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Posterior Segment Age-related Macular Degeneration Scanning Laser Ophthalmoscope in the Management of Age-related Macular Degeneration N i c o l e K S c r i p s e m a , B S 1,2 a n d R i c h a r d B R o s e n , M D 3,4 1. Retinal Photographer, The Retina Center, Department of Ophthalmology, New York Eye & Ear Infirmary, New York, US; 2. Medical Student, Department of Ophthalmology, New York Medical College, New York, US; 3. Vice Chairman, Suregon Director, Chief of Retinal Service and Director of Research, The Retina Center, Department of Ophthalmology, New York Eye & Ear Infirmary, New York, US; 4. Professor of Ophthalmology, Department of Ophthalmology, New York Medical College, New York, US Abstract Recent advances in retinal imaging have improved the evaluation and prognostication of age-related macular degeneration. The development and modification of the scanning laser ophthalmoscope (SLO) has played a pivotal role in our understanding of the disease. SLO has led to improved methods of visualizing characteristics of the disease, such as drusen and alterations in autofluorescence, and also provided a platform for the quantification of structural and functional changes occurring as a result of the disease process. This article provides a review of the current literature on the impact and clinical utility of SLO devices for infrared viewing, fundus autofluorescence, microperimetry, and as integraded multimodal imaging systems such as optical coherence tomography and SLO. Keywords Age-related macular degeneration, scanning laser ophthalmoscope, autofluorescence, spectral-domain optical coherence tomography, microperimetry Disclosure: NK Scripsema declares no competing interests. RB Rosen is a member of the Scientific Advisory Board of OPKO/OTI (Miami, Florida). Support was received from the Bendheim-Lowenstein Retinal Fund. Received: September 5, 2011 Accepted: January 3, 2012 Citation: US Ophthalmic Review, 2012;5(2):111–8 Correspondence: Richard B Rosen, MD, The Retina Center, Department of Ophthalmology, New York Eye and Ear Infirmary, 310 East 14th St, New York, NY 10003, US. E: rrosen@nyee.edu Age-related macular degeneration (AMD) is the most common cause of irreversible central vision loss and legal blindness in developed countries. 1–3 AMD represents a chronic disease with various phenotypic manifestations, disease stages, and rates of progression over time. Severe vision loss results from choroidal neovascularization (CNV), pigment epithelial detachment, or geographic atrophy (GA) of the retinal pigment epithelium (RPE). 4 While CNV is the most common cause of vision loss, GA is responsible for approximately 20 % of severe visual impairment in AMD. 5–8 The chronic nature of the disease, limited treatment options, and the aging population are all factors suggesting that the prevalence of AMD will increase with time unless effective interventions are developed. Retinal imaging plays a critical role in the detection and management of disease because it can reveal lesions difficult to visualize by funduscopic examination. Color fundus photography is the standard imaging modality used for assessment and documentation of AMD. Fluorescein angiography provides additional functional information on vascular involvement, which is important in the detection of CNV and other complications of advanced disease that involve disturbance of the blood–retinal barrier. The scanning laser ophthalmoscope (SLO) adds the ability to test and image the retina in a point-by-point fashion, which enhances the evaluation of © TOUCH BRIEFINGS 2012 structural and functional changes in the disease process of exudative and non-exudative AMD. The SLO was originally developed by Pomeranzeff and Webb to provide high-contrast images of the retina at illumination levels 1/1,000 of those required for indirect ophthalmoscopy. 9 The SLO scans a low energy laser beam (or other coherent illumination source such as the superluminescent diode) across the fundus and reconstructs images from reflected light, creating images with a higher level of contrast compared with fundus photography. 10,11 The technology of the sweeping illumination source provides a platform from which additional testing such as fluorescein angiography, manual and automated perimetry, and reflectometry of cone pigment densities can be accomplished. 10,12–15 Additional modifications of the device lead to the confocal SLO (cSLO), which uses light from a single plane for image reconstruction. By rejecting the returning scattered light, the cSLO provides improved contrast and complete retinal images (40°) without dilation of the pupil. 11,16 Pupil dilation is not necessary but it is often done in practice to obtain higher quality images. Currently there are three modalities that use the cSLO technology in the detection and management of AMD: fundus autofluorescence (FAF), optical coherence tomography (OCT)/SLO, and microperimetry 111