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Linda Zangwill, PhD; Inci Irak, MD; Charles C. Berry, PhD; Valerie Garden, MD; Marcia de Souza Lima, MD; Robert N. Weinreb, MD

Arch Ophthalmol. 1997;115(8):983-990.

Abstract
Objective
To determine the effect of pupil size and cataract on the reproducibility and image quality obtained with confocal scanning laser ophthalmoscopy.

Methods
Three image series were obtained with a confocal scanning laser ophthalmoscope (Heidelberg Retina Tomograph, Heidelberg, Germany) before and after pupillary dilation in each of 39 subjects (8 normal subjects, 5 glaucoma suspects, and 26 patients with glaucoma). The cataract density was measured with both a lens opacity meter and the Lens Opacities Classification System III system. The image quality of each image series was subjectively scored on a scale of 0 (poor) to 9 (high) by 2 independent observers who were unaware of the cataract density and pupil size during image acquisition. The image quality and reproducibility were objectively evaluated using the SD of the mean topography image of each subject.

Results
The mean pupil diameter in all subjects before and after dilation was 2.5±0.8 mm and 5.8±1.4 mm, respectively. After pupillary dilation, both the mean image quality score and mean SD of the mean topography image improved (from 4.5±3.5 to 7.4±2.3 and from 48.6±18.8 µm to 35.6±15.5 µm, respectively). The quality score of the images that were obtained before pupillary dilation was associated with the pupil size and density of nuclear and posterior subcapsular cataracts. The SD of the mean topography images that were obtained before pupillary dilation increased with a decreasing pupil size (P=.003) and an increasing density of the nuclear (P<.03), cortical (P=.02), and posterior subcapsular (P=.002) opacity.

Conclusions
Although pupillary dilation improved the image quality in most subjects, the improvement was sometimes small. Those subjects with small undilated pupils and/or cataracts may benefit most from pupillary dilation.

Author Affiliations
From the Glaucoma Center and Research Laboratories, Department of Ophthalmology (Drs Zangwill, Irak, Garden, de Souza Lima, and Weinreb), and Department of Family and Preventive Medicine (Dr Berry), University of California—San Diego, La Jolla.

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