Retinal imaging in the twenty-first century: state of the art and future directions

Assessment of chorioretinal disease is dependent on the ability to visualize pathologic changes occurring in the posterior segment of the eye using optical instruments, termed ophthalmoscopy. Ophthalmoscopy, in turn, has been enhanced greatly by the development of techniques that allow recording of these changes, termed retinal imaging. As well as documenting pathologic features, retinal and fundal imaging facilitates the identification of morphologic features not visible to the clinician on biomicroscopy. As such, advances in retinal imaging have proven fundamental to many paradigm shifts in our understanding and treatment of ocular disease. In the 1950s, with the advent of electronic flashes and 35-mm cameras, the field of modern fundus photography was born. Similarly, in the 1960s and 1970s, the introduction of fluorescein and indocyanine green angiography revolutionized our ability to assess the integrity of the chorioretinal vasculature. More recently, in the 1990s, the introduction of a wholly new form of noninvasive cross-sectional imaging, optical coherence tomography, has greatly facilitated use of emerging pharmacotherapies in diagnosing and monitoring chorioretinal disease. In this translational science review, we provide an overview of current, state-of-the-art retinal imaging technologies, as well as highlight many emerging imaging technologies that we believe are likely to transform the provision of eye care in the 21st century.