In vivo cell-scale imaging of the human retina by adaptive optics

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Diagnosis and monitoring of retinal diseases, the most important causes of blindness in developed countries, is largely based on accurate imaging of the retina. We have been using a flood imaging, commercially available AO camera (rtx1 from ImagineEye) to examine a variety of retinal diseases. Geographic atrophy can be detected at a very early stage under the form of patches of depigmented RPE filled with numerous clumps of melanin. Time-lapse imaging show the progression of atrophy at a very small spatial and temporal scale, as well as the motion of melanin clumps within and outside atrophic areas. Diabetic microaneurysms can be distinguished from hemorrages. Epiretinal membranes can be observed under the form of small star-like hyperreflective spots. Finally, parietal remodelling of small arteries following arterial hypertension can be detected, which may provide a novel quantitative biomarker. To sum up, while AO imaging was originally used for photoreceptor imaging, its scope is now extending. AO fundus imaging will probably establish itself as a reference methodology for early detection and monitoring of a variety of retinal diseases.

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