P. J. Delint

Fundus reflectance: historical and present ideas

In 1851 Helmholtz introduced the ophthalmoscope. The instrument allowed the observation of light reflected at the fundus. The development of this device was one of the major advancements in ophthalmology. Yet ophthalmoscopy allows only qualitative observation of the eye. Since 1950 attempts were made to address the challenging, quantitative assessment of the amount of light reflected by the fundus. At first, only comparative measurements were possible, applied in the study of macular and visual pigments. With improvements in light detecting techniques, and with the advent of microprocessors, the measurement of spectral and spatial distribution of the reflectance became feasible. This led to the development of models that explained the observed wavelength dependence and the directional behavior of light reflected from the fovea. The models allowed a quantitative assessment of many parameters on absorption and reflection by structures in the human eye. This paper provides a review of both the experimental and theoretical progress, and summarizes the results of fundamental and clinical research using fundus reflectometry.

Local photoreceptor alignment measured with a scanning laser ophthalmoscope.

The aim of this study was to develop a fast test for local photoreceptor alignment. Photoreceptor alignment is an important indicator of retinal integrity. Digitized images of fundus reflectance were obtained for 20-30 pupil entry positions with a custom built scanning laser ophthalmoscope (SLO). The data permitted the calculation of curve peakedness of the optical Stiles-Crawford effect (SCE) as a function of retinal location. We found that the peakedness is low in the central 0.5 deg, reaches a maximum at an eccentricity of 1-2 deg and gradually drops with increasing eccentricity. These data are in conformity with the anatomy of foveal cones. Additionally, the psychophysical SCE was measured with red light and an 8 deg stimulus. The mean peak position of the SCE in the pupil plane for both methods was similar, but the optical SCE was clearly steeper. The SLO provides a fast, reliable and objective way to determine local receptor alignment in the central retina.

Photoreceptor function in unilateral amblyopia

We investigated whether photoreceptor function in amblyopic eyes differed from that in non-amblyopic eyes. Photoreceptor function was assessed with the optical Stiles-Crawford effect (SCE), psychophysical SCE, and foveal visual pigment density in both eyes of ten unilateral amblyopic subjects. Optical SCE and density measurements were carried out with a custom-built scanning laser ophthalmoscope (SLO). Amblyopic and normal eyes did not differ in Stiles-Crawford effect, nor in foveal visual pigment density. Contrary to suggestions in the literature, we found no indication of retinal dysfunction at the level of the cone photoreceptors in amblyopic eyes.

Scanning laser densitometry in visual acuity loss of unknown origin.

AIM: To assess foveal cone photoreceptor function in patients with unexplained loss of central visual acuity. METHODS: Testing of foveal cone photoreceptor function was performed using scanning laser densitometry, colour matching (Rayleigh equation), and pattern electroretinography (ERG). Standard tests included full field ERG, electrooculography, visual evoked potentials, static perimetry, and fluorescein angiography. RESULTS: Decreased foveal cone photopigment density and abnormal pattern ERG were found in three patients. Results of colour matching were not unequivocal. CONCLUSION: Testing of foveal cone photoreceptor function using scanning laser densitometry may determine the location of pathological changes in certain patients with unexplained visual loss.

Photoreceptor function in eyes with macular edema

PURPOSE The irreversible loss of visual acuity in macular edema is usually attributed to permanent loss of photoreceptor cells, although there is hardly any information on changes in photoreceptor function in macular edema. The purpose of this study was to assess photoreceptor function in various stages of macular edema and to relate the findings to visual acuity and angiographic changes. METHODS Directional sensitivity (optical Stiles-Crawford effect) and visual pigment density of foveal cones was measured with a custom-built scanning laser ophthalmoscope (SLO) in 19 eyes of 19 patients. Twelve eyes exhibited macular edema: five of inflammatory origin, and seven of diabetic origin. Seven eyes with an intraocular inflammatory disease without clinical or angiographic evidence of edema were also included (four of which had previous macular edema and one of which had shown development of macular edema at the 1-year follow-up). Results of SLO measurements were related to findings using fluorescein angiography and Snellen visual acuity, both assessed at the time of SLO measurement and 6 months thereafter. RESULTS Eyes with macular edema exhibited diminished directional sensitivity of photoreceptor cells in the fovea compared with eyes without (P = 0.02). Visual pigment density of eyes with macular edema was decreased and associated with both initial and follow-up visual function and with the angiographic macular edema grade at follow-up. Abnormal directional sensitivity and pigment density were already present in eyes with slight edematous changes and normal visual acuity. CONCLUSIONS Eyes with inflammatory or diabetic macular edema showed decreased directional sensitivity and visual pigment density in the macular area. These findings may support a role for SLO measurements in detecting retinal damage due to macular edema.