Adaptive optics imaging of the retinal microvasculature

The eye has long been recognised as the window to pathological processes occurring in the brain and other organs. By imaging the vasculature of the retina we have improved the scientific understanding and clinical best practice for a diverse range of conditions, ranging from diabetes, to stroke, to dementia. Mounting evidence suggests that damage to the smallest and most delicate vessels in the body, the capillaries, is the first sign in many vasculopathies. These are the most critical vessels involved in the exchange of metabolites with tissue. Accurate assessment of retinal capillary structure and function would therefore be of great benefit across a broad range of disciplines in medical science; however, their small size does not make this an easy task. This has led to the development of high-resolution adaptive optics imaging methods to non-invasively explore retinal microvascular networks in living human eyes. This review describes the present state of the art in the field, the scientific breakthroughs that have been made possible in the understanding of vessel structure and function in health and disease, and future directions for this emerging technology.