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Robert W Knighton

Publications and source records attributed to Robert W Knighton.

18 recordsLinked to original sources

Quantifying retinal nerve fiber layer thickness in whole-mounted retina.

In order to relate optical measurement of the retinal nerve fiber layer (RNFL) to the underlying structure, one must have accurate values for RNFL thickness at the locations measured optically. The purpose of this study was to develop a method for measuring RNFL thickness at any location on retinal tissue previously studied by other optical imaging. The method developed used confocal laser scanning microscopy (cLSM) to provide both en face and cross-sectional images of a whole-mounted retina. Isolated rat retina was fixed with 3% glutaraldehyde. Nerve fiber bundles were identified by using phalloidin to label F-actin and ganglion cell bodies were identified by DAPI fluorescent counterstain of nuclei. The flat-mounted retina was examined by cLSM. 2-D images were collected through the retina to a depth at least covering the ganglion cell layer. The images were stacked to reconstruct cross-sectional images of the measured retina. Thickness of nerve fiber bundles was measured on these synthesized cross sections and compared with the measurement from conventional histologic sections. The en face image displayed individual nerve fiber bundles and ganglion cells between bundles as different colors. Blood vessels, which also bound phalloidin, were easily distinguished from nerve fiber bundles. The en face image displayed the same pattern of nerve fiber bundles as seen in imaging measurements and simplified the identification of corresponding areas in the two modalities. The cross-sectional images provided thickness measurements of the RNFL over the entire field-of-view, not just at the points represented by the conventional histologic section, resulting in a large increase in available data.

Actins↗

Microtubule contribution to the reflectance of the retinal nerve fiber layer.

PURPOSE: The reflectance of the retinal nerve fiber layer (RNFL) arises from light scattering by cylindrical structures oriented parallel to ganglion cell axons. In amphibian retinas, at 440 nm, microtubules (MTs) contribute about one half of RNFL reflectance. In rodent retinas, MTs are the only structure contributing to RNFL birefringence. To increase understanding of the anatomic basis for clinical RNFL measurements, this study was conducted to evaluate the MT contribution to RNFL reflectance in rodent retinas by using the MT depolymerizing agent colchicine. METHODS: Reflectance of nerve fiber bundles in isolated rat retinas was measured at 460, 580, and 830 nm with a multispectral imaging reflectometer. Images were taken frequently over an extended period. During baseline, the tissue was perfused with a physiological solution. During a treatment period, the solution was switched either to a control solution or to a solution containing colchicine. RESULTS: Because of the high reflectance of the RNFL, nerve fiber bundles appeared as bright stripes against a darker retina. The reflectance of bundles was relatively stable in control experiments. With colchicine treatment, however, bundle reflectance at first decreased rapidly and then became stable. After 70 minutes of colchicine treatment, RNFL reflectance had declined to approximately 50% below baseline at all wavelengths. CONCLUSIONS: MTs contribute to RNFL reflectance at all wavelengths. Unlike RNFL birefringence, however, which totally disappears after colchicine treatment, about one half of RNFL reflectance remained after colchicine treatment. This result suggests that, in addition to MTs, other mechanisms may contribute to RNFL reflectance.

Animals↗

Macular symmetry testing for glaucoma detection.

PURPOSE: To evaluate structural asymmetry in the macula using optical coherence tomography (OCT) in glaucomatous eyes with visual field defects localized to one hemifield. METHODS: Complete examination, standard automated perimetry (SAP), and OCT imaging (512 A-scans) of the peripapillary retina and macula were performed. Exclusion criteria were visual acuity <20/40, diseases other than glaucoma, and SAP defects localized to both hemifields. Macular OCT images were obtained using four 5-mm radial scans centered on the foveola and passing obliquely through the macula (15 degrees superotemporally and inferotemporally). Macular measurements temporal to the fovea (T) were sub-divided into nasal (T1) and temporal (T2) segments. Macular symmetry testing (MST) was performed in T, T1, and T2 segments by comparing the mean macular thickness of the perimetrically abnormal and perimetrically normal hemi-zones (macular thickness in perimetrically normal hemi-zone/macular thickness in perimetrically abnormal hemi-zone x 100), and superior and inferior hemi-zones in normal subjects (macular thickness in superior hemi-zone/macular thickness in inferior hemi-zone x 100). MST measurements were considered to be abnormal if they exceeded the 95% limits of normal variability. RESULTS: Forty eyes of 40 patients (20 normal, 20 glaucoma) were enrolled (mean age 60 +/- 19 years, range 21-89). All eyes with glaucoma had associated hemifield defect (average MD = -7.23 +/- 4.8 dB, range -0.9 to -15.4). In glaucomatous eyes, mean retinal thickness in T, T1, and T2 within the perimetrically abnormal hemi-zone (222 +/- 14 microm, 224+/- 17 microm, 221 +/-13 microm, respectively) was significantly less (P = 0.002, 0.008, 0.001, respectively) than the corresponding segments in the perimetrically normal hemi-zone (235 +/- 17 microm, 237 +/- 18 microm, 233 +/- 17 microm, respectively). Normal eyes showed no difference (P = 0.17, 0.20, 0.35) in T, T1, and T2 measurements within the superior hemi-zone (254 +/- 11, 249 +/- 14, 258 +/- 14) and inferior hemi-zone (252 +/- 11, 250 +/- 13, 255 +/- 13), respectively. MST values in glaucomatous eyes were outside 95% limits of normal variability in 17/20 (85%) T segments, 16 /20 (80%) T1 segments, and 16/20 (80%) T2 segments. CONCLUSION: Localized macular thickness changes exist in glaucomatous eyes with regional visual field loss. The MST may represent a novel strategy for glaucoma diagnosis.

Adult↗

Reproducibility of retinal nerve fiber thickness measurements using the stratus OCT in normal and glaucomatous eyes.

PURPOSE: To determine the reproducibility of Stratus Optical Coherence Tomography (OCT) retinal nerve fiber layer (RNFL) measurements around the optic nerve in normal and glaucomatous eyes. METHODS: One eye was chosen at random from 88 normal subjects and 59 glaucomatous subjects distributed among mild, moderate, and severe glaucoma, determined by visual field testing. Subjects underwent six RNFL thickness measurements performed by a single operator over a 30-minute period with a brief rest between sessions. Three scans were taken with the high-density Standard RNFL protocol, and three were taken with the Fast RNFL protocol, alternating between scan protocols. RESULTS: Reliability, as measured by intraclass correlation coefficient (ICC), was calculated for the overall mean RNFL thickness and for each quadrant. The ICC for the mean Standard RNFL thickness (and lower 95% confidence interval [CI]) in normal and glaucomatous eyes was 0.97 (0.96 CI) and 0.98 (0.97 CI), respectively. The ICC for the mean Fast RNFL thickness in normal and glaucomatous eyes was 0.95 (0.93 CI) and 0.97 (0.95 CI), respectively. Quadrant ICCs ranged between 0.79 and 0.97, with the nasal quadrant being the least reproducible of all four quadrants, using either the Standard or Fast RNFL program. The test-retest variability ranged from 3.5 microm for the average RNFL thickness measurements in normal eyes to 13.8 microm for the nasal quadrant measurements in glaucomatous eyes, which appeared to be the most variable. CONCLUSIONS: Reproducibility of RNFL measurements using the Stratus OCT is excellent in normal and glaucomatous eyes. The nasal quadrant appears to be the most variable measurement. Standard RNFL and Fast RNFL scans are equally reproducible and yield comparable measurements. These findings have implications for the diagnosis of glaucoma and glaucomatous progression.

Adult↗

Microtubules contribute to the birefringence of the retinal nerve fiber layer.

PURPOSE: The retinal nerve fiber layer (RNFL) exhibits birefringence that is due to the oriented cylindrical structure of the ganglion cell axons. Possible birefringent structures include axonal membranes, microtubules (MTs), and neurofilaments. MTs are generally assumed to be a major contributor, but this has not been demonstrated. In this study, the MT depolymerizing agent colchicine was used to evaluate the contribution of MTs to RNFL birefringence. METHODS: Retinal nerve fiber bundles of isolated rat retina were observed through an imaging polarimeter set near extinction. Images were taken over an extended period. During baseline, the tissue was perfused with a physiological solution. During a treatment period, the solution was switched either to a control solution identical with the baseline solution or to a similar solution containing colchicine. The contrast of nerve fiber bundles was used to follow change of RNFL birefringence over time. RESULTS: When imaged by the polarimeter, birefringent retinal nerve fiber bundles appeared as either bright or dark stripes. Bundles displayed as bright stripes were used to follow changes in retardance. The contrast of nerve fiber bundles was stable in control experiments. However, in treatment experiments, bundles were bright during the baseline period, but the contrast of bundles decreased rapidly when the colchicine solution was applied; bundles were barely visible after 30 minutes of treatment. After 70 minutes, the bundle contrast was close to zero at all wavelengths studied (440-780 nm). CONCLUSIONS: MTs make a significant contribution to RNFL birefringence. The decrease of RNFL birefringence in glaucoma may indicate a loss of MTs.

Animals↗

Variation of peripapillary retinal nerve fiber layer birefringence in normal human subjects.

PURPOSE: The retinal nerve fiber layer (RNFL) exhibits linear birefringence due to the oriented cylindrical structure of ganglion cell axons. The birefringence (Deltan) depends on the density and composition of axonal organelles. The purpose of this study was to evaluate the distribution of birefringence around the optic nerve head (ONH) in normal subjects. METHODS: Birefringence was calculated along circular scan paths around the ONH as Deltan = R/T, where R is RNFL retardance measured by scanning laser polarimetry (SLP) and T is RNFL thickness measured by optical coherence tomography (OCT). OCT scans on a 3.4 mm diameter circle were obtained from 26 normal subjects aged 18 to 53 years. Scans on circles with various diameters were obtained from 17 of these subjects. RESULTS: The average reproducibility of Deltan measured on three separate days in four subjects was +/- 0.05 nm/microm. In most subjects Deltan varied significantly along a circular path around the ONH, with maxima in superior and inferior bundles, minima temporally and nasally, and a mean of 0.32 +/- 0.03 nm/microm. Deltan profiles on circles of different diameter were similar, suggesting that Deltan did not vary along nerve fiber bundles. CONCLUSIONS: RNFL birefringence varies with position around the ONH. This variation may result from known structural differences among nerve fiber bundles that serve different retinal regions. Constant Deltan along bundles is consistent with this hypothesis. Measurements of RNFL birefringence may provide a means to detect early subcellular changes in glaucoma.

Adult↗

Theoretical model of the polarization properties of the retinal nerve fiber layer in reflection.

In several optical technologies for glaucoma diagnosis, polarized light is used to assess the retinal nerve fiber layer (RNFL) of the eye. For better understanding of the polarization properties of the RNFL, it was modeled as a thick birefringent slab containing parallel light-scattering cylinders, and the Mueller matrix for reflectance was derived. The model predicts that (1) the RNFL reflectance has weak intrinsic diattenuation; (2) the diattenuation spectrum depends strongly on the relative refractive indices of the cylinders; (3) both scattering and birefringence contribute to retardation; and (4) the RNFL reflectance generally preserves polarization, but depolarization may be detectable for thick RNFL at short wavelengths.

Animals↗

Diattenuation and polarization preservation of retinal nerve fiber layer reflectance.

The diattenuation spectrum of the retinal nerve fiber layer (RNFL) reflectance has been predicted to depend strongly on the relative refractive index (m) of light-scattering cylinders. To constrain the values of m, diattenuation of the RNFL reflectance of isolated rat retina was measured with a multispectral imaging micropolarimeter. The RNFL reflection has very weak intrinsic diattenuation at all wavelengths (400-830 nm), which rejects all values of m > or = 1.03. Degree of polarization (DOP) for reflection from the RNFL was also measured. DOP was close to unity at all wavelengths, which indicates that the RNFL is a polarization-preserving reflector.

Animals↗

Macular thickness changes in glaucomatous optic neuropathy detected using optical coherence tomography.

OBJECTIVE: To correlate macular thickness and retinal nerve fiber layer (RNFL) thickness in normal and glaucomatous eyes using optical coherence tomography. METHODS: Complete examination, automated achromatic perimetry, and optical coherence tomography of the peripapillary RNFL and macula were performed. Exclusion criteria were visual acuity of less than 20/40, diseases other than glaucoma, and unreliable automated achromatic perimetry. Macular thickness measurements were generated using 6 radial optical coherence tomographic scans (5.9 mm) centered on the fovea, and mean and quadrantic macular thickness values were calculated. RESULTS: Fifty-nine eyes of 59 patients (29 normal and 30 glaucomatous) were enrolled (mean +/- SD age, 56.7 +/- 20.3 years; range, 20-91 years). All eyes with glaucoma had associated visual field loss (mean +/- SD mean defect, -8.4 +/- 5.8 dB). Mean macular thickness was significantly associated with visual field mean defect (R2 = 0.47; P<.001), pattern standard deviation (R2 = 0.32; P<.001), and mean RNFL thickness (R2 = 0.38; P<.001). In glaucomatous eyes with visual field loss localized to 1 hemifield (n = 11), mean +/- SD macular thickness in the quadrant associated with the field defect (277 +/- 28 micro m) was significantly less (P =.005) than in the unaffected quadrant (286 +/- 27 micro m). Mean RNFL thickness in the affected quadrant (89 +/- 53 micro m) was significantly thinner (P =.009) than in the unaffected quadrant (121 +/- 39 micro m). MAIN OUTCOME MEASURES: Mean total and quadrantic macular and RNFL thickness measurements. CONCLUSIONS: Macular thickness changes are well correlated with changes in visual function and RNFL structure in glaucoma and may be a surrogate indicator of retinal ganglion cell loss.

Adult↗

Scanning laser polarimetry with variable corneal compensation and optical coherence tomography in normal and glaucomatous eyes.

PURPOSE: To evaluate the relationship between visual function and retinal nerve fiber layer (RNFL) measurements obtained with scanning laser polarimetry with variable corneal compensation (SLP-VCC) and optical coherence tomography (OCT). DESIGN: Cross-sectional analysis of normal and glaucomatous eyes in a tertiary care academic referral practice. METHODS: A commercial GDx nerve fiber analyzer was modified to enable the measurement of corneal polarization axis and magnitude so that compensation for corneal birefringence was eye specific. Complete examination, SLP with fixed corneal compensation (FCC) and variable corneal compensation (VCC), optical coherence tomography (OCT) imaging of the peripapillary RNFL, and automated achromatic perimetry were performed in all subjects. Exclusion criteria were visual acuity less than 20/40, diseases other than glaucoma, and unreliable perimetry. RESULTS: Fifty-nine patients (59 eyes; 29 normal, 30 glaucomatous) were enrolled (mean age, 56.7 +/- 20.3 years, range, 20-91). All eyes with glaucoma had associated visual field loss (average mean defect, -8.4 +/- 5.8 dB). Using SLP-FCC, nine of 12 retardation parameters (75%) were significantly less in glaucomatous eyes. Using SLP-VCC, 11of 12 retardation parameters (92%) were significantly less in glaucomatous eyes. Multiple regression models constructed for each retardation parameter with visual field demonstrated that the following VCC parameters were statistically significant whereas FCC parameters were not: ellipse average (FCC, P =.28, VCC, P =.001), superior average (FCC, P =.38, VCC, P <.001), inferior average (FCC, P =.10, VCC, P =.008), average thickness (FCC, P =.30, VCC, P =.031), and superior integral (FCC, P =.43, VCC, P =.001). Similar results were obtained for multiple regression models constructed with OCT-derived RNFL thickness: ellipse average (FCC, P =.99, VCC, P =.002), superior average (FCC, P =.90, VCC, P <.001), inferior average (FCC, P =.61, VCC, P =.007), and superior integral (FCC, P =.92, VCC, P <.001). CONCLUSIONS: Compared with fixed compensation, mean-based SLP parameters generated with SLP-VCC have greater correlation with visual function and RNFL thickness assessments obtained with OCT.

Adult↗

Optical coherence tomographic findings in acute exudative polymorphous vitelliform maculopathy.

PURPOSE: To report two cases of acute exudative polymorphous vitelliform maculopathy. DESIGN: Observational case reports. METHODS: Fluorescein angiography, optical coherence tomography, and electrophysiology were performed. RESULTS: Both patients presented with sudden onset of blurred vision and bilaterally symmetric, central, and perimacular vitelliform lesions. Perimacular lesions were faintly hyperfluorescent early in the disease, but there was no abnormal fluorescence in the macular centers. Optical coherence tomography revealed anterior displacement of the photoreceptor layer by a hypereflective subretinal layer overlying a hyporeflective space above the retinal pigment epithelium-choriocapillaris complex under all lesions and no subretinal fluid. The electrooculogram was abnormal. Near complete resolution occurred over 4 to 8 months, with no improvement in the electrooculogram. CONCLUSIONS: Transient multifocal vitelliform lesions suggest a diagnosis of acute exudative polymorphous vitelliform maculopathy. Optical coherence tomography reveals characteristic anterior displacement of the photoreceptor layer by a subretinal hypereflective deposit similar to that seen in adult-onset foveomacular vitelliform dystrophy.

Acute Disease↗

Effect of individualized compensation for anterior segment birefringence on retinal nerve fiber layer assessments as determined by scanning laser polarimetry.

PURPOSE: Scanning laser polarimetry estimates retinal nerve fiber layer (RNFL) thickness through measurement of retardation of a polarized laser light passing through the naturally birefringent RNFL and cornea. The commercial instrument, the GDx Nerve Fiber Analyzer (Laser Diagnostic Technologies, Inc., San Diego, CA), uses an anterior segment compensator of fixed magnitude and slow polarization axis to eliminate the contribution of the cornea to the total signal. Previous studies have shown up to 30% of patients are not adequately compensated by this method. The aim of this study was to determine the effect of individualized anterior segment compensation using a newly designed variable compensator on estimates of retinal nerve fiber layer thickness compared with those as determined with the fixed compensator in the commercial device. DESIGN: Comparative, observational case series. PARTICIPANTS: Twenty-eight eyes from 14 normal participants and 24 eyes from 12 patients with bilateral glaucoma. METHODS: Using information derived from a scan of the macula, a newly designed variable anterior segment compensator for the GDx was set to neutralize anterior segment birefringence. Normal participants and patients with glaucoma underwent RNFL measurements using the standard (fixed) compensator and the variable compensator. The results were compared using Hotelling's generalized means test and Bonferroni's adjustment for multiple comparisons. MAIN OUTCOME MEASURES: Standard GDx modulation and thickness parameters as determined with the fixed and variable compensators. RESULTS: All thickness values were statistically significantly lower as determined with the variable compensator, with no discernible differences in any of the modulation parameters. CONCLUSIONS: Individualized anterior segment compensation lowers the RNFL thickness values as determined by scanning laser polarimetry compared with those determined with the standard fixed compensator. This may narrow the normal range and increase the discriminating ability of scanning laser polarimetry between normal and disease. However, modulation is less affected, and the modulation parameters may thus prove more useful for distinguishing between normal and glaucoma.

Aged↗

Scanning laser polarimetry with variable corneal compensation: identification and correction for corneal birefringence in eyes with macular disease.

PURPOSE: In scanning laser polarimetry with variable corneal compensation (SLP-VCC), the macula is used as an intraocular polarimeter to calculate and neutralize corneal birefringence based on an intact Henle's layer. The purpose of this investigation was to validate this strategy in eyes with macular structural disease. METHODS: A nerve fiber analyzer was modified to enable the measurement of corneal polarization axis and magnitude so that compensation for corneal birefringence was eye specific. Normal subjects and patients with a variety of pathologic macular conditions underwent complete ocular examination, SLP-VCC, and direct measurement of the corneal polarization axis (CPA), with a slit-lamp-mounted corneal polarimeter. Macular birefringence patterns were classified as well defined, weak, or indeterminate bow ties. A new "screen" method is described that determines the anterior segment birefringence without relying on the presence of macular bow-tie patterns. RESULTS: Forty-seven eyes (20 normal, 27 with maculopathy) of 47 patients (mean age, 59.0 +/- 19.0 years; range, 24-88) were enrolled. The correlation between CPA measured with corneal polarimetry (CPA by P(IV) [fourth Purkinje image]) and SLP-VCC was less in eyes with macular disease (R(2) = 0.22, P = 0.024) compared with normal eyes (R(2) = 0.72, P < 0.0001). Eyes with macular disease had significantly (P = 0.007) more indeterminate macular bow ties (8/27; 29%) than did normal eyes (0/20). The magnitude of difference between CPA by P(IV) and CPA by SLP-VCC was significantly (P = 0.0007) greater in eyes with indeterminate bow-tie patterns than in weak and well-defined patterns. Although no relationship was observed between CPA and 12 retardation parameters obtained with SLP-VCC in normal eyes (P > 0.05), eyes with macular disease showed a significant association between CPA and average thickness (R(2) = 0.27, P = 0.005), ellipse average (R(2) = 0.24, P = 0.0085), superior average (R(2) = 0.24, P = 0.009), inferior average (R(2) = 0.28, P = 0.004), and superior integral (R(2) = 0.37, P = 0.0008), suggesting incomplete corneal compensation. Greater correlation between CPA by P(IV) and CPA derived by SLP-VCC was found by using the screen method (R(2) = 0.83, P < 0.0001) compared with the bow-tie method (R(2) = 0.22, P = 0.024) in eyes with maculopathy. CONCLUSIONS: Macular strategies for neutralization of corneal birefringence using SLP-VCC can fail if Henle's layer is disrupted by macular disease. The screen method provides a more robust measure of the anterior segment birefringence in some eyes with macular disease.

Adult↗

Correction for corneal polarization axis improves the discriminating power of scanning laser polarimetry.

PURPOSE: Corneal polarization axis (CPA) has been reported to affect retardation measurements obtained with scanning laser polarimetry (SLP). The purpose of this investigation was to prospectively determine whether correction for CPA improves the discriminating power of SLP for detection of mild-to-moderate glaucoma. DESIGN: Cross-sectional analysis of normal and glaucomatous eyes. METHODS: We constructed a noninvasive slit-lamp-mounted device incorporating two crossed linear polarizers and an optical retarder to measure the slow axis of corneal polarization. Complete ocular examination, standard automated perimetry, SLP imaging, and CPA measurements were performed on normal and glaucomatous eyes. One eye/subject was enrolled; if both eyes of a patient were eligible for the study, the right eye was selected. For each of the 13 SLP parameters, logistic regression was used to determine if including CPA in the model influenced the ability to discriminate between normal and glaucomatous eyes. RESULTS: Forty-three normal eyes (average visual field mean defect, -0.53 +/- 1.4 dB) and 33 glaucomatous eyes (average visual field mean defect, -5.93 +/- 6.5 dB) were enrolled. CPA was significantly correlated with summary retardation parameters (average thickness and integral values) in normal (r = 0.72-0.83, P <.001 for all values) and glaucomatous eyes (r = 0.43-0.62, P =.013 to <.001). Including CPA in the model improved the ability to discriminate between normal and glaucomatous eyes for five retardation parameters quantifying retinal nerve fiber layer (RNFL) thickness (range of P values: 0.045-0.001). For inferior average thickness, area under the receiver operating characteristic (ROC) curve increased significantly (P =.002) from 0.70 to 0.78 after accounting for CPA; with a sensitivity set at 80% specificity improved from 33% to 72%. Correlations between visual field corrected pattern standard deviation and average thickness, ellipse average, superior average, and inferior average significantly increased (range of P values,.018-.001) after adjustment for CPA (r = -0.35 and -0.45, -0.38 and -0.47, -0.46 and -0.57, and -0.42 and -0.49, respectively). CONCLUSIONS: Correction for CPA significantly increases the correlation between retinal nerve fiber layer structural damage and visual function and significantly improves the discriminating power of SLP for detection of mild-to-moderate glaucoma.

Adult↗

Linear birefringence of the retinal nerve fiber layer measured in vitro with a multispectral imaging micropolarimeter.

Scanning laser polarimetry (SLP) assesses the retinal nerve fiber layer (RNFL) for glaucoma diagnosis by detecting the birefringence of the peripapillary RNFL. A detailed understanding of SLP requires an accurate value for RNFL birefringence in order to relate measured retardance to RNFL thickness, but current knowledge of this value is limited. A multispectral imaging micropolarimeter of PSC'A type was used to measure the retardance in transmission of the RNFL of isolated rat retina before (living) and after (fixed) 20 min of glutaraldehyde fixation. The thickness of the nerve fiber bundles measured was then determined histologically. As previously known from reflectance measurements, in transmission the RNFL behaved as a linear retarder. The retardance of the RNFL was constant at wavelengths from 440 to 830 nm and persisted after tissue fixation. In 37 nerve fiber bundles of 8 retinas, the average RNFL birefringence was 0.23 nm/microm before and 0.19 nm/microm after fixation, with an uncertainty of 0.01 nm/microm. The wavelength independence is consistent with a mechanism of form birefringence from thin cylindrical organelles. These results allow extrapolation of previous visible wavelength measurements to the near-infrared wavelengths used by SLP and validate the use of fixed tissue for RNFL research.

Animals↗

Linear birefringence of the central human cornea.

PURPOSE: To determine the polarization properties of the central cornea at perpendicular incidence in a normal human population on the assumption that the cornea behaves as a linear retarder. METHODS: A corneal polarimeter provided a view of the fourth Purkinje image of a yellow (585 nm) light-emitting diode through crossed polarizers and a variable retarder. The Purkinje image was extinguished by adjusting the fast axis and retardance of the retarder to match the slow axis and double-pass retardance of the cornea. Both eyes of 73 normal subjects (49 women, 24 men; ages, 21-71 years) were measured. Correlations were expressed as Pearson's r. RESULTS: In most corneas the slow axis pointed nasally downward, with the peak of the axis distribution falling between 10 degrees and 20 degrees nasally downward. Double-pass corneal retardance varied widely (range, 0-250 nm); 80% of retardance values were uniformly distributed from 40 to 140 nm. Retardance was moderately correlated with axis (r approximately 0.5), such that weaker retardance was associated with axes that were more nasally downward. Corneal birefringence was well correlated between the two eyes of a subject in both axis (r = 0.77) and retardance (r = 0.75). CONCLUSIONS: The variation of corneal birefringence among individuals is substantial enough to produce large, uncontrolled differences in the polarization state of a measuring beam, differences that can introduce variability in newer technologies for ophthalmic diagnosis. The interocular similarity of corneal birefringence suggests deterministic control of corneal development.

Adult↗

Analytical model of scanning laser polarimetry for retinal nerve fiber layer assessment.

PURPOSE: To develop a quantitative understanding of scanning laser polarimetry (SLP) for retinal nerve fiber layer (RNFL) assessment in glaucoma diagnosis and management. METHODS: The Mueller calculus was used to model the polarization optics of SLP. A birefringent retinal structure (RNFL or macula) was represented as a circularly symmetric linear retarder with a radial slow axis. The birefringent cornea and a corneal compensator within the SLP instrument were represented as fixed linear retarders. The model provided images of the radial retarder that were compared with retardance images obtained by SLP of the macula in eight normal subjects. Theoretical and experimental images were quantified with circular profiles around the center of the radial retarder or macula. Experimental retardance profiles were varied by tilting the subject's head to rotate the corneal axis. The SLP model was fit to the experimental profiles by nonlinear least-squares curve fitting. RESULTS: The combined retarder formed by the cornea and corneal compensator induced bow-tie patterns in images of the radial retarder. Macular SLP images exhibited similar patterns. Retardance profiles could be characterized by three parameters: modulation, mean, and axis. The SLP model fit the experimental profiles very well (r(2) = 0.8 - 0.9). CONCLUSIONS: The SLP model provided a quantitative framework within which to interpret SLP studies. Modulation-based parameters were generally more sensitive to retinal birefringence than mean-based parameters. Corneal birefringence is an important source of variance in SLP, especially for mean-based parameters. The theory developed for this study may guide improvements in clinical SLP.

Adult↗

Normative retardation data corrected for the corneal polarization axis with scanning laser polarimetry.

BACKGROUND AND OBJECTIVE: To evaluate the distribution of retinal nerve fiber layer thickness measurements in normal eyes corrected for corneal polarization axis (CPA). METHODS: Complete ocular examination, standard automated perimetry, peripapillary and macular scanning laser polarimetry imaging, and CPA measurements were performed in normal eyes. A noninvasive device mounted on a slit lamp that incorporated two crossed linear polarizers and an optical retarder to measure the slow axis of corneal birefringence was constructed. One eye per patient was enrolled. Exclusion criteria consisted of visual acuity of less than 20/40, a refractive error exceeding +/- 5.0 diopter sphere, 2.0 diopter cylinder, or both, previous intraocular surgery, or ocular disease except cataract. According to scanning laser polarimetry, peripapillary retardation parameters within 90% normal limits were recorded as "normal," parameters outside 95% normal limits were recorded as "abnormal," and parameters between 90% and 95% limits were recorded as "borderline." RESULTS: Fifty-one eyes of 51 subjects (14 men, 37 women) were enrolled (mean age, 51 +/- 17 years). Prediction limits (+/- 2 standard deviation outside of regression line) were calculated for 14 peripapillary retardation parameters. The prediction limits of the average thickness of the retinal nerve fiber layer (microm) were reduced 35% by correction of the CPA; for ellipse average (microm), the limits were reduced 33%. Sixteen of 51 normal eyes (31%) had at least one abnormal retardation parameter, and among these 16 eyes there was a bimodal distribution of CPA values (0 degrees to 20 degrees nasally downward, 60 degrees to 80 degrees nasally downward). CONCLUSIONS: Correction for CPA reduces the variance of normal retardation measurements. Normal eyes with a CPA of 0 degrees to 20 degrees nasally downward and 60 degrees to 80 degrees nasally downward were characterized by "abnormal" summary retardation parameters as interby scanning laser polarimetry.

Adult↗