Updates on ophthalmic imaging features of optic disc drusen, papilledema, and optic disc edema.

PURPOSE OF REVIEW: Optic nerve head elevation can be associated with vision loss. This review provides an update regarding key features of optic disc drusen (ODD) compared with papilledema from increased intracranial pressure and optic disc edema from other causes. RECENT FINDINGS: Clinical history and funduscopic examination are not sufficient to correctly diagnose different causes of optic nerve head elevation. Multimodal ophthalmic imaging is noninvasive and should be used as first-line diagnostic testing to distinguish optic disc edema or papilledema from pseudoedema. Advanced ophthalmic imaging, including enhanced depth imaging optical coherence tomography (EDI-OCT) and autofluorescence imaging, can visualize ODD at high resolution and determine whether there is optic disc edema. OCT angiography does not require contrast and can rapidly visualize papillary, peripapillary, and macular microvasculature and identify important vascular biomarker of ischemia and, potentially, visual prognosis. SUMMARY: Multimodal ophthalmic imaging can help in the diagnosis of ODD and optic disc edema and identify patients at high risk of vision loss and neurological issues in order to ensure appropriate diagnosis and treatment.

[The value of autofluorescence imaging in diagnosis of retinal diseases].

Results of fundus autofluorescence imaging using confocal scanning laser ophthalmoscope HRA II ("Heidelberg Engeneering", Heidelberg, Germany) are presented. 106 patients with various retinal and optic nerve conditions were examined. The following conditions were diagnosed using autofluorescence imaging: early stage of age-related macular degeneration, macular hard and soft drusen, signs of retinitis pigmentosa, senile macular hole, central serous chorioretinopathy and optic disc drusen.

Scanning laser polarimetry - a review.

Glaucoma is a leading cause of irreversible blindness worldwide. Retinal ganglion cells and their axons represent the selective target of the disease. When visual function is still intact on standard automated perimetry and optic disc appearance is suspicious, an early diagnosis may be supported by the identification of a retinal nerve fibre layer (RNFL) defect in the peripapillary area. At present days, computer-based, real-time imaging of the peripapillary RNFL is available through instruments of easy use and with high levels of accuracy and reproducibility. Scanning laser polarimetry is performed by a confocal scanning laser ophthalmoscope with an integrated polarimeter (GDx-VCC). There is a considerable amount of scientific evidence about the role of this imaging technique for glaucoma diagnosis. The aim of this review is to describe the principles of operation, the examination procedure, the clinical role, the results of main diagnostic studies and the future development of the software for the scanning laser polarimetry.

[Ophthalmoscopy in the era of optical coherence tomography]. / Ophthalmoskopie im Zeitalter der optischen Kohärenztomographie.

For more than one and a half centuries ophthalmoscopy has been the main diagnostic procedure in ophthalmology for diagnosing retinal diseases. The techniques have improved over the years and ophthalmoscopy is still the gold standard for all retinal diseases, especially for peripheral retinal diseases. The introduction of optical coherence tomography (OCT) has revolutionized ocular diagnostics of macular diseases as OCT is able to detect retinal changes that cannot be diagnosed as well with ophthalmoscopy alone. Nevertheless, diagnosis of a retinal disease should not be made on the basis of OCT findings alone but always in combination with ophthalmoscopy. If necessary further diagnostic procedures should be added to improve the accuracy of diagnosis, to follow the course of the disease and to control the success of treatment.

The scanning laser ophthalmoscope--a review of its role in bioscience and medicine.

The scanning laser ophthalmoscope (SLO) offers the potential for retinal imaging that is complementary both to that of the fundus camera and also the newly developing technique of optical coherence tomography (OCT). It has the ability to produce rapid images at low light levels using light of specific wavelengths. This permits temporal studies of fluorescent-labelled cells which offer a unique insight into inflammatory processes in the eye. The facility to image with several different wavelengths simultaneously offers the potential for spectral imaging of retinal tissue with the aim of revealing those early changes in tissue perfusion that indicate the onset of retinal disease, so increasing the probability of successful therapy.

Evaluation of corneal topography: past, present and future trends.

The keratometer and photokeratoscope have long been the standard instruments for measuring corneal curvature. The recent development of computer-assisted photokeratoscopy has greatly enhanced the evaluation of corneal topography, helping improve our understanding of both normal and abnormal topography and their influence on visual acuity. The authors review normal corneal topography and compare various tools, both new and old, currently available for evaluating corneal contour. Case studies are presented to illustrate some of the clinical and research applications of computer-assisted photokeratoscopy in an ophthalmology practice. Future applications of computer-assisted photokeratoscopy include intraoperative topography, the design of custom-fitted contact lenses and combination with ray-tracing analysis.

Clinical trial of fundoscopy under general anesthesia for pediatric outpatients with retinoblastoma.

Retinoblastoma brings suffering, particularly to children. Formerly management during fundoscopy for children in Japan saw children's movements restricted with a blanket held by their parents or by nurses. This situation was sad, and the performance of the fundoscopy was limited because the children were crying and moving during the examination. After we received letters from the families of such children, we decided to introduce day-care general anesthesia for fundoscopy. After we investigated the current status of the treatment of retinoblastoma in leading countries, we carried out a trial of day-care general anesthesia for fundoscopy in 70 pediatric patients with retinoblastoma. We have now finished this first trial of day-care anesthesia, and we expect that discharge from hospital to places a longer distance away will be feasible.

Three-dimensional confocal microscopy of the living human eye.

Three-dimensional confocal microscopy of the living eye is a major development in instrumentation for biomicroscopy of the eye. This noninvasive optical technology has its roots in the application of optics to reflected light imaging of the eye. These instrument developments began with Leeuwenhoek's use of his single lens microscope to investigate the structure of the eye. There followed a series of connected instruments: the ophthalmoscope, the slit lamp, the specular microscope, and the clinical confocal microscope. In vivo confocal microscopy produces high contrast, reflected light images or optical sections through the depth of living ocular tissue. Stacks of registered optical sections can be transformed by computer visualization techniques into three-dimensional volume images of ocular tissues: cornea, ocular lens, retina, and optic nerve. The clinical confocal microscope has resulted in new diagnostic techniques and new cellular descriptions of ocular disorders and pathology.