Spectral fundus reflectance was obtained with the Utrecht
single-spot densitometer.
18 The entrance beam had a spot
size of 2.7° on the retina. The intensity was 3.1 log td. In the
entrance beam a rotating wheel (14 revolutions per second) offered a
sequence of 12 interference filters in the range of 450 to 740 nm (half
bandwidth, 7 nm) to enable a quasisimultaneous measurement of
reflectance across the visual spectrum. Light reflected from the fovea
was detected in a retinal field of 2.4°
(Fig. 1) concentric to the entrance beam spot.
Light adaptation was attained using a yellow light (OG495
filter; Schott Glasswerke, Mainz, Germany) from a second channel of
30° with a maximum of 5.7 log td, which bleached more than 95% of
the available photopigments.
19 In the dark period, neutral
density filters were inserted lowering the intensity of the yellow
light to 2.5 log td. The subject was asked to fixate on a set of cross
hairs during the complete run. The combined intensity of the measuring
beam and the yellow light resulted in a level of 3.2 log td.
All subjects gave their informed consent, after the nature and possible
consequences of the study were explained. The research followed the
tenets of the Declaration of Helsinki, and the study was approved by
the local ethics committee. Of five healthy subjects (age, 21–30
years; mean, 24) one eye was tested. Each subject had a best corrected
Snellen visual acuity of 1.0 or better, no ophthalmologic problems, no
history of ingesting drugs, no diabetes or neurologic abnormalities,
and a negative family history of retinal degeneration. During all
tests, a maximum pupil size was ensured by dilating the pupils with 1
or 2 drops of tropicamide 1% once every hour. A bite board with a
dental compound and two forehead rests ensured proper fixation of the
subject’s head. The subjects were asked to gaze at the middle of a
cross to reduce eye movements.
Densitometer measuring sessions lasted 66 minutes. Before the run was
started, the entrance beam was aligned in the subject’s pupil plane so
that the foveal reflectance was at its highest (i.e., the peak of the
SCE). Next, subjects were adapted for 30 minutes to complete darkness.
During the runs, subjects interrupted the measurement at preset times
to relax, alleviating the strain of the long and careful fixation. A
run involved a 15-minute baseline in the dark, followed by 16 minutes
of light, and finally 35 minutes in the dark (
Fig. 2A ). The densitometer enabled the examiner to view the fundus
(during bleaching) in a 30° field while reflectance was recorded.
Thus, we monitored the quasispecular reflections of the inner limiting
membrane, because these are very sensitive to changes in pupil position
in relation to the entrance beam. If these reflections changed position
or shape during a run, the data were discarded. In our subjects these
reflections were at least 2° from the edge of the 2.4° detection
field
(Fig. 1) .
Because light seemed to trigger slow reflectance changes, variations in
adapting light intensity were explored. The intensity was regulated by
inserting neutral density filters.
The optical SCE
5 6 7 8 9 10 was measured with a custom-built
scanning laser ophthalmoscope (SLO),
13 20 in three
conditions: 1) light adapted for 12 minutes at 5.9 log td at 514 nm, 2)
after 6 minutes in the dark, and 3) after 30 minutes in the dark.
Fundus images were acquired at 514, 633, and 790 nm. Before the first
series, the entrance beam was aligned in the subject’s pupil plane so
that the foveal reflectance was at its highest, ensuring optimum
vertical positioning. Entrance and exit pupil moved jointly. The size
of the retinal detection spot was 0.43°. A series of 15 to 30 fundus
images was made by acquiring an image roughly every 0.25 mm of the
horizontal meridian, from the nasal to the temporal pupil edge. The
precise position of each image was recorded by the computer using a
digital slide ruler (accuracy, ±0.01 mm) attached to the horizontal
adjustment. Between series the subject was allowed to sit back and
relax. Because the flash (0.04 seconds) of each image bleached up to
0.5% of the available visual pigment in a completely dark-adapted
state,
19 the number of images was kept to a maximum of 15
in case of 514- or 633-nm wavelength. Because bleaching visual pigment
is not a concern at 790 nm, we acquired up to 30 images in a single
series at that wavelength. During the optical SCE measurement, fundus
images with fixation deviations of more than 2° were discarded. The
remaining images with slight eye movements were aligned to a common
reference point, usually a retinal blood vessel intersection. From each
image a mean background image was subtracted. To improve
signal-to-noise ratio, the reflectance was averaged over the central
2.5° × 2.5°
(Fig. 1) . To quantify these results we fitted the
reflectance percentage (least χ
2 method) with a model for
the optical SCE
f(
x)
8 :
\[f(x){=}A\ {\cdot}\ 10^{-\mathrm{{\rho}}(x-x_{\mathit{0}})^{2}}{+}B\]
with
A representing directionally dependent light,
B nondirectionally dependent (stray) light, ρ curve
peakedness,
x horizontal pupil position, and
x 0 the pupil position at which reflectance
is at its maximum.
Reflectance was calibrated at 1% for both instruments by measuring
reflectance of a white diffuser (a surface painted with Eastman
6080 white; Kodak, Rochester, NY) at 220 mm from the pupil
plane of each instrument, assuming a focal length of the eye of 22 mm
and Lambertian reflectance.