduces to equation (10),
shown below.
[0082] Preferably, apparatus 100 is operated on a living mammal,
preferable a person, with undilated eyes in a darkened room.
Background noise levels can be in the range of 100 counts per
pixel; signal counts typically about 30,000 counts per pixel. The
CCD camera temperature is preferably kept uniform, for example at a
temperature at or below 5.degree. C. during measurements.
[0083] Laser speckle in the images obtained when using coherent
laser light as excitation sources can be effectively removed by
mechanically shaking the light delivery fiber during measurements,
which generates a spatially homogeneous laser excitation spot via
fiber mode mixing. The resulting speckle removal effect and its
impact on the obtainable image quality is illustrated in FIG. 5 for
images of millimeter graph paper, (a) to (b), and the macular area
of a human retina (c) to (d), respectively, demonstrating that fine
details such as small retinal blood vessels in the peripheral
macula can be resolved after speckle removal. Since a 1 mm distance
is imaged onto a pixel array distance of 120 pixels, the invention
provides about a 10 micron spatial resolution under the used
imaging conditions after speckle removal. Speckle removal
procedures will not be necessary if incoherent, non-laser light
excitation sources are used.
[0084] For correct imaging of large tissue regions, and for the
purpose of comparing MP measurements for single-wavelength (488 nm)
and dual-wavelength (488 and 532 nm) measurements, intensity
corrections have to be made that account for intensity variations
of the typically Gaussian shaped laser beam profile and the
resulting fluorescence response across the excitation spot. To
illustrate this point, the lipofuscin distribution in the
peripheral macula and in the foveal area was imaged using an
approximately 3.5 mm diameter light excitation disk. As seen from
FIG. 6, the measured lipofuscin intensity distribution, which is
shown as dashed curve, follows again a Gaussian beam profile,
dropping for both wavelengths (488 and 532 nm) by about 20% from
the central intensity level to reduced level at the periphery of
the fluorescence image. Thus, fluorescence intensity levels at the
edge of the image disk have to be multiplied by a corresponding
correction factor (about 25%) before comparing them with central
image values.
[0085] To eliminate the potential for any deviations from these
profiles in living human eyes due to scattering and absorption
effects of the anterior ocular media, the lipofuscin distribution
of the retina was imaged in two specific locations. As sketched in
FIG. 6, one of the two images is centered on the fovea. It is
recorded for this centrally fixated subject such that a 7-degree
eccentric location, termed S, is recorded along with the fovea, F.
Subsequently, a second image is recorded which is now centered on
the same peripheral location S, achieved by having the subject
fixate on the aiming laser that has been changed in direction by 7
degrees. Since the spot S has an unchanging lipofuscin
concentration, any detected difference in fluorescence intensities
originating from the spot S in the two images has to be due to the
laser excitation intensity beam profile plus the combination of
scattering and absorption effects of anterior ocular media.
Comparing the corresponding intensities of the two images, in view
of the disclosure herein one can derive a spatial correction factor
map for each subject.
[0086] In a preferred aspect of the invention, laser power levels
at the cornea can be 2 mW during measurements with exposure times
of 200 msec. At a retinal excitation disk size of 3.5 mm diameter,
the light exposure was thus about 3 mJ/cm.sup.2, which is
approximately a factor of 3 below the photothermal safety limit of
10 mJ/cm.sup.2 set forth by the ANSI standard. The photochemical
limit for retinal injury is listed in the same standard as 15.5
J/cm.sup.2 for the used wavelengths. At the used energy density of
3 mJ/cm.sup.2, the exposure is therefore a factor of about 5,000
below the photochemical limit. Accordingly, exposures suitable for
use in the invention are preferably less than about 10 mJ/cm.sup.2,
more preferably less than about 5 mJ/cm.sup.2, still more
preferably less than about 3 mJ/cm.sup.2. Exposure times are
preferably less than about 1 second, more preferably less than
about 500 msec, still more preferably less than about 200 msec. In
fact, and as mentioned elsewhere herein, such low levels can be
used with the methods and apparatus of the invention that light
emitting diodes can substitute for lasers in some embodiments.
[0087] FIG. 7 includes photomicrographs of the macular region of
the retina of a human volunteer subject. Image a is an image
obtained by measuring the reflection of white light (standard
fundus image). Images b and c are typical retinal lipofuscin
fluorescence images, or pixel intensity maps, with image b showing
a lipofuscin fluorescence digital fundus image obtained under 488
nm excitation and image c showing a lipofuscin fluorescence digital
fundus image obtained under 532 nm excitation, each obtained at
near IR wavelengths (.lamda.>700 nm). The field of view for
image a is larger than for images b and c in order to illustrate
the relative location of the macular region (gray shaded area on
left side of image a) with respect to the optic nerve disk (bright
white spot on right side of image a). Images b and c are centered
on the macular region and are recorded, respectively, with 488 nm
light that is absorbed by both lipofuscin and macular pigments, and
with 532 nm light that falls outside the absorption range of
macular pigments, and therefore only weakly excites the lipofuscin
emission.
[0088] The two images b and c differ substantially in the macular
region, showing pronounced absorption due to MP under 488 nm light,
and virtually no absorption under 532 nm light excitation, as
expected from the MP absorption behavior (see FIG. 1).
[0089] Small blood vessel patterns in these images can be used as
landmarks to align these two distributions for digital image
processing. A digital subtraction image due only to the MP
absorption can be obtained by subtracting image c from image b. For
example, the spatial extent of MP and its topographic concentration
distribution can be obtained by digitally subtracting image c,
serving as a reference pixel intensity map, from image b, which has
pixel areas with reduced intensities due to absorption of the
lipofuscin emission by MP (central shaded area).
[0090] Particularly, the lipofuscin fluorescence intensity map
obtained under 532 nm excitation can be used to assess the
distribution of the lipofuscin and melanin concentration throughout
the retinal area of interest, i.e. the area centered on the fovea
and subtending to about 7 degrees or higher eccentricity. This is
the case since the I.sub.532 intensities decrease from the macular
image location with I.sub.max,532 to the peripheral location with
I.sub.min,532 only by the known correction factor, c.sub.Gauss
(this factor is described above and is due to the combined Gaussian
laser excitation and fluorescence response profile).
[0091] Next, in order to derive the MP optical density in the fovea
or surrounding regions, The invention use the measured lipofuscin
fluorescence intensity maps obtained under 488 nm and 532 nm
excitation, respectively, to determine the MP optical density
difference from equation (9), which becomes O . D . = 1.2 .times. [
log .function. ( .times. I _ max .times. I _ min ) .lamda. = 488 -
log .function. ( .times. I _ max .times. I _ min ) .lamda. = 532 ]
, ( Eq . .times. 10 ) ##EQU8## where {overscore (I)}.sub.max and
{overscore (I)}.sub.min are intensities averaged over certain pixel
areas (see below). The factor 1.2 takes into account the ratio
between the absorption of MP at its maximum (460 nm) and the used
excitation wavelengths of 488 nm and 532 nm. The invention
determined this factor from the absorption spectrum of MP measured
from an excised eye cup.
[0092] FIG. 8 illustrates schematics showing processing of specific
CCD pixel intensity regions chosen to derive optical density values
of MP absorption at any desired location in the retina. By way of
example, for the calculation of average MP levels in specific
locations or along nasal-temporal and inferior-superior meridians,
individual pixels can be grouped into disks with a diameter of 20
pixels, as illustrated in FIG. 8. Averaged peripheral pixel
intensities are determined from twelve peripheral pixel disks
located on a circle with 7 degrees eccentricity to the fovea, and
the average pixel intensity in an area of interest is determined
from an additional, single, disk positioned in that area, for
example in the fovea, as shown in FIG. 8. One central disk is
located at the center of the macula, the foveola, with a resulting
intensity I.sub.min (ave). Twelve additional discs are chosen on a
circle with 7 degrees eccentricity to the foveola, with equidistant
spacing, to calculate an average fluorescence intensity I.sub.max
(ave) in the periphery. The maximum MP image contrast, derived from
these two averaged intensities, is proportional to the optical
density of MP in the center of the macula, according to equation
(8) or (10). Disks in between the center and the peripheral circle
(not shown) can be chosen to calculate the image contrast and MP at
any eccentricity toward the peripheral retina.
[0093] In measurements of dozens of healthy subjects it was seen
that images recorded with 532 mn excitation contributed only 5%
change to the MP levels obtained from imaged recorded with 488 nm
excitation alone. In a preferred embodiment a single wavelength,
488 nm laser exposure is therefore adequate to determine the MP
levels with high (about 95%) accuracy, and for most practical
purposes it is therefore not necessary to use an additional second
excitation wavelength outside the MP absorption range for MP level
determinations.
[0094] However, in the presence of macular pathology, it is very
likely that dual wavelength measurements will be necessary to
account for spatially non-uniform lipofuscin and melanin
distributions. The fluorescence based MP detection method, as
carried out in this invention, shows a statistically significant
correlation with MP measurements using highly MP specific Resonance
Raman spectroscopy in healthy subjects, as seen from a direct
comparison of both techniques in a subgroup of 48 subjects. MP
levels showed a tight correlation up to integrated MP optical
density levels of about 0.35. At higher MP levels, deviations occur
that are likely correlated to nonlinear effects of both optical
methods at higher MP levels. Possible factors include (a) screening
effects in the MP Raman and lipofuscin fluorescence responses at
high molecule concentrations, (b) an under-sampling of the MP
distributions caused by lens opacity effects in elderly subjects in
the Raman method, (c) non-vanishing MP levels at the peripheral
retinal reference point in the fluorescence based method, and (d)
residual absorption of photoreceptors in the fluorescence
detection. The invention expects further insight into the
differences between both methods by a direct comparison of
fluorescence based imaging results with Raman images of MP
distributions in the same subjects.
[0095] The invention can be used in a variety of contexts to
benefit subjects. For example, correlative studies can be performed
using spatial imaging of MP concentrations with changes over time
or particular shapes (See FIGS. 14 and 16) to correlate MP levels
with pathologies, and potential increases occurring upon dietary
interventions and supplementation. Particularly, either 3d patterns
or observed changes with aging may be indicative of certain
diseases. In a preferred aspect of the invention, the measured MP
data can be used to proscribe a treatment, vitamins, dietary
supplements, etc. to a subject. Because the test can be performed
in under a second using low light power, even LEDs in some
instances, and in non-mydriatic conditions, the test is ideal for
rapid and proscribed or elective testing in a variety of
environments, from doctors offices and hospitals to less formal
setting such as optometry shops and dietary supplement stores. The
data obtained from a test can be used to customize treatment plans
and counteract health problems.
[0096] The following examples are given to illustrate the present
invention, and are not intended to limit the scope of the
invention.
EXAMPLES
Example 1
[0097] For the determination of the MP optical density, the
obtained image contrast is important, being directly proportional
to the MP optical density. In living eyes, care must be taken that
the lipofuscin fluorescence image contrast is not artifactually
reduced or enhanced by other absorbing or fluorescing compounds
besides MP. For example, if an artifactual fluorescence signal
existed in the macula, it would add to the fluorescence level of
lipofuscin, and thus reduce the image contrast. Likewise, an extra
fluorescence signal in the periphery, or an absorption in the
center from unbleached photoreceptors, would enhance the image
contrast. A presence of artifacts would be obvious if there were to
be a wavelength dependence of the obtained image contrast, i.e. if
the image contrast were to change depending on which spectral
portions of the lipofuscin fluorescence were included in the
measurement and subsequent derivation of the MP levels.
[0098] With reference therefore to FIG. 10, in order to check for
the existence of artifacts, a series of measurements were carried
out in which the detected lipofuscin fluorescence signals were
limited to progressively longer wavelength regions. Using
long-wavelength step function transmission filters with
successively longer cut-on wavelengths with the two-wavelength
measuring scheme (488 and 532 nm), and testing the effect on three
subjects, the MP results shown in FIG. 10 were obtained. The
optical density values were computed with equation (10), and
included correction of the respective digital images for laser
intensity variations within the excitation disk (c.sub.Gauss).
Enhancement factors of 1.71, 1.72, and 1.85 were observed,
respectively, of the image contrast at wavelengths limited to 700
nm and beyond, as compared to MP levels obtained when including
fluorescence components in the blue-green spectral region. The
variability of the results in FIG. 10 did not correlate with the
age of the subjects.
Example 2
[0099] To test whether the interfering green fluorescence component
originates from intrinsic MP fluorescence (see FIG. 1 for the
emission spectrum), an excised eye cup was imaged from a donor eye,
using essentially the same imaging setup as for living eyes an MP
O.D. value of about 0.4.+-.10% was obtained for this sample
throughout the wavelength range 530-700 nm, thus revealing an
absence of a wavelength effect on the optical density. This proves
that intrinsic MP fluorescence is too weak to interfere with the
obtainable image contrast of the lipofuscin fluorescence based
imaging technique.
Example 3
[0100] Next, the wavelength dependence for the foveal MP levels of
a subject having an implanted, non-fluorescing prosthetic eye lens
was measured. Again, an absence of a wavelength effect over the
range 530-700 nm was observed. From these results it is seen that
the artifactual green fluorescence present in living eyes
originates from fluorophores present in the living eye lens. For
the purpose of obtaining optimum image contrast and corresponding
MP level determination, according to the invention it is important
to detect fluorescence levels only on the long wavelength shoulder
of the lipofuscin fluorescence, i.e. above about 700 nm.
Example 4
[0101] In order to test the setup in FIG. 4 and the image
processing routines, a tissue phantom was imaged in exactly the
same geometry and under the same conditions as used for living eye
measurements (180 degree detection geometry with CCD camera
detection), including identical light filtering and pixel
processing routines. The tissue phantom consisted of a dried drop
of lutein solution spotted onto one of the side windows of a
thin-walled cuvette filled with a methanolic A2E solution, as
illustrated in FIGS. 9a and 9b. The optical density of the solution
had a value of 0.35 at 488 nm. The dried lutein spot was roughly
circular in diameter (about 2.5 mm), and had a non-uniform
thickness and concentration that increased from the center on
outwards. Using a small diameter (200 .mu.m) 488 nm laser
excitation spot, the lipofuscin fluorescence intensity of the
lutein spot/A2E solution combination, or the A2E solution alone,
was imaged progressing from the center of the lutein spot toward
the periphery and beyond. Simultaneously, the in-situ sample
transmissions at the laser wavelength was also measured, using a
light chopper in the excitation laser beam, and phase-sensitive
detection of the transmitted laser beam with a silicon
photo-detector placed behind the tissue phantom. From these
measurements lipofuscin-emission based optical densities of local
lutein concentrations inside the phantom spot was correlated with
optical density values obtained from transmission data. The results
are displayed in FIG. 9c for a few dozen locations within the
lutein spot. They demonstrate excellent agreement between the two
methods (correlation coefficient R=0.96), proving that the imaging
procedures and data processing routines lead indeed to the desired
lutein optical density determination for this tissue phantom.
Transmission based absorption levels had an accuracy of 2%;
indirect, lipofuscin based absorption levels an accuracy of 4%.
Examples 5-8
[0102] FIG. 11 shows representative MP imaging results for four
healthy volunteer subjects, labeled (a)-(d), with the obtained
spatial MP distributions displayed as gray-scaled intensity levels
with 16-bit accuracy. FIG. 11 is lipofuscin fluorescence images of
four volunteer subjects (a-d), obtained under 488 nm excitation,
shown in gray scale. Fluorescence intensities are lowest in central
dark image regions due to absorption of excitation light by MP.
Note pronounced variation of MP distributions regarding strength,
symmetry, and spatial extent among individuals. These tests were
carried out with 488 and 532 nm imaging and corrected for spatial
laser intensity variation over the excitation disk (c.sub.Gauss).
In FIG. 12 intensity line plots are displayed that are derived from
the gray-scale images for each subject along nasal-temporal and
inferior-superior meridians, both running through the center of the
macula, respectively. Plots are derived from pixel intensity maps
of FIG. 10 for each of four subjects (a)-(d). A transmission value
in the foveola can be calculated from the averaged pixel
intensities in the peripheral macula and the foveola. In FIG. 13,
the MP optical density data are plotted for each subject along the
nasal-temporal meridian. In the line plots of FIGS. 12 and 13,
pixel intensities were averaged over 14 pixels (280 .mu.m) oriented
perpendicularly to the respective meridians, and transmission
values were calculated versus distance from the fovea. For one of
the subjects, the MP distribution was imaged eight times over a
period of four weeks, showing that the MP optical densities could
be determined with a test-retest accuracy (standard deviation) of
2.4%.
[0103] FIG. 14 displays pseudo-color scaled, 3-d MP distributions
derived from the 2-d gray scaled lipofuscin fluorescence pixel
intensity maps of FIG. 8. Note significant inter-subject variations
in MP levels, symmetries, and spatial extent.
[0104] As can be clearly seen from FIGS. 11-14, the spatial widths,
symmetries, and concentrations of MP vary significantly between the
four subjects. In subject (a), the MP distribution shows only a
weakly enhanced central level compared to the parafovea. In subject
(b) the MP distribution has a very low central level and is
surrounded by a ring of MP. Subject (c) has a strongly peaked MP
distribution in the center, and almost no parafoveal levels and
finally, subject (d) has both high central and parafoveal MP
levels.
Example 9
[0105] To further evaluate the lipofuscin fluorescence-based MP
imaging technique, a clinical population study was performed
involving 70 healthy volunteer subjects The demographic
characteristics of the patient population are shown in Table 1
below. TABLE-US-00001 TABLE 1 Demographics of Population Number of
Normal Subjects 70 Age (yrs: mean +/- SD 53 +/- 16 Age Range (yrs)
23-89 Female (%) 50 Male (%) 50 White Subjects (%) 90 Nonwhite
subjects (%) 10 Nonsmokers (%) 86 Active Smokers (%) 14
[0106] The MP measurements of the population sample involving 70
healthy subjects reveal distinct patterns of MP distributions, such
as a pattern with high central MP levels surrounded by eccentric
shoulders or rings of lower MP levels. Also, it is seen that MP
levels can differ very strongly among individuals, i.e. by more
than an order of magnitude, and that the average MP levels decline
slowly with age in the sampled population (on average by a factor
of three between age 25 and age 80).
[0107] FIG. 16 shows distinctive MP distribution patterns observed
in these subjects. Five categories, A-E, based on striking spatial
features in the MP distributions are depicted at the top of FIG.
16. Two examples are shown for, each category. The bottom of FIG.
16b illustrates the distribution of 122 measured eyes among
categories A to E. A large fraction of subjects, 28%, has a sharp,
central MP distribution. In category A, MP optical densities were
very low (smaller than about 0.05). This is observed for 11% of the
population sample. In category B, the MP distribution is laterally
extended and has enhanced central MP levels; it is seen in 22% of
the subjects. Category C features only a sharp central MP
distribution, and is seen in 28% of subjects. Category D has a
sharp central MP distribution and an additional MP ring located in
the parafovea; this pattern is seen in 17% of the subjects, and has
been previously noted by other investigators using autofluorescence
and reflectometry. Finally, category E has a relatively uniform,
laterally extended, MP distribution with no elevated central MP
levels, and is seen in 12% of the subjects.
[0108] For twenty of the subjects, the invention recorded images
for both 488 nm and 532 nm excitation, and evaluated the MP levels
according to equation (10). However, in all subjects an image
contrast due to macular MP concentrations was practically absent
under 532 nm excitation. The images all looked very similar to that
shown in FIG. 7, and contributed at most 5% of the contrast
relative to that observed with 488 nm excitation alone. From this,
it was concluded that 532 nm images are not essential for MP
determinations, at least not in healthy subjects. To facilitate
rapid scanning of a clinical population sample, only single
wavelength, 488 nm, measurements were used for the remaining
subjects. It was also determined, however, that two-wavelength
imaging is required to achieve highest accuracies, and it is very
likely to be required also for subjects with pathologies.
[0109] In FIG. 17 illustrates the macular pigment levels measured
in 90 eyes of a clinical population of 70 volunteer subjects,
displayed as a function of age. Each data point corresponds to the
maximum MP level determined from lipofuscin fluorescence images
over its foveolar region (150 .mu.m diameter). Filled circles
represent subjects measured after cataract surgery (lens implant).
Note the significant variation of MP levels between individuals at
any age and the average decline of levels with age. In several
subjects with age near 40 years, for example, the MP levels are
seen to range from an O.D. near zero to O.D. of about 0.6. Also,
there is a statistically significant decline of average MP levels
with increasing age; with a correlation coefficient r=-0.47.
Calculating the correlation coefficient with 1 data point per
subject (one eye per subject), r=-0.54) was obtained.
Example 10
[0110] The correlation of the indirect, lipofuscin
fluorescence-based MP detection technique, was compared with the
direct technique of integral Resonance Raman detection, the latter
measuring MP responses over an approximately 1.2 mm diameter
excitation disk in an integral fashion. For this purpose a clinical
population subgroup of 48 subjects was recruited, and 72 eyes were
measured. The results are shown in FIG. 18, revealing a
statistically significant and strong correlation between both
methods (correlation coefficient r=0.73, p<0.0001 including all
eyes measured, and r=0.75, p<0.0001, including only one eye per
subject). The plotted fluorescence based MP optical density levels
are maximum levels at the foveola. They are calculated from
lipofuscin fluorescence pixel intensity maps integrated and
averaged for a circular area, centered at the fovea, having 20
pixel diameter (150 .mu.m). Filled circles in FIG. 18 correspond to
data points for subjects with lens implants. Limiting the
correlation to MP optical densities below about 0.35, the
correlation is even stronger. At optical densities above about
0.35, the variance of the levels increases, likely caused by
breakdown of the assumptions underlying the lipofuscin based MP
detection method and the resonance Raman methods.
[0111] Raman based MP levels are derived from Raman scattered light
intensities at the carbon double stretch frequency of 1525
cm.sup.-1. Since the latter are obtained with a 1 mm diameter, 488
nm laser, excitation spot centered on the macula, Raman based MP
levels are averaged over an approximately 1 mm diameter area. Raman
based levels are not corrected for media opacities, while
fluorescence based levels are not influenced by media opacities.
The high correlation therefore demonstrates indirectly that media
opacities are not very significant in Raman measurements.
Example 11
[0112] To investigate the influence of blood vessels on the spatial
MP asymmetries, the measured pixel intensity maps were processed
with reduced vertical pixel averaging, and with software filter
masks to enhance finer spatial details. Two gray scale images and
corresponding nasal-temporal meridional line plots illustrate the
results. They are shown in FIG. 15. In the image shown at the top
of FIG. 15, the pixel intensity map is unfiltered. In the image
shown at the bottom, the map is filtered and weighted with a
Gaussian mask. For both images, resulting transmission line plots
are shown resulting from averaging over 15 pixels (solid curves)
and 5 pixels (dashed curves), respectively. Averaging of 15
vertical pixels produces smooth curves but reveals pronounced
asymmetries in the shoulders of the distribution at about 400 .mu.m
eccentricity. Averaging of only 5 pixels, results in a clearly
visible spatial fine structure (about 50 .mu.m width) in the
shoulders of the MP distribution, as evidenced by large amplitude
oscillations in the profile in the about 300-600 .mu.m eccentricity
range. The overall spatial asymmetry of the profile, however, is
not influenced by the blood vessels. In the higher resolution
plots, other spatial details not related to blood vessels are
discernible, too, such as the small but clearly resolved dip of the
MP absorption profile in the foveola of this subject.
[0113] The present invention may be embodied in other specific
forms without departing from its spirit or essential
characteristics. The described embodiments are to be considered in
all respects only as illustrative and not restrictive. The scope of
the invention is, therefore, indicated by the appended claims
rather than by the foregoing description. All changes which come
within the meaning and range of equivalency of the claims are to be
embraced within their scope.
* * * * *