After discussing the rationale and assumptions of the ANSI Z136.1-2000 Standard for protection of the human eye from laser exposure, we present the concise formulation of the exposure limits expressed as maximum permissible radiant exposure (in J/cm(2)) for light overfilling the pupil. We then translate the Standard to a form that is more practical for typical ophthalmic devices or in vision research situations, implementing the special qualifications of the Standard. The safety limits are then expressed as radiant power (watts) entering the pupil of the eye. Exposure by repetitive pulses is also addressed, as this is frequently employed in ophthalmic applications. Examples are given that will familiarize potential users with this format.

Quantitative AF imaging appears feasible. It may enhance understanding of retinal degeneration, serve as a diagnostic aid and as a sensitive marker of disease progression, and provide a tool to monitor the effects of therapeutic interventions.

A confocal scanning imager moves an illumination spot over the object and a (virtual) detector synchronously over the image. In the confocal scanning laser ophthalmoscope this is accomplished by reusing the source optics for detection. The common optical elements are all mirrors-either flat or spherical-and the scanners are positioned to compensate astigmatism due to mirror tilt. The source beam aperture at the horizontal scanner is small. Light returning from the eye is processed by the same elements, but now the polygon's facet is overfilled. A solid-state detector may be at either a pupillary or retinal conjugate plane in the descanned beam and still have proper throughput matching. Our 1-mm avalanche photodiode at a pupillary plane is preceded by interchangeable stops at an image (retinal) plane. Not only can we reject scattered light to a degree unusual for viewing the retina, but we choose selectively among direct and scattered components of the light returning from the eye. One (of many) consequences is that this ophthalmoscope gives crisp and complete retinal images in He-Ne light without dilation of the pupil.

We present a technique for estimating the density of the human macular pigment noninvasively that takes advantage of the autofluorescence of lipofuscin, which is normally present in the human retinal pigment epithelium. By measuring the intensity of fluorescence at 710 nm, where macular pigment has essentially zero absorption, and stimulating the fluorescence with two wavelengths, one well absorbed by macular pigment and the other minimally absorbed by macular pigment, we can make accurate single-pass measurements of the macular pigment density. We used the technique to measure macular pigment density in a group of 159 subjects with normal retinal status ranging in age between 15 and 80 years. Average macular pigment density was 0.48 +/- 0.16 density unit (D.U.) for a 2 degrees -diameter test field. We show that these estimates are highly correlated with reflectometric (mean: 0.23 +/- 0.07 D.U.) and psychophysical (mean: 0.37 +/- 0.26 D.U.; obtained by heterochromatic flicker photometry) estimates of macular pigment in the same subjects, despite the fact that systematic differences in the estimated density exist between techniques. Repeat measurements over both short- and long-time intervals indicate that the autofluorescence technique is reproducible: The mean absolute difference between estimates was less than 0.05 D.U., superior to the reproducibility obtained by reflectometry and flicker photometry. To understand the systematic differences between density estimates obtained from the different methods, we analyzed the underlying assumptions of each technique. Specifically, we looked at the effect of self-screening by visual pigment, the effect of changes in optical property of the deeper retinal layers, including the role of retinal pigmented epithelium melanin, and the role of secondary fluorophores and reflectors in the anterior layers of the retina.

The interaction of infrared light with the human ocular fundus, particularly sub-retinal structures, was studied in vivo. Visible and infra-red wavelengths and a scanning laser ophthalmoscope were used to acquire digital images of the human fundus. The contrast and reflectance of selected retinal and sub-retinal features were computed for a series of wavelengths or modes of imaging. Near infrared light provides better visibility than visible light for sub-retinal features. Sub-retinal deposits appear light and thickened; the optic nerve head, retinal vessels, and choroidal vessels appear dark. Contrast and visibility of features increases with increasing wavelength from 795 to 895 nm. Optimizing the mode of imaging improves the visibility of some structures. This new quantitative basis for near infrared imaging techniques can be applied to a wide range of imaging modalities for the study of pathophysiology and treatment in diseases affecting the retinal pigment epithelium and Bruch's membrane, such as age-related macular degeneration.

Normative qAF data are a reference tool essential to the interpretation of qAF measurements in ocular disease.

Reflectance spectra from discrete sites in the human ocular fundus were measured with an experimental reflectometer in the visible and near-infrared parts of the spectrum. The principal study population consisted of ten subjects 22 to 38 years of age with a wide range of degree of fundus melanin pigmentation. Reflectance spectra were obtained from the nasal fundus, the fovea, and an area 2.5 degrees from the fovea. Spectra were also recorded from several older subjects and from one aphakic patient with a coloboma. The reflectance spectra were found to be influenced by the degree of individual and local melanin pigmentation of the fundus, the amount of blood in the choroid, the transmission properties of the ocular media, and the discrete reflections in the stratified fundus layers. Mathematical models of the optical properties of the stratified layers are proposed and are fitted to the experimental fundus reflectance spectra. The models account for the absorption by blood, melanin, macular pigment, and ocular media, and incorporate tissue scattering and discrete reflectors corresponding to anatomical layers.

Quantified fundus autofluorescence is an indirect approach to measuring RPE lipofuscin in vivo. We report that ABCA4 mutations cause significantly elevated qAF, consistent with previous reports indicating that increased RPE lipofuscin is a hallmark of STGD1. Even when qualitative differences in fundus AF images are not evident, qAF can elucidate phenotypic variation. Quantified fundus autofluorescence will serve to establish genotype-phenotype correlations and as an outcome measure in clinical trials.