TY - JOUR
T1 - Towards automatically controlled dosing for selective laser trabeculoplasty
AU - Bliedtner, Katharina
AU - Seifert, Eric
AU - Brinkmann, Ralf
N1 - Funding Information:
This work was supported by the World Class 300 Project (S2340708) of the SMBA (Small and Medium Business Administration), Republic of Korea.
Publisher Copyright:
© 2019 The Authors.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - Purpose: Selective laser trabeculoplasty (SLT) is a treatment option for open-angle glaucoma; however, it lacks an instant evidence for successful irradiation. So far ophthalmologists use the visible appearance of permanent champagnelike bubbles (macro bubbles) as an indicator for appropriate pulse energy. We hypothesize that micro bubbles, which start energetically far below the appearance of macro bubbles, already trigger the therapeutic benefit. Here we present two methods to capture the onset of these micro bubbles. Methods: The trabecular meshwork of freshly enucleated porcine eye globes was irradiated with a series of 15 pulses with a pulse duration of 1.7 μs and with increasing energy at a repetition rate of 100 Hz per each spot of 200 μm in diameter. An optical and an optoacoustic method have been developed and appropriate algorithms investigated towards the real-time detection of the onset of micro bubbles. Results: Both observation methods are capable of detecting micro bubble nucleation. Threshold radiant exposures were found at 310 6 137 mJ/cm2. By combination of both methods a sensitivity and specificity of 0.96 was reached. Conclusions: In case that the therapeutically demanded pressure reduction is already achieved with these micro bubbles, which needs to be proven clinically, then the methods presented here can be used in an automatic feedback loop controlling the laser irradiation. This will unburden the clinicians from any dosing during SLT. Translational Relevance: Automatic real-time pulse energy dosing based on the formation of micro bubbles in SLT significantly improves and facilitates the treatment for the physician.
AB - Purpose: Selective laser trabeculoplasty (SLT) is a treatment option for open-angle glaucoma; however, it lacks an instant evidence for successful irradiation. So far ophthalmologists use the visible appearance of permanent champagnelike bubbles (macro bubbles) as an indicator for appropriate pulse energy. We hypothesize that micro bubbles, which start energetically far below the appearance of macro bubbles, already trigger the therapeutic benefit. Here we present two methods to capture the onset of these micro bubbles. Methods: The trabecular meshwork of freshly enucleated porcine eye globes was irradiated with a series of 15 pulses with a pulse duration of 1.7 μs and with increasing energy at a repetition rate of 100 Hz per each spot of 200 μm in diameter. An optical and an optoacoustic method have been developed and appropriate algorithms investigated towards the real-time detection of the onset of micro bubbles. Results: Both observation methods are capable of detecting micro bubble nucleation. Threshold radiant exposures were found at 310 6 137 mJ/cm2. By combination of both methods a sensitivity and specificity of 0.96 was reached. Conclusions: In case that the therapeutically demanded pressure reduction is already achieved with these micro bubbles, which needs to be proven clinically, then the methods presented here can be used in an automatic feedback loop controlling the laser irradiation. This will unburden the clinicians from any dosing during SLT. Translational Relevance: Automatic real-time pulse energy dosing based on the formation of micro bubbles in SLT significantly improves and facilitates the treatment for the physician.
UR - http://www.scopus.com/inward/record.url?scp=85076320184&partnerID=8YFLogxK
U2 - 10.1167/tvst.8.6.24
DO - 10.1167/tvst.8.6.24
M3 - Journal articles
AN - SCOPUS:85076320184
SN - 2164-2591
VL - 8
JO - Translational Vision Science and Technology
JF - Translational Vision Science and Technology
IS - 6
M1 - 24
ER -