Avaliação da perimetria macular em pacientes com degeneração macular relacionada à idade por meio do oftalmoscópio de rastreamento a laser

Moraes, Luís Henrique Rapucci; Elsner, Ann E.; Kunze, Christian; Suzuki, Hisashi; Nehemy, Márcio Bittar; Soriano, Danilo Sone; Kara‐José, Newton

doi:10.1590/s0004-27492007000500021

Cited by 4 publications

(7 citation statements)

References 17 publications

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“…13–16,22–25 The MP-1 provides a wide field image, but does not use scanning laser technology, resulting in a lower contrast image that does not reveal drusen with the same clarity that an SLO does. 8,26–28 The MP-1 visual stimuli lack sufficient dynamic range to provide sufficiently bright stimuli for some patients, which creates a ceiling effect in the data collection. Further, the lack of uniformity of the background has led to spurious visual defects when compared with standardized perimetry results.…”

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confidence: 99%

“…This is similar to increasing the distance between a confocal aperture and the center of the optical path of the returning light. 27,28 The indirect mode of detection enhances the visibility of certain structures, particularly deeper ones such as the choroidal rim of the optic nerve head, which are normally obscured by the highly reflective, overlying retina. 28,30 …”

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confidence: 99%

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Fixation Stability and Scotoma Mapping for Patients With Low Vision

Elsner¹,

Petrig

Papay

et al. 2013

Optometry and Vision Science

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Purpose To develop a simplified device that performs fundus perimetry techniques, such as fixation mapping and kinetic perimetry. Methods We added visual stimulation to a near infrared retinal imager, the Laser Scanning Digital Camera (LSDC). This device uses slit scanning illumination combined with a 2 dimensional CMOS detector, with continuous viewing of the retina. The CMOS read-out was synchronized with the slit scanning, thereby serving as a confocal aperture to reduce stray light in retinal images. Series of retinal images of 36 deg were automatically aligned to provide data for fixation maps and quantification of fixation stability. The LSDC and alignment techniques also provided fundus viewing with retinal location correction for scotoma mapping. Results First, fixation mapping was readily performed in patients with central scotoma or amblyopia. The automatic alignment algorithm allowed quantification of fixation stability in patients with macular pathologies that did not cause scotoma. Second, fixation stability was rapidly and quantitatively assessed by the automatic registration of a series of retina images. There was no significant difference in the fixation stability with automatic vs. manual alignment. Kinetic perimetry demonstrated that fundus imaging helped reduce the variability of perimetric data by identifying and preventing false positives due to eye motion. We found that the size of the blind spot was significantly larger for dark targets on brighter backgrounds than when the contrast was reversed (p < 0.045). This is consistent with incremental targets being detected partially or wholly due to scattered light falling on more sensitive retinal locations. Conclusions Fundus perimetry with the LSDC allows for a wide range of fixation and perimetry tasks.

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confidence: 99%

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confidence: 99%

Fixation Stability and Scotoma Mapping for Patients With Low Vision

Elsner¹,

Petrig

Papay

et al. 2013

Optometry and Vision Science

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“… 18,24,28,36,49 I shaped beams, battled chromatic aberration, added intensity controls, and configured separate video-rate beam modulation at all visible wavelengths. This permitted stimulation for visual function, both by modulating the laser beam to produce graphics as described by Dr. George Timberlake 27,34,39,70 and also comparison with the microenvironment seen in near-infrared images to visual function 17,39,71–73 …”

Section: Translating Advances: Toward Better or Affordable Methodologiesmentioning

confidence: 99%

2022 Prentice Award Lecture: Advancing Retinal Imaging and Visual Function in Patient Management and Disease Mechanisms

Elsner

2023

Optom Vis Sci

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SIGNIFICANCE: Patient-based research plays a key role in probing basic visual mechanisms. Less-well recognized is the role of patient-based retinal imaging and visual function studies in elucidating disease mechanisms, which are accelerated by advances in imaging and function techniques and are most powerful when combined with the results from histology and animal models.A patient's visual complaints can be one key to patient management, but human data are also key to understanding disease mechanisms. Unfortunately, pathological changes can be difficult to detect. Before advanced retinal imaging, the measurement of visual function indicated the presence of pathological changes that were undetectable with existing clinical examination. Over the past few decades, advances in retinal imaging have increasingly revealed the unseen. This has led to great strides in the management of many diseases, particularly diabetic retinopathy and macular edema, and age-related macular degeneration. It is likely widely accepted that patient-based research, as in clinical trials, led to such positive outcomes. Both visual function measures and advanced retinal imaging have clearly demonstrated differences among retinal diseases. Contrary to initial thinking, sight-threatening damage in diabetes occurs to the outer retina and not only to the inner retina. This has been clearly indicated in patient results but has only gradually entered the clinical classifications and understanding of disease etiology. There is strikingly different pathophysiology for age-related macular degeneration compared with photoreceptor and retinal pigment epithelial genetic defects, yet research models and even some treatments confuse these. It is important to recognize the role that patient-based research plays in probing basic visual mechanisms and elucidating disease mechanisms, combining these findings with the concepts from histology and animal models. Thus, this article combines sample instrumentation from my laboratory and progress in the fields of retinal imaging and visual function.

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“…Other novel near infrared sources include a diode pumped tunable Chr:Li:SaF 4 laser, tunable over about 810–870 nm with excellent beam quality. This source provided excellent images that were used to readily visualize features in normal subjects [33] and pathological features in age-related macular degeneration [34–35]. These near infrared illumination sources have also been used in combination with a variety of visible wavelength sources that can provide visual stimuli to probe retinal function while simultaneously imaging structures within or beneath the retina [23].…”

Section: Light Delivery: Laser Scanning and Confocal Imaging Systemsmentioning

confidence: 99%

“…The most readily configured version is to use a single axis for illumination and detection, and to employ annular apertures appropriately. This design provides rapid, noninvasive detection and localization of exudation and deep retinal structures that scatter light in inflammatory disease and age-related macular degeneration [26,35,43–44], illustrated in Figures 10 and 11.…”

Section: Light Delivery: Laser Scanning and Confocal Imaging Systemsmentioning

confidence: 99%

Laser applications and system considerations in ocular imaging

Elsner¹,

Muller

2008

Laser & Photonics Reviews

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We review laser applications for primarily in vivo ocular imaging techniques, describing their constraints based on biological tissue properties, safety, and the performance of the imaging system. We discuss the need for cost effective sources with practical wavelength tuning capabilities for spectral studies. Techniques to probe the pathological changes of layers beneath the highly scattering retina and diagnose the onset of various eye diseases are described. The recent development of several optical coherence tomography based systems for functional ocular imaging is reviewed, as well as linear and nonlinear ocular imaging techniques performed with ultrafast lasers, emphasizing recent source developments and methods to enhance imaging contrast. KeywordsRetinal imaging; confocal imaging; Vertical Cavity Surface Emitting Laser (VCSEL); Adaptive Optics; OCT (Optical Coherence Tomography); swept source lasers; ultrafast lasers; nonlinear interactions INTRODUCTONImaging of the eye presents several optical challenges, of which only some are found in microscopy. Millions of neural cells, together with their metabolic support structures, line the inside of the eyeball, forming the retina [1]. Figure 1 shows the large scale view of the eye in cross section, and Figure 2 shows detail of the layers of the retina.The healthy eye must be relatively transparent over a distance of roughly 22 mm, from cornea to retina, to permit the transmission of light to the photoreceptors, which are the neurons that Ann E. Elsner has been a Professor at the Indiana University School of Optometry since 2005 and serves as Director of the Borish Center for Ophthalmic Research. From 1987 until 2005, she was at the Schepens Eye Research Institute, an affiliate of Harvard Medical School, where she served as the group head in Vision and Visual Optics. She is known for the novel application of lasers as sources in imaging and display devices. The applications of the imaging devices are focused on discovering the pathophysiology of diseases of the retina, as well as probing visual function throughout the lifespan. By determining the optical signature of pathological states that are important in patient management, she then develops optical techniques that maximize the chance to detect damage due to disease, with a view towards wide applicability and low cost. She is best known for her retinal imaging work with near infrared sources, polarized light, and image processing techniques that use multiply scattered light to provide improved detection of pathology. Dr. Elsner is a Fellow of the Optical Society of America, and a Fellow of the American Academy of Optometry. She serves as an Associate Editor for Investigative Ophthalmology and Vision Science. She is an author or co-author on more than 75 papers in refereed journals, and over 150 published abstracts from major scientific meetings. Matthew S. Muller has been an Optical Engineer at the Indiana University School of Optometry since January, 2008. He received his Master's of Science (Engin...

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Avaliação da perimetria macular em pacientes com degeneração macular relacionada à idade por meio do oftalmoscópio de rastreamento a laser

Cited by 4 publications

References 17 publications

Fixation Stability and Scotoma Mapping for Patients With Low Vision

Fixation Stability and Scotoma Mapping for Patients With Low Vision

2022 Prentice Award Lecture: Advancing Retinal Imaging and Visual Function in Patient Management and Disease Mechanisms

Laser applications and system considerations in ocular imaging

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