RESUMO
BACKGROUND AND OBJECTIVE: The authors evaluated adaptive optics scanning laser ophthalmoscopy (AO-SLO) in a simulated real-life clinical setting to identify factors that impact its reliability in this setting. PATIENTS AND METHODS: For this prospective study, macular cones were imaged in five healthy eyes using an AO-SLO prototype machine. Multilevel mixed-effect regression was used to compare the cone densities across different analysis parameters. Intergrader, intragrader, interphotographer, and intersession reliabilities were determined with intraclass correlation coefficients (ICCs). RESULTS: Cone densities in the largest measurement window size, 150 µm × 150 µm, were most consistent. Image quality strongly impacted cone analysis. Intragrader and intergrader ICCs were 0.99 and 0.98, respectively. Intersession and interphotographer reliability both had an ICC of 0.72. CONCLUSIONS: Larger measurement window sizes and higher image quality improve the reliability of cone density measurement. Although there were excellent intergrader and intragrader reliabilities, intersession and interphotographer reliabilities were not as robust. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:228-235.].