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Updated: May 4, 2026
Quantitative Fundus Autofluorescence for the Evaluation of Retinal Diseases
Published on: March 11, 2016
Classification of human retinal microaneurysms using adaptive optics scanning light ophthalmoscope fluorescein
Michael Dubow1, Alexander Pinhas, Nishit Shah
1Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York.
Purpose:
Microaneurysms (MAs) are considered a hallmark of retinal vascular disease, yet what little is known about them is mostly based upon histology, not clinical observation. Here, we use the recently developed adaptive optics scanning light ophthalmoscope (AOSLO) fluorescein angiography (FA) to image human MAs in vivo and to expand on previously described MA morphologic classification schemes.
Methods:
Patients with vascular retinopathies (diabetic, hypertensive, and branch and central retinal vein occlusion) were imaged with reflectance AOSLO and AOSLO FA. Ninety-three MAs, from 14 eyes, were imaged and classified according to appearance into six morphologic groups: focal bulge, saccular, fusiform, mixed, pedunculated, and irregular. The MA perimeter, area, and feret maximum and minimum were correlated to morphology and retinal pathology. Select MAs were imaged longitudinally in two eyes.
Results:
Adaptive optics scanning light ophthalmoscope fluorescein angiography imaging revealed microscopic features of MAs not appreciated on conventional images. Saccular MAs were most prevalent (47%). No association was found between the type of retinal pathology and MA morphology (P = 0.44). Pedunculated and irregular MAs were among the largest MAs with average areas of 4188 and 4116 μm(2), respectively. Focal hypofluorescent regions were noted in 30% of MAs and were more likely to be associated with larger MAs (3086 vs. 1448 μm(2), P = 0.0001).
Conclusions:
Retinal MAs can be classified in vivo into six different morphologic types, according to the geometry of their two-dimensional (2D) en face view. Adaptive optics scanning light ophthalmoscope fluorescein angiography imaging of MAs offers the possibility of studying microvascular change on a histologic scale, which may help our understanding of disease progression and treatment response.
Insights
Microaneurysms (MAs) in retinal vascular disease can now be classified into six types using adaptive optics scanning light ophthalmoscopy fluorescein angiography. This in vivo imaging allows for detailed study of microvascular changes, aiding disease understanding and treatment.
Area of Science:
- Ophthalmology
- Medical Imaging
- Retinal Vascular Diseases
Background:
- Microaneurysms (MAs) are key indicators of retinal vascular disease.
- Previous MA research relied on histology, limiting clinical observation.
- Adaptive optics scanning light ophthalmoscopy (AOSLO) offers advanced in vivo imaging capabilities.
Purpose of the Study:
- To image human microaneurysms (MAs) in vivo using adaptive optics scanning light ophthalmoscopy (AOSLO) fluorescein angiography (FA).
- To expand existing morphological classification schemes for MAs.
- To correlate MA morphology with retinal pathology.
Main Methods:
- Vascular retinopathy patients underwent imaging with reflectance AOSLO and AOSLO FA.
- Ninety-three MAs from 14 eyes were classified into six morphologic groups.
- MA dimensions were correlated with morphology and pathology; longitudinal imaging was performed on select MAs.
Main Results:
- AOSLO FA revealed microscopic MA features not visible with conventional imaging.
- Saccular MAs were the most common type (47%).
- No significant association was found between MA morphology and specific retinal pathologies. Pedunculated and irregular MAs were largest. Focal hypofluorescent regions correlated with larger MAs.
Conclusions:
- Retinal MAs can be classified in vivo into six distinct morphologic types based on their 2D en face view.
- AOSLO FA imaging of MAs enables study at a histologic scale.
- This advanced imaging may improve understanding of disease progression and treatment efficacy.
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