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PubMedDate not supplied

Treatment of macular disease with a binocular indirect ophthalmoscope laser delivery system.

BACKGROUND AND OBJECTIVE: Some patients with macular disease, because of physical infirmity or disability, cannot be treated with laser photocoagulation using a typical slit lamp delivery system. The purpose of this study was to determine whether the binocular indirect ophthalmoscope could be used to deliver treatment to the macula when photocoagulation would otherwise be very difficult, if not impossible, to perform. MATERIALS AND METHODS: Ten eyes of 10 patients who could not sit for slit lamp laser delivery were treated with binocular indirect ophthalmoscope laser photocoagulation over a 36 month period. Eight had subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD), and 2 patients had clinically significant macular edema (CSME) from diabetes mellitus. Argon laser photocoagulation was delivered to the choroidal neovascular membrane in patients with exudative AMD, and a grid treatment was given to eyes with diabetic macular edema. RESULTS: Six of 8 patients with exudative AMD were successfully treated with eradication of the CNV. Two required retreatment within 6 months of original treatment. Both patients with CSME had resolution of their edema at 3 and 6 months after treatment. Best corrected visual acuity did not change by more than 2 Snellen lines in any patient with CNV and 1 Snellen line in patients with CSME. No complications of treatment were encountered. CONCLUSION: In certain circumstances, laser photocoagulation of the macula using the indirect ophthalmoscope laser delivery system should be considered when more conventional treatment strategies cannot be implemented.

Aged↗
PubMed2000

[Reproducibility of planimetric optic nerve head analysis with scanning laser ophthalmoscope].

PURPOSE: To determine the variability of disc and cup area measurements in digital images obtained with scanning laser ophthalmoscope. METHODS: 10 sets of images of 4 optic discs (normal, myopic, ocular hypertensive and glaucomatous) were obtained with the Rodenstock scanning laser ophthalmoscope. Images focused at different depths were used by 2 operators (with and without experience in planimetry) to determine the disc and cup areas by means of an image analysis program (Visilog). This study was performed in 10 images obtained from the same optic nerve (inter-image analysis) and 10 times in the same image of each optic nerve (intra-image analysis). RESULTS: The variability of all the measurements was under 5%. Disc area measurements were lower than cup area determination. The experienced operator obtained lower variability. The myopic optic disc images were less reproducible than the other groups of images. CONCLUSIONS: The planimetric analysis of optic nerve head digital images obtained with scanning laser ophthalmoscope is reproducible and allows quantification of optic disc areas.

Humans↗
PubMedDate not supplied

Observation of macular lesion in Best's vitelliform macular dystrophy by scanning laser ophthalmoscope.

Using a scanning laser ophthalmoscope (SLO), the ocular fundus of a patient with Best's vitelliform macular dystrophy was examined. With the argon blue laser, a dark area was seen in the fovea. Areas of weakly bright reflex were seen corresponding to the scrambled-egg lesion observed by ophthalmoscope. With the argon green laser, highly bright spots were observed at the foveola. Intense bright reflex was seen over the scrambled-egg lesion at the posterior pole. The helium-neon laser revealed highly bright patches corresponding to the orderly ring distribution of the yellowish deposits at the posterior pole. The diode laser revealed a mottled appearance with dark and bright patches in the scrambled-egg lesion. SLO provided a morphologic enhancement in the specifically affected layers of the macula in Best's vitelliform macular dystrophy.

Adult↗
PubMed1994

Focal visual evoked potentials generated by scanning laser ophthalmoscope in patients with age-related macular degeneration treated by perifoveal photocoagulation.

Perifoveal laser photocoagulation has been proposed for the treatment of subfoveal neovascular membranes in age-related macular degeneration. We evaluated residual function in seven eyes of six treated patients by means of transient focal visual potentials evoked with a scanning laser ophthalmoscope. The site of the preferred retinal locus was determined. The modulation of the helium-neon laser beam generated three tests (a homogeneous 6 x 6 degrees square--offset and onset--and two alternating pattern checkerboards 6 x 6 degrees and 2.5 x 2.5 degrees 60', 2 Hz) projected onto the preferred retinal locus. The focal visual evoked potentials were recorded. One eye had an unstable fixation with no discernible focal visual evoked potentials. The other six eyes had a stable fixation located in the superior retina, temporally for the right eyes and nasally for the left eyes. The homogeneous 6 x 6 degrees square evoked discernible responses in all six patients. The two checkerboards evoked discernible responses in five of six patients. These results were compared with those recorded in four controls in whom the three tests were projected onto the same retinal areas as in the patients. Evoked responses were more often recorded in the preferred retinal locus of the treated patients with age-related macular degeneration than in the corresponding retinal areas of the controls. The scanning laser ophthalmoscope allowed us to control the site of stimulation in the patients' and controls' retinas. These preliminary results suggest that there may be a functional plasticity of the visual system after therapeutic laser-induced central scotoma.

Aged↗
PubMed1998

Retinal sensitivity measurement over drusen using scanning laser ophthalmoscope microperimetry.

BACKGROUND: Retinal sensitivity over drusen was examined using a scanning laser ophthalmoscope to confirm a previous report of no change in sensitivity over drusen. METHODS: Microperimetry was performed using a scanning laser ophthalmoscope in 23 eyes of 19 subjects. Subject age ranged from 42 to 86 years (mean 68.5 years). Fifty-four drusen bigger than the diameter of a major retinal vein at the optic disc rim were examined, and drusen were classified as soft drusen and other large drusen. RESULTS: Nine eyes of eight subjects showed a decrease in retinal sensitivity over drusen. The decrease in retinal sensitivity was more than 5 dB less than the sensitivity at a peripheral non-drusen area peripheral to the measurement point. The sensitivity decrease was noted over 15 of 29 large drusen and the decrease was statistically significant (P < 0.02). However, no relationship between the size of the drusen and the amount by which sensitivity decreased was found. Nevertheless, a decrease in retinal sensitivity was not seen over any of 25 soft drusen. CONCLUSION: Large drusen may influence retinal sensitivity and function.

Adult↗
PubMed1995

Scanning laser ophthalmoscopic analysis of the pattern of visual loss in age-related geographic atrophy of the macula.

PURPOSE: We explored the clinical impression that geographic atrophy of the retinal pigment epithelium, a form of advanced age-related macular degeneration, is perceived by the patient as progressing gradually, even when fixation switches from foveal to extrafoveal. METHODS: We analyzed the responses of 60 patients with geographic atrophy to a questionnaire administered as part of a five-year study of the natural course of geographic atrophy, funded by the National Eye Institute. We performed scanning laser opthalmoscope perimetry on all patients. We examined two additional patients with geographic atrophy who reported abrupt visual loss. RESULTS: No eye with geographic atrophy was reported by any patient to have had sudden visual loss. Although most patients with geographic atrophy show foveal fixation until the fovea is atrophic and then show extrafoveal fixation, scanning laser ophthalmoscope perimetry in three patients with geographic atrophy showed alternation between a foveal and an extrafoveal retinal locus for fixation. Two patients with geographic atrophy who complained of abrupt visual loss were found to have occult choroidal neovascularization, which evolved in one patient to classic choroidal neovascularization. The neovascularization was difficult to detect because of the presence of geographic atrophy and its associated ophthalmoscopic and fluorescein angiographic features. CONCLUSIONS: Visual loss in geographic atrophy is nearly always perceived by the patient as being gradual, even when considerable decreases in visual acuity occur and when foveal vision and fixation are lost. A possible explanation for this perception is that there is a transitional period during which a patient uses both a foveal and extrafoveal site for fixation. The complaint of abrupt visual loss in a patient with geographic atrophy should raise the suspicion of choroidal neovascularization, which may be occult and difficult to detect.

Aged↗
PubMed1998

Scanning laser ophthalmoscope fundus perimetry after surgery for choroidal neovascularization.

PURPOSE: Submacular surgery is under investigation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration, ocular histoplasmosis syndrome, and other causes. The aims of this study were to determine whether the macular area from which choroidal neovascularization was removed surgically remained functional and whether there was any qualitative difference between eyes with different disease conditions or between eyes of younger and older patients. METHODS: Our study included 19 patients (19 eyes) with choroidal neovascularization, seven cases caused by age-related macular degeneration and 12 caused by ocular histoplasmosis syndrome, pathologic myopia, or idiopathic causes. All tests were performed at least 6 months after surgical removal of choroidal neovascularization. All patients underwent fundus perimetry with the scanning laser ophthalmoscope for evaluation of dense and relative scotomas and fixation site. RESULTS: After submacular surgery in 19 patients, 10 patients (one with age-related macular degeneration and nine with pathologic myopia, ocular histoplasmosis syndrome, or an idiopathic cause of choroidal neovascularization) fixated within an area that ophthalmoscopically and angiographically was an area of retinal pigment epithelial disturbance occupied by choroidal neovascularization preoperatively. Of 12 patients without age-related macular degeneration, seven of eight patients younger than 50 years of age compared with two of four patients 50 years or older fixated within the area of retinal pigment epithelial disturbance. CONCLUSIONS: Our data suggest that in patients without age-related macular degeneration who undergo submacular surgery, the surgically disturbed area previously occupied by choroidal neovascularization can remain functional postoperatively. Furthermore, occasionally a patient with age-related macular degeneration undergoing submacular surgery still can fixate in the area from which the choroidal neovascularization was removed.

Adolescent↗
PubMed2000

Scanning laser ophthalmoscope fundus perimetry before and after laser photocoagulation for clinically significant diabetic macular edema.

PURPOSE: To prospectively evaluate functional and funduscopic changes after laser treatment in patients with diabetic retinopathy and clinically significant macular edema by scanning laser ophthalmoscope fundus perimetry. METHODS: Thirty eyes of 30 patients with clinically significant macular edema as a result of diabetic retinopathy were prospectively examined before and at least 3 months after focal laser treatment with automatic fundus threshold perimetry using the scanning laser ophthalmoscope. Thresholds of light sensitivity were compared with age-corrected normal values and correlated with corrected visual acuity and subjective appraisal of visual function. RESULTS: In 30 eyes, fundus perimetry lasted for 10.5+/-2.7 (mean+/-SD) minutes with 322+/-67 stimulus presentations for each eye. Whereas eight eyes remained stable (< +/-1 dB change), 15 improved concerning mean deviation (MD) (3.1+/-1.7 dB) after focal laser treatment. Stability of fixation remained the same after focal laser treatment (0.75+/-0.57 degree). Laser scars showed marked loss of function (MD > 13 dB). CONCLUSIONS: Although light sensitivity was reduced in areas of macular edema, there was no correlation between the amount of edema and visual function. Fundus perimetry allows the creation of exact maps of retinal dysfunction before and after laser treatment. It may help in making management decisions in diabetic and nondiabetic patients by offering a sensitive parameter in addition to visual acuity.

Adult↗
PubMed2002

Patient selection for macular translocation surgery using the scanning laser ophthalmoscope.

OBJECTIVES: To evaluate the use of the scanning laser ophthalmoscope (SLO) as a predictor for potential visual improvement in eyes with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) undergoing limited macular translocation. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Consecutive series of 71 eyes of 70 patients with subfoveal CNV secondary to AMD that underwent effective and uncomplicated limited macular translocation at the Wilmer Ophthalmological Institute. METHODS: Evaluation of the fundus microperimetry and fixation pattern was conducted on all patients using the Rodenstock scanning laser ophthalmoscope (G. Rodenstock Instrument GmbH, Munich, Germany) within 72 hours before surgery. MAIN OUTCOME MEASURES: Sensitivity and specificity in addition to positive and negative predictive values of SLO findings for visual outcome after macular translocation. RESULTS: Stable fixation presented the highest positive predictive value for visual acuity equal to or better than 20/100 (30 of 33 = 0.91), and predominantly eccentric fixation had the highest negative predictive value for visual acuity worse than 20/100 (7 of 9 = 0.78). Sensitivity was higher for the presence of predominantly central fixation (42 of 48 = 0.87), and specificity was higher for relatively unstable/unstable fixation (20 of 23 = 0.87). CONCLUSIONS: Eyes with stable and central fixation (without dense central scotoma) good preoperative visual acuity, and short length of symptoms are those with the greatest chance to achieve good vision after macular translocation. The knowledge of the fixation and microperimetry pattern enables better understanding of the macular function in eyes with AMD and may be useful for evaluation of baseline retinal cell viability. Incorporation of these testing modalities may help to optimize patient selection for macular translocation or other future techniques aimed at rescuing photoreceptors.

Aged↗
PubMed1995

Reproducibility of topographic measurements of the macula with a scanning laser ophthalmoscope.

BACKGROUND: The Heidelberg retina tomograph, a scanning laser ophthalmoscope that uses confocal optics to provide high resolution of images, is able to scan the retina in three dimensions to obtain quantitative topographic measurements. The authors evaluated its usefulness for measuring macular lesions by determining the reproducibility of its topographic measurements at the macula. METHODS: For each of ten healthy patients, the authors took five images with the patient's right eye undilated and five with the eye cyclopleged and dilated. As a measure of reproducibility, the standard deviation of height measurements for the same location at the macula was calculated for each patient and then the pooled standard deviation for all patients was calculated. The authors performed similar calculations for the mean depth within a contour line. RESULTS: The pooled standard deviation for height measurements was 47.4 microns in undilated eyes and 36.0 microns in cyclopleged, dilated eyes. The authors obtained an extremely low standard deviation of 2.2 microns when the software calculated relative differences between measurements, such as the mean depth within a contour line. When the average of three height measurement values on 1 day was compared with the average of the three values on another day, the 95% confidence interval was +/- 58.7 microns for mean height values and +/- 3.7 microns for mean depth values within a contour line. CONCLUSIONS: The authors obtained good reproducibility for height measurements with the Heidelberg retina tomograph and excellent reproducibility when the instrument calculated relative differences in height measurements. The authors recommend that patients, especially young patients, be dilated and cyclopleged to obtain lower variability of measurements. The scanning laser ophthalmoscope could potentially be used to quantify small changes in retinal lesions.

Adult↗
PubMed1996

Correlation between scanning laser ophthalmoscope microperimetry and anatomic abnormalities in patients with subfoveal neovascularization.

PURPOSE: The purpose of the study is to identify the anatomic abnormalities associated with an absolute scotoma and the location and stability of fixation in patients with subfoveal neovascularization in age-related macular degeneration, presumed ocular histoplasmosis syndrome, and other disorders. METHODS: Scanning laser ophthalmoscope microperimetry was superimposed on color fundus photographs and fluorescein angiograms of 21 eyes with subfoveal neovascular membranes secondary to age-related macular degeneration (14 eyes) and presumed ocular histoplasmosis syndrome (7 eyes). The authors determined the location and the area occupied by the absolute scotoma and each of the following subretinal lesions: subretinal hemorrhage, neurosensory retinal detachment, retinal pigment epithelial (RPE) atrophy, RPE hyperplasia, atrophy of the choriocapillaris, hard exudates, and the subfoveal neovascular membrane. The area of absolute scotoma determined by scanning laser ophthalmoscope microperimetry was superimposed on the anatomic lesions. The authors calculated the relative risk ratio (RR) of an absolute scotoma occurring in regions corresponding to each anatomic abnormality, and determined the preferred location and stability of fixation in each eye. RESULTS: An absolute scotoma was present in areas of chorioretinal scar (RR = 107.61), RPE atrophy (RR = 9.97), subretinal hemorrhage (RR = 2.88), and the neovascular membrane (RR = 1.86). Fixation was stable in all patients with presumed ocular histoplasmosis syndrome but only 29% of patients with age-related macular degeneration. Fifty-five percent of patients with stable fixation fixated over an area of RPE hyperplasia. CONCLUSION: The relative risk of an absolute scotoma is highest over areas of chorioretinal scars, RPE atrophy, subretinal hemorrhage, and the neovascular membrane. Fixation is more stable in patients with subfoveal neovascularization from presumed ocular histoplasmosis syndrome than with age-related macular degeneration and frequently is present over an area of RPE hyperplasia.

Adult↗
PubMed1982

Office nail fold capillary microscopy using ophthalmoscope.

A method for performing capillary microscopy using an ophthalmoscope is described. Using this technic, we examined 130 patients with various connective tissue diseases. As in prior studies, four patterns could be discerned; scleroderma (SD) pattern, lupus erythematosus (LE) pattern, normal pattern, and a nonspecific pattern. Of the patients with systemic SD, 70% had SD pattern. Of LE patients, 53% had LE pattern. There was little crossover. It is hoped that the use of the ophthalmoscope will result in the widespread use of capillary microscopy.

Capillaries↗
PubMed1990

[The TV head ophthalmoscope for videodocumentation of fundus changes].

The present paper describes the TV head ophthalmoscope, a logical further development in indirect ophthalmoscopy. It comprises a modern indirect binocular head ophthalmoscope and a micro-CCD color camera. The instrument enables all structures on the fundus to be observed as far as the periphery. Objects seen dynamically include detached retina and vitreous membranes. Practical fields of application are retinal detachment surgery and for demonstration and training in indirect ophthalmoscopy.

Humans↗
PubMed1986

[Prototype of an ophthalmoscope for studying an upright image with light amplification].

The instrument described here is the prototype of a direct ophthalmoscope with amplification of available light. The beam path has already been published and patented under reference number 3124305. It does not require drug-induced mydriasis, reduces light toxicity of the retina, and facilitates examination of pre-eclamptic and other patients who are sensitive to light. With this ophthalmoscope it may be possible to demonstrate the autofluorescence of the hyalocytes, described by Cremer-Bartels and Balacz.

Fluorescence↗
PubMed1982

[A new indirect binocular spectacle ophthalmoscope].

A new indirect spectacle ophthalmoscope is described. Its main features are a fixed interpupillary distance (59, 62, 65, 68 mm.), a variable viewing beam stereoangle, a precentered halogen lighting beam with Maxwellian view and an iris diaphragm to limit the viewing area, which has never been a feature of a binocular ophthalmoscope before. These features, on a lightweight spectacle frame, make indirect binocular ophthalmoscopy an easy-to-master method even for examining patients with small pupils and hazy media.

Humans↗
PubMed2001

Ophthalmoscopic contact lenses for transpupillary thermotherapy.

Ophthalmoscopic contact lenses for transpupillary thermotherapy (TTT) must provide effective visualization of retinal treatment sites and transmission of infrared diode laser radiation. Selection and proper use of retinal laser lenses requires knowledge of their lateral magnification, laser beam magnification factor, field of view and resolution. Optical performance is analyzed for Goldmann-type lenses and a series of inverted image lenses of differing magnification. Goldmann lenses have the highest resolution, but inverted image lenses of comparable magnification have 2.5 times or more their field of view. Inverted image lenses of similar magnification can differ in resolution. They require 2-4% more incident laser power to produce the same retinal irradiance as a Goldmann lens, but this difference is small in comparison to other clinical variables. Tilting an ophthalmoscopic contact lens up to 15 degrees causes little distortion in the circularity of the retinal spot formed by a laser beam or difference in retinal irradiance across the spot. Inverted image lenses produce higher anterior segment irradiances than Goldmann-type lenses, but anterior segment injuries are less likely in TTT than conventional visible light, short-pulse retinal photocoagulation because of the comparatively low irradiances used in TTT and the decreased absorption of diode laser infrared radiation in ocular media and melanin.

Contact Lenses↗
PubMed1986

Safety aspects of laser scanning ophthalmoscopes.

Safety standards such as American National Standards Institute Z-136.1 do not give clear light-level limitations for laser scanning ophthalmoscopes. To have more than a rough estimation the retinal temperature rise due to intraocular scanning laser illumination was calculated on the basis of a thermal model. The predicted temperature development with time was compared with the calculated effect of other retinal illumination patterns with well-known hazard risks. The similarity of the thermal effect of retinal scanning and extended-source pulsed illumination is discussed and used to give maximum permissible light-level recommendations for the safe use of laser scanning ophthalmoscopes.

Body Temperature↗