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Henry Feng, Sumit Sharma, Sanjay G Asrani, Sandra Stinnett, Prithvi Mruthyunjaya; En face imaging of retinal pathology using multicolor confocal scanning laser ophthalmoscopy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):391.
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© ARVO (1962-2015); The Authors (2016-present)
Multicolor confocal scanning laser ophthalmoscopy (cSLO) is a novel imaging modality that utilizes blue, green, and infrared (IR) lasers to generate a composite multicolor image. Our study correlates multispectral laser reflectance patterns with findings on SD-OCT in order to evaluate the ability of multicolor cSLO to detect sub-, intra-, and epi-retinal pathology.
Retrospective review of 159 eyes that underwent posterior pole imaging using multicolor cSLO and SD-OCT on the Heidelberg Spectralis (Heidelberg Retina Angiograph-Optical Coherence Tomography, Heidelberg Engineering, Heidelberg, Germany) in a single session. Multicolor cSLO was acquired using 820nm, 518nm, and 488nm lasers with a scan angle of 30°, laser power of 25%, and automatic real time image averaging of 25. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated for each finding on each en face cSLO image using SD-OCT as the reference standard.
Multicolor reflectance demonstrated equal or greater PPA compared to IR, green, and blue reflectance images in the detection of choroidal lesions (1.00), chorioretinal scars (0.90), peripapillary atrophy (1.00), drusen (0.77), and pigment epithelial detachment (0.77). RPE atrophy was most effectively detected on IR reflectance with a PPA of 0.92. NPA was 0.98 or greater for these subretinal and choroidal findings on all reflectance images. For intraretinal and subretinal fluid, multicolor reflectance demonstrated the highest PPA at 0.49 and 0.54, respectively, while IR reflectance demonstrated the lowest PPA at 0.08 and 0.25, respectively. Intraretinal and subretinal hemorrhage was detected most often on multicolor cSLO with NPA at 0.87 and 0.97, respectively, although PPA could not be calculated because zero cases were detected on SD-OCT (Figure 1). Epiretinal membrane was equally detected on green, blue, and multicolor reflectance with a PPA of 0.94, and least detected on IR reflectance with a PPA of 0.40 (Figure 2).
Multicolor cSLO, compared to SD-OCT, effectively visualizes sub- and epi-retinal pathology, choroidal lesions, and hemorrhages at various fundal depths. This modality may be clinically useful for detecting en face aberrations in retinal contour and may be combined with SD-OCT to improve diagnostic accuracy.
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