Compact orthogonal view OCT: clinical exploration of human trabecular meshwork and cornea at cell resolution

Abstract: Glaucoma remains among the leading causes of blindness despite many treatment options available today. Effective treatment requires early diagnosis, which is difficult to achieve with existing imaging technologies that detect the already inflicted irreversible posterior eye damage. One improved approach could be to detect the changes in trabecular meshwork of the anterior eye that precede the intraocular pressure buildup and vision loss. Here we report a device that enables in vivo exploration of trabecular meshwork at cell resolution. The instrument combines two orthogonal views: en face view of time-domain full-field OCT for high-resolution and cross-sectional view of spectral-domain OCT for aligning to the meshwork. The device resolves micron-level corneoscleral and uveal pores, meshwork beams and internal elastic fibers, ciliary body tendons and trabecular cell nuclei. Capable of detecting blockage of trabecular pores, orthogonal view OCT presents a promising solution to the long-standing problem of early glaucoma diagnosis. Future clinical adoption of the device is facilitated by the compact footprint and broad functionality that includes corneal imaging in healthy subjects and patients (with keratoconus, Fuchs endothelial dystrophy) using the same design.