Unifying Structure and Function Towards a Comprehensive Macular Evaluation in Eye Disorders: A Multi-Modal Approach Using Microperimetry and Optical Coherence Tomography

Objective: We present a new automatic and comprehensive framework to evaluate retinal sub-layer thickness and visual sensitivity at precise retinal locations through multi-modal registration of confocal scanning laser ophthalmoscope (cSLO) images obtained separately from an optical coherence tomography (OCT) device and a microperimeter. Methods: We map consecutive B-scans onto the cSLO images after accounting for eye motion. Next, we coarsely register the SLO-microperimetry and cSLO-OCT images using SIFT, followed by precise elastic image registration. Subsequently, we ensure the quality of the co-registered images through single-particle and object tracking of the warped microperimetry test locations. Finally, the retinal thickness is queried from the segmented retinal layers in the co-registered space. A manual mode involving projective transformation accounting for perspective distortions in the images arising from the two modalities is also included. Results: Validation using retinal images of 8 adults with albinism, 16 adults with amblyopia, 3 adults with macular diseases, and 15 visually healthy adults showed results with excellent reliability. Conclusion: The proposed framework enables the evaluation of retinal thickness by utilizing precise structural and functional relationships of the eye through a self-assessing multi-tiered approach. Significance: Our framework lays the foundation towards a comprehensive structure-function assessment of the macular region in various eye disorders.