Adaptive optics ophthalmoscopy: a systematic review of vascular biomarkers

Elise Bakker, Felix Anne Dikland, Roan van Bakel, Danilo Andrade De Jesus*, Luisa Sánchez Brea, Stefan Klein, Theo van Walsum, Florence Rossant, Daniela Castro Farías, Kate Grieve, Michel Paques

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

6 Citations (Scopus)
2 Downloads (Pure)


Retinal vascular diseases are a leading cause for blindness and partial sight certifications. By applying adaptive optics (AO) to conventional imaging modalities, the microstructures of the retinal vasculature can be observed with high spatial resolution, hence offering a unique opportunity for the exploration of the human microcirculation. The objective of this systematic review is to describe the current state of retinal vascular biomarkers imaged by AO flood illumination ophthalmoscopy (FIO) and AO scanning laser ophthalmoscopy (SLO). A literature research was conducted in the PubMed and Scopus databases on July 9, 2020. From 217 screened studies, 42 were eligible for this review. All studies underwent a quality check regarding their content. A meta-analysis was performed for the biomarkers reported for the same pathology in at least three studies using the same modality. The most frequently studied vascular biomarkers were the inner diameter (ID), outer diameter (OD), parietal thickness (PT), wall cross-sectional area (WCSA), and wall-to-lumen ratio (WLR). The applicability of AO vascular biomarkers has been mostly explored in systemic hypertension using AO FIO and in diabetes using AO SLO. The result of the meta-analysis for hypertensive patients showed that WLR, PT, and ID were significantly different when compared to healthy controls, while WCSA was not (P < 0.001, P = 0.002, P < 0.001, and P = 0.070, respectively). The presented review shows that, although a substantial number of retinal vascular biomarkers have been explored in AO en face imaging, further clinical research and standardization of procedures is needed to validate such biomarkers for the longitudinal monitoring of arterial hypertension and other diseases.

Original languageEnglish
Pages (from-to)369-387
Number of pages19
JournalSurvey of Ophthalmology
Issue number2
Publication statusPublished - 1 Mar 2022

Bibliographical note

This work was supported by the Horizon 2020 research and
innovation programme (grant agreement no 780989: Multimodal, multi-scale retinal imaging project). Authors thank
Thomas Poldervaart for his help in the early stage of the study.
The authors reported no other potential COI.

Copyright © 2021. Published by Elsevier Inc.


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