Purpose: To assess the clinical application of multicolor imaging by confocal scanning laser ophthalmoscopy (cSLO). Methods: Retinal imaging was performed in 76 patients including cSLO multicolor imaging (SPECTRALIS SD-OCT, Heidelberg Engineering, Heidelberg, Germany) and color fundus photography (CFP). Results: The use of confocal optics, reduced light scatter and automated eye tracking enable high-resolution cSLO reflectance images. Compared to CFP, the appearance of pigment alterations and hemorrhages were some of the differences observed. Various artifacts including those derived from optical media alterations need to be considered when interpreting images. Specific pathological findings including epiretinal membranes, fibrovascular proliferations, and reticular pseudodrusen may be better visualized on multicolor images. Conclusions: When using multicolor imaging, ophthalmologists need to be mindful about differences in the appearance of pathological changes and artifacts. Multicolor imaging may offer information over and above conventional CFP; it can be performed through undilated pupils and is less affected by media opacities.

1.
Keane PA, Sadda SR: Retinal imaging in the twenty-first century: state of the art and future directions. Ophthalmology 2014;121:2489-2500.
2.
Yannuzzi LA, Ober MD, Slakter JS, Spaide RF, Fisher YL, Flower RW, Rosen R: Ophthalmic fundus imaging: today and beyond. Am J Ophthalmol 2004;137:511-524.
3.
Cavallerano JD, Aiello LP, Cavallerano AA, Katalinic P, Hock K, Kirby R, Aiello LM; Joslin Vision Network Clinical Team: Nonmydriatic digital imaging alternative for annual retinal examination in persons with previously documented no or mild diabetic retinopathy. Am J Ophthalmol 2005;140:667-673.
4.
Bursell SE, Cavallerano JD, Cavallerano AA, Clermont AC, Birkmire-Peters D, Aiello LP, Aiello LM; Joslin Vision Network Research Team: Stereo nonmydriatic digital-video color retinal imaging compared with Early Treatment Diabetic Retinopathy Study seven standard field 35-mm stereo color photos for determining level of diabetic retinopathy. Ophthalmology 2001;108:572-585.
5.
Manivannan A, Plskova J, Farrow A, McKay S, Sharp PF, Forrester JV: Ultra-wide-field fluorescein angiography of the ocular fundus. Am J Ophthalmol 2005;140:525-527.
6.
Friberg TR, Pandya A, Eller AW: Non-mydriatic panoramic fundus imaging using a non-contact scanning laser-based system. Ophthalmic Surg Lasers Imaging 2003;34:488-497.
7.
Witmer MT, Kiss S: Wide-field imaging of the retina. Surv Ophthalmol 2013;58:143-154.
8.
Moussa NB, Georges A, Capuano V, Merle B, Souied EH, Querques G: MultiColor imaging in the evaluation of geographic atrophy due to age-related macular degeneration. Br J Ophthalmol 2015;99:842-847.
9.
Webb RH, Hughes GW, Pomerantzeff O: Flying spot TV ophthalmoscope. Appl Opt 1980;19:2991-2997.
10.
Manivannan A, Van der Hoek J, Vieira P, Farrow A, Olson J, Sharp PF, Forrester JV: Clinical investigation of a true color scanning laser ophthalmoscope. Arch Ophthalmol 2001;119:819-824.
11.
Pang CE, Freund KB: Ghost maculopathy: an artifact on near-infrared reflectance and multicolor imaging masquerading as chorioretinal pathology. Am J Ophthalmol 2014;158:171-178.e2.
12.
Alten F, Clemens CR, Heiduschka P, Eter N: Characterisation of reticular pseudodrusen and their central target aspect in multi-spectral, confocal scanning laser ophthalmoscopy. Graefes Arch Clin Exp Ophthalmol 2014;252:715-721.
13.
Sarks J, Arnold J, Ho IV, Sarks S, Killingsworth M: Evolution of reticular pseudodrusen. Br J Ophthalmol 2011;95:979-985.
14.
Pumariega NM, Smith RT, Sohrab MA, Letien V, Souied EH: A prospective study of reticular macular disease. Ophthalmology 2011;118:1619-1625.
15.
Klein R, Meuer SM, Knudtson MD, Iyengar SK, Klein BE: The epidemiology of retinal reticular drusen. Am J Ophthalmol 2008;145:317-326.
16.
Keilhauer CN, Delori FC: Near-infrared autofluorescence imaging of the fundus: visualization of ocular melanin. Investig Ophthalmol Vis Sci 2006;47:3556-3564.
17.
McBain VA, Townend J, Lois N: Fundus autofluorescence in exudative age-related macular degeneration. Br J Ophthalmol 2007;91:491-496.
18.
Javitt JC, Aiello LP: Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996;124:164-169.
19.
Grading diabetic retinopathy from stereoscopic color fundus photographs - an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(suppl): 786-806.
20.
Williams GA, Scott IU, Haller JA, Maguire AM, Marcus D, McDonald HR: Single-field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology. Ophthalmology 2004; 111:1055-1062.
21.
Chow SP, Aiello LM, Cavallerano JD, Katalinic P, Hock K, Tolson A, Kirby R, Bursell SE, Aiello LP: Comparison of nonmydriatic digital retinal imaging versus dilated ophthalmic examination for nondiabetic eye disease in persons with diabetes. Ophthalmology 2006;113:833-840.
22.
Niemeijer M, van Ginneken B, Russell SR, Suttorp-Schulten MS, Abramoff MD: Automated detection and differentiation of drusen, exudates, and cotton-wool spots in digital color fundus photographs for diabetic retinopathy diagnosis. Invest Ophthalmol Vis Sci 2007;48:2260-2267.
23.
Manjunath V, Papastavrou V, Steel DH, Menon G, Taylor R, Peto T, Talks J: Wide-field imaging and OCT vs clinical evaluation of patients referred from diabetic retinopathy screening. Eye 2015;29:416-423.
24.
Neubauer AS, Kernt M, Haritoglou C, Priglinger SG, Kampik A, Ulbig MW: Nonmydriatic screening for diabetic retinopathy by ultra-widefield scanning laser ophthalmoscopy (Optomap). Graefes Arch Clin Exp Ophthalmol 2008;246:229-235.
25.
Prescott G, Sharp P, Goatman K, Scotland G, Fleming A, Philip S, Staff R, Santiago C, Borooah S, Broadbent D, Chong V, Dodson P, Harding S, Leese G, Megaw R, Styles C, Swa K, Wharton H, Olson J: Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study. Br J Ophthalmol 2014;98:1042-1049.
26.
Litvin TV, Ozawa GY, Bresnick GH, Cuadros JA, Muller MS, Elsner AE, Gast TJ: Utility of hard exudates for the screening of macular edema. Optom Vis Sci 2014;91:370-375.
27.
Regnier SA, Larsen M, Bezlyak V, Allen F: Comparative efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion: a network meta-analysis. BMJ Open 2015;5:e007527.
28.
Rehak J, Rehak M: Branch retinal vein occlusion: pathogenesis, visual prognosis, and treatment modalities. Curr Eye Res 2008;33:111-131.
29.
Daruich A, Matet A, Dirani A, Bousquet E, Zhao M, Farman N, Jaisser F, Behar-Cohen F: Central serous chorioretinopathy: recent findings and new physiopathology hypothesis. Prog Retin Eye Res 2015;48:82-118.
30.
Ahlers C, Geitzenauer W, Stock G, Golbaz I, Schmidt-Erfurth U, Prunte C: Alterations of intraretinal layers in acute central serous chorioretinopathy. Acta Ophthalmol 2009;87:511-516.
31.
Baran NV, Gurlu VP, Esgin H: Long-term macular function in eyes with central serous chorioretinopathy. Clin Exp Ophthalmol 2005;33:369-372.
32.
Piccolino FC, de la Longrais RR, Ravera G, Eandi CM, Ventre L, Abdollahi A, Manea M: The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. Am J Ophthalmol 2005;139:87-99.
33.
Eandi CM, Piccolino FC, Alovisi C, Tridico F, Giacomello D, Grignolo FM: Correlation between fundus autofluorescence and central visual function in chronic central serous chorioretinopathy. Am J Ophthalmol 2015;159:652-658.
34.
Clarkson JG, Altman RD: Angioid streaks. Surv Ophthalmol 1982;26:235-246.
35.
Pece A, Avanza P, Galli L, Brancato R: Laser photocoagulation of choroidal neovascularization in angioid streaks. Retina 1997;17:12-16.
36.
Pece A, Avanza P, Introini U, Brancato R: Indocyanine green angiography in angioid streaks. Acta Ophthalmol Scand 1997;75:261-265.
37.
Alagoz C, Alagoz N, Ozkaya A, Celik U, Turan MF, Yazici AT, Cekic O, Demirok A: Intravitreal bevacizumab in the treatment of choroidal neovascular membrane due to angioid streaks. Retina 2015;35:2001-2010.
38.
Armstrong JD, Meyer D, Xu S, Elfervig JL: Long-term follow-up of Stargardt's disease and fundus flavimaculatus. Ophthalmology 1998;105:448-457; discussion 457-448.
39.
Hadden OB, Gass JD: Fundus flavimaculatus and Stargardt's disease. Am J Ophthalmol 1976;82:527-539.
40.
Gerber S, Rozet JM, Bonneau D, Souied E, Camuzat A, Dufier JL, Amalric P, Weissenbach J, Munnich A, Kaplan J: A gene for late-onset fundus flavimaculatus with macular dystrophy maps to chromosome 1p13. Am J Hum Genet 1995;56:396-399.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.