Role Of Adaptive Optics In Early Diagnosis Of Glaucoma From A Clinician’s Perspective

ABSTRACT

Background

Glaucoma is one of the leading causes of irreversible blindness across the world. Early detection is important to minimize the loss of visual function. The diagnostic tools, optical coherence tomography (OCT) and standard automated perimetry (SAP) form the keystones of the diagnosis and monitoring of the condition. However, the ability of these tools to diagnose early forms of glaucoma is limited. Adaptive optics (AO) is a technology that could help to overcome this limitation. AO technology can detect slightest changes occurring at the cellular level by compensating for ocular aberrations.

Methods

We searched PubMed for publications between 2002 and 2019 on adaptive optics in Ophthalmology. The key words were adaptive optics, lamina cribrosa, retinal nerve fiber layer defects, scanning laser ophthalmoscope and OCT.

Results

Out of 38 publications, 17 original articles or case series with relevance to glaucoma, and written in English were selected and reviewed.

Conclusions

The AO technology, combined with various platforms such as fundus photography, scanning laser ophthalmoscopy and OCT, has been used in glaucoma patients to study the lamina cribrosa, retinal nerve fiber layer (RNFL), retinal photoreceptors as well as ocular circulation in minute detail. Imaging the subtle changes in morphology and reflectivity of RNFL at the preclinical stage may lead to early detection of glaucoma. Longitudinal monitoring of RNFL alterations in glaucoma patients is possible. At present, the technology is expensive with limited availability, and has several limitations.

KEYWORDS:

• Adaptive optics
• lamina cribrosa
• optical coherence tomography
• retinal nerve fibre layer defects
• scanning laser ophthalmoscope

Acknowledgments

We thank Ashutosh Richhariya and Sanjay Kumar from our engineering group at Dr. Kallam Anji Reddy campus, L V Prasad Eye Institute, Hyderabad, India, for building the AOSLO system as well as contributing to the scientific content. We acknowledge the support of David Williams and the Advance Retinal Imaging Alliance (ARIA), Center for Visual Science, Flaum Eye Institute, University of Rochester in building the AOSLO system.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Hyderabad, India