We have developed a custom scanning laser ophthalmoscope that uses phase plates produced by photolithography to improve the contrast of human retinal images. We combined the scanning engine from a commercial real-time confocal microscope with custom optics to provide medium magnification imaging of the human retina (3° field of view). Defocus and astigmatism were corrected with conventional trial lenses. Higher-order aberrations of the eye were corrected with a phase plate. A 633-nm laser was used for illuminating the retina. Inserting the phase plate into the optical system increased the contrast of a sample retinal vessel by 26%. Additionally, a number of small features of the retina, which were not visible with standard commercial imaging systems, became visible. There results illustrate that, with the rapid development of custom fabrication techniques for refractive corrections, improved diagnostic imaging with little added complexity to existing ophthalmic imaging systems may be realistic.The introduction of adaptive optics into the ophthalmic research community has resulted in a great deal of interest in both correction of aberrations of the eye for improved vision 1-5 and high-resolution imaging of the retina. 1,6 One of the major problems in retinal imaging is that contrasts of most features are low because of both multiple scattering from different layers of the retina and the aberrations of the ocular optics. 7 The scanning laser ophthalmoscope 8 (SLO) has provided a major advantage for retinal imaging because of its ability to improve retinal contrast, especially at longer wavelengths. 9 However, both the spatial resolution and the contrast of confocal SLOs are still limited by the degradation in image quality that is imposed by the optics of the eye.Retinal imaging is commonly used in ophthalmology for the identification and localization of retinal and neural damage. Typically, retinal imaging is performed with fields of view ranging from 10° to 50° of retinal area (approximately 3000-15,000 µ m). We tested whether using customized phase plates allowed higher-contrast imaging of the retina. Although the phase plate used in this study was specially made, the rapid development of excimer laser systems for customized corneal ablation or lathing systems for customized contact lenses may allow manufacturing of custom phase plates at a relatively low incremental cost. To test the approach we developed a new, medium-magnification confocal imaging system (approximately 3° field of view) that uses a combination of trial lenses for correcting a subject's spherical and cylindrical refractive errors and a custom phase plate 15 to correct higher-order aberrations of the eye statically.Our custom SLO is based on a design for dermatological applications 16 (Fig. 1). This SLO uses a polygon to generate the horizontal scan and a galvanometer to generate the vertical scan. 16 We have added a magnification system to increase the pupil size to 5 mm and decrease the field scan to a 3°angle. An optical relay provi...