Adaptive Optiken – Möglichkeiten für die Diagnostik hereditärer Netzhauterkrankungen

Zusammenfassung

Adaptive Optiken (AO) stellen eine technologische Schlüsselinnovation für die Bildgebung in der Ophthalmologie dar. Mit AO ausgestattete Ophthalmoskope erlauben es, die mikroskopische Netzhautstruktur nicht invasiv und auf zellulärer Ebene darzustellen. So kann die strukturelle Integrität der retinalen Nervenfaserschicht, des perifovealen Kapillarnetzwerks, einzelner Stäbchen- und Zapfenphotorezeptoren und des zellulären Mosaiks des retinalen Pigmentepithels in vivo beobachtet werden. Für die Beurteilung des Verlaufs von Netzhauterkrankungen, einer möglichen pharmakologischen Intervention und die Entschlüsselung der zugrunde liegenden physiologischen Mechanismen bedeutet dies eine völlig neue Untersuchungsebene. Insbesondere monogenetische Erkrankungen liegen im Fokus der aktuellen Forschung. Zum einen können Rückschlüsse auf einzelne Pathologien anderer multifaktorieller Netzhauterkrankungen gezogen und so die zugrundeliegenden physiologischen Mechanismen bzw. Verläufe genauer untersucht werden (Modellerkrankung). Zum anderen werden auch im Hinblick auf aktuelle und kommende Interventionen (u. a. Gentherapie) neuartige und zuverlässige Endpunkte zur Interpretation des Therapieerfolgs notwendig. Erste kommerzielle AO-Ophthalmoskope sind für den klinischen Einsatz erhältlich, und die Zahl mit AO untersuchter Netzhautpathologien wächst zunehmend. Für eine zellgenaue Struktur-Funktions-Korrelation kann jüngstens eine AO-basierte Mikrostimulationstechnologie eingesetzt werden.

Abstract

The use of adaptive optics in ophthalmoscopy is a breakthrough technological achievement. With AO ophthalmoscopes, the microscopic retinal structure can be visualised non-invasively and on a cellular level, allowing for cellular scale imaging of the retinal nerve fibre layer, the smallest retinal capillaries, rod and cone photoreceptors, and the retinal pigment epithelium mosaic in the living subject. Regarding the diagnostic evaluation of retinal diseases, the current research focuses on monogenetic retinal diseases, which – when better understood – may allow for conclusions to be drawn about other multifactorial diseases and their underlying mechanisms (model disease). For disease monitoring and current and future pharmacological intervention (e.g. gene therapy), they will help to better establish novel and reliable clinical endpoints. New AO imaging devices have just become commercially available, and the number of retinal pathologies visualised with AO is increasing. Recently, an AO-based microstimulation technique has been introduced, which offers the possibility to directly correlate retinal structure with visual function on a cellular level.

Schlüsselwörter

adaptive Optiken - funktionelle Bildgebung - In-vivo-Histologie - Neuroretina - Mikrostimulation - Psychophysik

Key words

functional imaging - in vivo histology - neuroretina - psychophysics - microstimulation - adaptive optics

^* Geteilte Erstautorenschaft.

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