Porcine skin visible lesion thresholds for near-infrared lasers including modeling at two pulse durations and spot sizes.

With the advent of such systems as the airborne laser and advanced tactical laser, high-energy lasers that use 1315-nm wavelengths in the near-infrared band will soon present a new laser safety challenge to armed forces and civilian populations. Experiments in nonhuman primates using this wavelength have demonstrated a range of ocular injuries, including corneal, lenticular, and retinal lesions as a function of pulse duration. American National Standards Institute (ANSI) laser safety standards have traditionally been based on experimental data, and there is scant data for this wavelength. We are reporting minimum visible lesion (MVL) threshold measurements using a porcine skin model for two different pulse durations and spot sizes for this wavelength. We also compare our measurements to results from our model based on the heat transfer equation and rate process equation, together with actual temperature measurements on the skin surface using a high-speed infrared camera. Our MVL-ED50 thresholds for long pulses (350 micros) at 24-h postexposure are measured to be 99 and 83 J cm(-2) for spot sizes of 0.7 and 1.3 mm diam, respectively. Q-switched laser pulses of 50 ns have a lower threshold of 11 J cm(-2) for a 5-mm-diam top-hat laser pulse.

Comparison of macular versus paramacular retinal sensitivity to femtosecond laser pulses.

Single 130 fs laser pulses in the near-IR (800 nm) were used to create ophthalmoscopically viewed minimum visible lesions (MVLs) within the macular and paramacular regions in rhesus monkey eyes. MVL thresholds at 1 and 24 h are reported as the 50% probability for damage (ED50) together with their fiducial limits at the 95% confidence level. These measured thresholds are compared with previously reported thresholds for near-IR and visible wavelengths for both macular and paramacular areas. Threshold doses were lower at the 24 h reading than at the 1 h reading for both retinal regions and the ED50s for the macula were slightly lower than for the paramacula. We measured the 24 h MVL ED50 thresholds to be 0.35 and 0.55 microJ for the macular and paramacular areas, respectively. The combined data for both areas yielded a threshold of 0.45 microJ.

Spectrally resolved white-light interferometry for measurement of ocular dispersion.

Spectrally resolved white-light interferometry was used to measure the wavelength dependence of refractive index (i.e., dispersion) for various ocular components. Verification of the technique's efficacy was substantiated by accurate measurement of the dispersive properties of water and fused silica, which have both been well-characterized in the past by single-wavelength measurement of the refractive index. The dispersion of bovine and rabbit aqueous and vitreous humors was measured from 400 to 1100 nm. In addition, the dispersion was measured from 400 to 700 nm for aqueous and vitreous humors extracted from goat and rhesus monkey eyes. An unsuccessful attempt was also made to use the technique for dispersion measurement of bovine cornea and lens. The principles of white-light interferometry, including image analysis, measurement accuracy, and limitations of the technique, are discussed. In addition, alternate techniques and previous measurements of ocular dispersion are reviewed.

Thresholds for visible lesions in the primate eye produced by ultrashort near-infrared laser pulses.

PURPOSE: To evaluate the effects of near-infrared (near-IR) ultrashort laser pulses on the retinas of rhesus monkey eyes and to perform threshold measurements for minimum visible lesions (MVLs) at pulse widths ranging from nanoseconds to femtoseconds. METHODS: Near-infrared single laser pulses were placed within the macular area of live rhesus monkey eyes for five different pulse widths (7 nsec; 80, 20, and 1 psec; and 150 fsec). One visible wavelength of 530 nm at 100 fsec was also included in the study. Visible lesion thresholds (MVL-ED50) were determined 1 hour and 24 hours after exposure. Fluorescein angiography thresholds (FAVL-ED50) were also determined using a probit analysis of the dosage. Thresholds were calculated as that dosage causing a 50% probability for damage, and the fiducial limits were calculated at the 95% confidence level. RESULTS: For all pulse widths, the 24-hour MVL-ED50 was lower than the 1-hour MVL-ED50, and they both decreased with decreasing pulse width. Thresholds at the 1-hour reading decreased from 28.7 microJ at 7 nsec to 1.8 microJ at 150 fsec, whereas thresholds at 24 hours decreased from 19.1 microJ at 7 nsec to 1.0 microJ at 150 fsec. The doubled 1060-nm wavelength of the 530-nm threshold decreased from 0.36 to 0.16 microJ after 24 hours. FAVL-ED50s were much higher than MVL-ED50s, showing that FA was not as sensitive in determining damage levels. CONCLUSIONS: Laser pulse widths less than 1 nsec in the near-IR are capable of producing visible lesions in rhesus monkey eyes with pulse energies between 5 and 1 microJ. Also, the near-IR thresholds for these pulse widths are much higher than for the visible wavelengths. As with visible wavelengths, FA is not as sensitive in determining threshold levels as is visually observing the retina through a fundus camera.

Ultrashort laser pulse bioeffects and safety.

Recent studies of retinal damage due to ultrashort laser pulses have shown that less energy is required for retinal damage for pulses shorter than 1 ns than that for longer pulses. It has also been shown that more energy is required for near-infrared (NIR) wavelengths than in the visible because the light focuses behind the retina, requiring more energy to produce a damaging fluence on the retina. We review the progress made in determining the trends in retinal damage from laser pulses of 1 ns to 100 fs in the visible and NIR wavelength regimes. We have determined the most likely damage mechanism(s) operative in this pulse width regime.

Proposed maximum permissible exposure limits for ultrashort laser pulses.

Recent studies have provided considerable ED50 data for both visible and near infrared wavelengths from single laser pulses below one nanosecond of exposure. The current ANSI Z136.1 standard does not offer an approved maximum permissible exposure limit for subnanosecond single laser pulses and the current suggested maximum permissible exposure limit may be overly conservative. Lacking an approved standard industrial, medical, educational, and military uses of these types of laser systems may be limited or prohibited. A new set of laser maximum permissible exposure limits for subnanosecond visible and near infrared single laser pulses is recommended, along with the steps taken to develop the proposed standard.

Influence of optical aberrations on laser-induced plasma formation in water and their consequences for intraocular photodisruption.

The influence of spherical aberrations on laser-induced plasma formation in water by 6-ns Nd:YAG laser pulses was investigated for focusing angles that are used in intraocular microsurgery. Waveform distortions of 5.5lambda and 18.5lambda between the optical axis and the 1/e(2) irradiance values of the laser beam were introduced by replacement of laser achromats in the delivery system by planoconvex lenses. Aberrations of 18.5lambda increased the energy threshold for plasma formation by a factor of 8.5 compared with the optimized system. The actual irradiance threshold for optical breakdown was determined from the threshold energy in the optimized system and the spot size measured with a knife-edge technique. For aberrations of 18.5lambda the irradiance threshold was 48 times larger than the actual threshold when it was calculated by use of the diffraction-limited spot size but was 35 times smaller when it was calculated by use of the measured spot size. The latter discrepancy is probably due to hot spots in the focal region of the aberrated laser beam. Hence the determination of the optical-breakdown threshold in the presence of aberrations leads to highly erroneous results. In the presence of aberrations the plasmas are as much as 3 times longer and the transmitted energy is 17-20 times higher than without aberrations. Aberrations can thus strongly compromise the precision and the safety of intraocular microsurgery. They can further account for a major part of the differences in the breakdown-threshold and the plasma-transmission values reported in previous investigations.

Comparative study of laser damage threshold energies in the artificial retina.

Laser damage threshold energies produced from ultrashort (i.e., ⩽1 ns) laser pulses are investigated as a function of both pulse width and spot size for an artificial retina. A piece of film acts as the absorbing layer and is positioned at the focus of a variant on the Cain artificial eye [C. Cain, G. D. Noojin, D. X. Hammer, R. J. Thomas, and B. A. Rockwell, "Artificial eye for in vitro experiments of laser light interaction with aqueous media," J. Biomed. Opt.2, 88-94 (1997)]. Experiments were performed at the focal point and at two and ten Rayleigh ranges (RR) in front of the focus with the damage end point being the presence of a bubble imaged at the film plane. Pulse energy thresholds were determined for wavelengths of 1064, 580, and 532 nm with pulse durations ranging from the nanosecond (ns) to the femtosecond (fs) regime. For the at-focus data in the visible regime, the threshold dropped from 0.25 µJ for a 532 nm, 5 ns pulse to 0.11 µJ for a 580 nm, 100 fs pulse. The near-infrared (NIR) threshold changed from 5.5 µJ for a 5 ns pulse to 0.9 µJ for a 130 fs pulse at a distance two RR in front of the focus. The experiment was repeated using the same pulse widths and wavelengths, except the water path was removed to determine the impact of nonlinear self-focusing in water. A vertical microscope imaging system was employed in order to observe the threshold event. The NIR fluence threshold of 0.5 J/cm2 remained constant within an experimental uncertainty for all pulse widths, which corresponds to values in the literature [C. P. Lin and M. W. Kelly, "Ultrafast time-resolved imaging of stress transient and cavitation from short pulsed laser irradiated melanin particles," SPIE Laser-Tissue Interactions VI, Proc. SPIE2391, 294-299 (1995)]. The visible data also demonstrated a nearly constant fluence of 0.07 J/cm2. The disparity in thresholds between the two techniques arises from nonlinear optical phenomena related to propagation differences in the ocular fluid. © 1999 Society of Photo-Optical Instrumentation Engineers.

Pathology of macular lesions from subnanosecond pulses of visible laser energy.

PURPOSE: To demonstrate how current theories regarding ultrashort laser pulse effects may apply to ocular tissue, a prospective clinicopathologic study of macular lesions from ultrashort laser pulses compared the pathologic effects with the clinical and fluorescein angiographic appearance of the laser lesions. METHODS: Ninety-femtosecond, 3-picosecond, and 60-picosecond laser pulses, throughout a range of energies, were delivered to the retina of Macaca mulatta. Clinical examination and fluorescein angiography were performed at 1 hour in all eyes and 24 hours after exposure in selected eyes. Eyes were enucleated at 1 or 24 hours after lesion placement. The structure and extent of retinal lesions were scored for comparison with the clinical findings. RESULTS: Focal retinal pathologic appearance correlated well with a clinically visible lesion observed 24 hours after laser delivery. Retinal lesions were small foci of retinal pigment epithelium (RPE) and retinal disruption, without choriocapillaris involvement. Lesions that contained focal RPE vacuoles or lifting of the RPE also demonstrated leakage, in fluorescein angiographic studies. Suprathreshold laser delivery frequently caused focal columns of retinal injury and intraretinal hemorrhages from retinal vessel bleeding, with no rupture of choroidal blood vessels. CONCLUSIONS: The retinal response to ultrashort laser pulses at moderate energy followed a pattern of focal damage from laser-induced breakdown without significant thermal spread.

Shielding properties of laser-induced breakdown in water for pulse durations from 5 ns to 125 fs.

The shielding effectiveness of laser-induced breakdown from focused, visible laser pulses from 5 ns to 125 fs is determined from measurements of transmission of energy through the focal volume. The shielding efficiency decreases as a function of pulse duration from 5 ns to 300 fs and increases from 300 fs to 125 fs. The results are compared with past studies at similar pulse durations. The results of the measurements support laser-induced breakdown models and may lead to an optimization of laser-induced breakdown in ophthalmic surgery by reduction of collateral effects.

Longitudinal relaxation and diffusion measurements using magnetic resonance signals from laser-hyperpolarized 129Xe nuclei.

Methods for T1 relaxation and diffusion measurements based on magnetic resonance signals from laser-hyperpolarized 129Xe nuclei are introduced. The methods involve optimum use of the perishable hyperpolarized magnetization of 129Xe. The necessary theoretical framework for the methods is developed, and then the methods are applied to measure the longitudinal relaxation constant, T1, and the self-diffusion constant, D, of hyperpolarized 129Xe. In a cell containing natural abundance 129Xe at 790 Torr, the T1 value was determined to be 155 +/- 5 min at 20 degrees C and at 2.0 T field. For a second cell at 896 Torr, at the same field and temperature, the T1 value was determined to be 66 +/- 2 min. At a higher field of 7.05 T, the T1 values for the two cells were found to be 185 +/- 10 and 88 +/- 5 min, respectively. The 129Xe self-diffusion constant for the first cell was measured to be 0.057 cm2/ s and for the second cell it was 0.044 cm2/s. The methods were applied to 129Xe in the gas phase, in vitro; however, they are, in principle, applicable for in vivo or ex vivo studies. The potential role of these methods in the development of newly emerging hyper-polarized 129Xe MRI applications is discussed.

Perceived level and sources of stress in university professional schools.

The purpose of this study was to investigate the perception of level and sources of stress in students of two baccalaureate nursing programs, to compare these groups in their perceived stress and to compare the nursing groups to those enrolled in other health-related disciplines: Medicine, Pharmacy and Social Work. The study was descriptive correlational in design. The sample consisted of 552 full-time university students enrolled in years 2, 3 and 4 of their programs in selected disciplines. Data were collected by means of a questionnaire consisting of three main instruments: the Beck-Srivastava Stress Inventory (BSSI), the General Health Questionnaire 30-item version (GHQ-30) and a demographic profile. Data were analyzed using the SPSSx Statistical Package and included analysis of variance, frequency distribution, measures of correlation, item analysis and factor analysis. The results revealed that baccalaureate nursing students, regardless of year in program or university of attendance, experienced higher levels of stress and higher levels of physiological and psychological symptoms than students in other health-related disciplines. Identified stressors among the disciplines are also reported in the article.

Intraocular laser surgical probe for membrane disruption by laser-induced breakdown.

A fiber probe has been designed as a surgical aid to cut intraocular membranes with laser-induced breakdown as the mechanism. The design of the intraocular laser surgical probe is discussed. A preliminary retinal damage distance has been calculated with breakdown threshold, spot size, and shielding measurements. Collateral mechanical-damage effects caused by shock wave and cavitation are discussed.

Digital integrated retinal surgical laser system.

The year is 2001--ophthalmic retinal surgery is now fully computer assisted. Patients arriving for scheduled treatments of diabetic retinopathy, retinal tears, or macular degeneration have their retina digitally mapped by a technician. From the retinal map, the ophthalmologist plots therapeutic lesion sites with a light pen on the computer screen that will automatically be placed by a computer controlled argon laser. The treatment only requires 100 ms per lesion placement thus reducing office calls to approximately 45 minutes freeing the ophthalmologist for other pressing cases. This paper reports on the development of a clinically significant prototype system that will help bring this scenario to fruition.

Retinal damage and laser-induced breakdown produced by ultrashort-pulse lasers.

BACKGROUND: In vivo retinal injury studies using ultra-short-pulse lasers at visible wavelengths for both rabbit and primate eyes have shown that the degree of injury to the retina is not proportional to the pulse energy, especially at suprathreshold levels. In this paper we present results of calculations and measurements for laser-induced breakdown (LIB), bubble generation, and self-focusing within the eye. METHODS: We recorded on video and measured the first in vivo LIB and bubble generation thresholds within the vitreous in rabbit and primate eyes, using external optics and femtosecond pulses. These thresholds were then compared with calculations from our LIB model, and calculations were made for self-focusing effects within the vitreous for the high peak power pulses. RESULTS: Results of our nonlinear modeling and calculations for self-focusing and LIB within the eye were compared with experimental results. The LIB ED50 bubble threshold for the monkey eye was measured and found to be 0.56 microJ at 120 fs, compared with the minimum visible lesion (MVL) threshold of 0.43 microJ at 90 fs. Self-focusing effects were found to be possible for pulsewidths below 1 ps and are probably a contributing factor in femtosecond-pulse LIB in the eye. CONCLUSIONS: Based on our measurements for the MVL thresholds and LIB bubble generation thresholds in the monkey eye, we conclude that in the femtosecond pulsewidth regime for visible laser pulses, LIB and self-focusing are contributing factors in the lesion thresholds measured. Our results may also explain why it is so difficult to produce hemorrhagic lesions in either the rabbit or primate eye with visible 100-fs laser pulses even at 100 microJ of energy.

Development of an integrated automated retinal surgical laser system.

Researchers at the University of Texas and the USAF Academy have worked toward the development of a retinal robotic laser system. The overall goal of this ongoing project is to precisely place and control the depth of laser lesions for the treatment of various retinal diseases such as diabetic retinopathy and retinal tears. Separate low speed prototype subsystems have been developed to control lesion depth using lesion reflectance feedback parameters and lesion placement using retinal vessels as tracking landmarks. Both subsystems have been successfully demonstrated in vivo on pigmented rabbits using an argon continuous wave laser. Preliminary testing on rhesus primate subjects have been accomplished with the CW argon laser and also the ultrashort pulse laser. Recent efforts have concentrated on combining the two subsystems into a single prototype capable of simultaneously controlling both lesion depth and placement. We have designated this combined system CALOSOS for Computer Aided Laser Optics System for Ophthalmic Surgery. Several interesting areas of study have developed in integrating the two subsystems: 1) "doughnut" shaped lesions that occur under certain combinations of laser power, spot size, and irradiation time complicating measurements of central lesion reflectance, 2) the optimal retinal field of view (FOV) to achieve both tracking and lesion parameter control, and 3) development of a hybrid analog/digital tracker using confocal reflectometry to achieve retinal tracking speeds of up to 100 dgs. This presentation will discuss these design issues of this clinically significant prototype system. Details of the hybrid prototype system are provided in "Hybrid Eye Tracking for Computer-Aided Retinal Surgery" at this conference. The paper will close with remaining technical hurdles to clear prior to testing the full-up clinical prototype system.

Traumatic internal carotid artery dissection presenting as delayed hemilingual paresis.

A case of internal carotid artery dissection presenting as delayed right hemilingual paresis after blunt craniocervical trauma is presented. Diagnosis is discussed with emphasis on MR and MR angiographic findings. Mechanisms of injury and lower cranial nerve palsy are also briefly discussed.

Isolated cerebral intraaxial varix.

A case of isolated parenchymal venous varix not seen on angiography is reported. CT demonstrated a well-defined cystic lesion with peripheral enhancement deep within the left temporal lobe. MR demonstrated a high-signal-intensity lesion with hemosiderin rim.