João Barbosa Breda

Rita Marques, Danilo Andrade De Jesus, João Barbosa Breda et al.

The optic nerve head represents the intraocular section of the optic nerve (ONH), which is prone to damage by intraocular pressure. The advent of optical coherence tomography (OCT) has enabled the evaluation of novel optic nerve head parameters, namely the depth and curvature of the lamina cribrosa (LC). Together with the Bruch's membrane opening minimum-rim-width, these seem to be promising optic nerve head parameters for diagnosis and monitoring of retinal diseases such as glaucoma. Nonetheless, these optical coherence tomography derived biomarkers are mostly extracted through manual segmentation, which is time-consuming and prone to bias, thus limiting their usability in clinical practice. The automatic segmentation of optic nerve head in OCT scans could further improve the current clinical management of glaucoma and other diseases. This review summarizes the current state-of-the-art in automatic segmentation of the ONH in OCT. PubMed and Scopus were used to perform a systematic review. Additional works from other databases (IEEE, Google Scholar and ARVO IOVS) were also included, resulting in a total of 27 reviewed studies. For each algorithm, the methods, the size and type of dataset used for validation, and the respective results were carefully analyzed. The results show that deep learning-based algorithms provide the highest accuracy, sensitivity and specificity for segmenting the different structures of the ONH including the LC. However, a lack of consensus regarding the definition of segmented regions, extracted parameters and validation approaches has been observed, highlighting the importance and need of standardized methodologies for ONH segmentation.

Ruben Hemelings, Bart Elen, João Barbosa Breda et al.

Background/Aims: Standard Automated Perimetry (SAP) is the gold standard to monitor visual field (VF) loss in glaucoma management, but is prone to intra-subject variability. We developed and validated a deep learning (DL) regression model that estimates pointwise and overall VF loss from unsegmented optical coherence tomography (OCT) scans. Methods: Eight DL regression models were trained with various retinal imaging modalities: circumpapillary OCT at 3.5mm, 4.1mm, 4.7mm diameter, and scanning laser ophthalmoscopy (SLO) en face images to estimate mean deviation (MD) and 52 threshold values. This retrospective study used data from patients who underwent a complete glaucoma examination, including a reliable Humphrey Field Analyzer (HFA) 24-2 SITA Standard VF exam and a SPECTRALIS OCT scan using the Glaucoma Module Premium Edition. Results: A total of 1378 matched OCT-VF pairs of 496 patients (863 eyes) were included for training and evaluation of the DL models. Average sample MD was -7.53dB (from -33.8dB to +2.0dB). For 52 VF threshold values estimation, the circumpapillary OCT scan with the largest radius (4.7mm) achieved the best performance among all individual models (Pearson r=0.77, 95% CI=[0.72-0.82]). For MD, prediction averaging of OCT-trained models (3.5mm, 4.1mm, 4.7mm) resulted in a Pearson r of 0.78 [0.73-0.83] on the validation set and comparable performance on the test set (Pearson r=0.79 [0.75-0.82]). Conclusion: DL on unsegmented OCT scans accurately predicts pointwise and mean deviation of 24-2 VF in glaucoma patients. Automated VF from unsegmented OCT could be a solution for patients unable to produce reliable perimetry results.

José Ignacio Orlando, João Barbosa Breda, Karel van Keer et al.

Glaucoma is the leading cause of irreversible but preventable blindness in the world. Its major treatable risk factor is the intra-ocular pressure, although other biomarkers are being explored to improve the understanding of the pathophysiology of the disease. It has been recently observed that glaucoma induces changes in the ocular hemodynamics. However, its effects on the functional behavior of the retinal arterioles have not been studied yet. In this paper we propose a first approach for characterizing those changes using computational hemodynamics. The retinal blood flow is simulated using a 0D model for a steady, incompressible non Newtonian fluid in rigid domains. The simulation is performed on patient-specific arterial trees extracted from fundus images. We also propose a novel feature representation technique to comprise the outcomes of the simulation stage into a fixed length feature vector that can be used for classification studies. Our experiments on a new database of fundus images show that our approach is able to capture representative changes in the hemodynamics of glaucomatous patients. Code and data are publicly available in https://ignaciorlando.github.io.