Photodynamic therapy (PDT) is a new treatment modality for exudative forms of age-related maculopathy. It can be combined with others types of selective or conventional laser therapy. Imaging and functional testing with the scanning laser ophthalmoscope (SLO) are important for detailed diagnostic information as well as for the interpretation of the long term outcome of different treatment strategies. For example, infrared imaging in a confocal mode superbly outlines areas of minimal edema due to slow leakage and switching of wavelengths enables simultaneous and repeated angiographic studies of the retina with the same instrument. Visual acuities are strongly influenced by background illuminance and binocular fixation patterns, and absolute but not incremental microperimetric thresholds measure correctly the functional status of the photoreceptor-pigment epithelium complex. The scanning laser ophthalmoscope has been adapted for use as a delivery system in microphotocoagulation and photodynamic therapy. A non- scanning external therapeutic laser source uses the same Maxwellian view entrance location into the eye as the SLO. Advantages include a non-contact delivery, fixation control, registration of treatment locations, and the possibility to spatially modulate the area being treated.
The confocal scanning laser ophthalmoscope, cSLO, can be used for microphotocoagulation of the retina. For this purpose, external and non-scanning therapeutic laser sources are coupled with the instrument. An opto-mechanical coupling device is calibrated to obtain the same Maxwellian view entrance location in the eye for both scanning and external lasers. Two separate but synchronized confocal detection pathways are capable of monitoring the progression of thermal laser applications on the retina. Real-time image processing is further used to indicate the position and size of the aiming beam on the retina. This aiming beam can be pulsed in anti-aliased fashion with regard to its confocal detection, to allow for higher intensities. Its polarization is exploited to sharply reduce corneal reflections. MInimal optical distribution of the therapeutic laser beam, full documentation of application characteristics, simultaneous microperimetry, infra-red and angiographic imaging are useful features to guide microphotocoagulation.
We present a new technique, scanning laser retinoscopy, to spatially resolve in two dimensions the optical aberrations and refractive power of the ocular media. For this purpose, the Maxwellian view of a confocal scanning laser ophthalmoscope (SLO) is configured to scan simultaneously the posterior and the anterior segment of the eye at different levels of prefocussing. This set-up allows retinal imaging and psychophysics through different optical zones of the cornea and lens. In addition, the size of the anatomical pupil can be dynamically controlled by adjusting the colinear infrared and visible light intensities of the illuminating system. In retinoscopic images we can see a part of the retina superimposed by distinctive patterns of shadows in the pupillary area. The variable patterns of shadows in the retinoscopic images change with the level of prefocussing of the SLO. The patterns are the result of local variations in refraction or wavefront aberrations within the lens and cornea. In cases of excimer laser refractive surgery, for example, scanning laser retinoscopy is able to distinguish between a treated central area, transition zone and peripheral cornea. As a corollary, we can document differences between excimer laser delivery systems and also correlate the retinoscopic images with the subjective complaints of refractive surgery patients. These include monocular diplopia, glare, loss of contrast sensitivity besides reduced visual acuity.
Retinal function can be evaluated with the scanning laser ophthalmoscope (SLO). the main advantage is a precise localization of the psychophysical stimulus on the retina. Four alternative forced choice (4AFC) and parameter estimation by sequential testing (PEST) are classic adaptive algorithms that have been optimized for use with the SLO, and combined with strategies to correct for small eye movements. Efficient calibration procedures are essential for quantitative microperimetry. These techniques measure precisely visual acuity and retinal sensitivity at distinct locations on the retina. A combined 632 nm and IR Maxwellian view illumination provides a maximal transmittance through the ocular media and has a animal interference with xanthophyll or hemoglobin. Future modifications of the instrument include the possibility of binocular evaluation, Maxwellian view control, fundus tracking using normalized gray-scale correlation, and microphotocoagulation. The techniques are useful in low vision rehabilitation and the application of laser to the retina.