Abstract:
Methods and apparatus for taking autofluorescence images with a fundus camera capable of a field of view of at least 30 degrees and preferably 50 degrees or more using high quality thin film optical interference filters. In one embodiment, a filter set is disclosed for achieving this functionality. Using these methods and/or apparatus, a practitioner can (among other procedures, which are described) take high-quality autofluorescence images of the fundus using a CCD camera that does not have to be cooled, take such images without exciting damaging photochemical reactions in the retina, detect accumulation of fluorophores in the retina prior to the significant accumulation of fluorophores in the retinal pigment epithelium, and topographically localize and quantitate retinal abnormalities and retinal pigment epithelium abnormalities.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The Invention is in the field of opthalmology, and concerns the use of a fundus camera to take autoflourescence images using high performance thin film optical interference filters. 
         [0003]    2. Background of the Related Art 
         [0004]    The diagnosis and treatment of retinal diseases is highly dependent on the ability to image the ocular fundus. Monochromatic and color photography provide means to record the fundus photographically. Fluorescein angiography affords a way to investigate and document vascular anatomy and physiology of the eye. In this test fluorescein dye is injected into the circulation, (usually in the arm) and the passage of the dye is photographed as it traverses the ocular circulation. The fluorescein dye passes through the vessels in the eye and can be recorded photographically. 
         [0005]      FIG. 1  shows illustrative spectra for purposes of the following discussion, including lipofuscin, fluorescein and indocyanine green excitation and emission spectra, as well as the excitation and barrier filters for autofluorescence detection as employed by commercial scanning laser opthalmoscope systems. The lens autofluorescence shown is for an excitation of 485 nm, for comparison purposes. To image the fluorescein dye two optical filters are used. One filter, called an excitation filter, uses wavelengths generally centered between 490-500 nm to excite fluorescein. As shown in spectral curve  101 , fluorescein can absorb, and potentially produce fluorescence from, wavelengths up to 530 nm. The other filter, called a barrier filter, is a low-pass filter having an upper cutoff at about 500 nm. Fluorescein fluoresces at a peak between 520-530 nm as illustrated by the spectral curve  102 . Indocyanine green angiography (for which the applicable excitation ( 103 ) and emission ( 104 ) spectra are also shown in  FIG. 1 ) is done in a somewhat similar fashion in that the dye is injected, and the fluorescence of the dye, which occurs in the near infra-red region (peaking at 825 to 835 nm), is photographed. With these dyes we could directly visualize the vessels of the ocular fundus and could indirectly obtain information about other layers of the fundus. 
         [0006]    Another approach to imaging the fundus would be to cause naturally occurring fluorophores in the fundus to fluoresce and then record that fluorescence. There is a waste material that accumulates within cells, namely lipofuscin, that is highly autofluorescent. 1-5  (All bibliographic references are listed by number in Table I.) Lipofuscin accumulates in cells as a normal consequence of life. Increased amounts of lipofuscin can accumulate through a variety of mechanisms. In many cell types, oxidative damage can increase the amount of lipofuscin present. 6,7  Lipofuscin accumulation can occur in a number of different inherited diseases. In the eye, lipofuscin accumulates through a novel mechanism within a cell monolayer called the retinal pigment epithelium (RPE). The retina is the light sensitive structure within the eye. On the bottom surface of the retina there are photoreceptors, which are cells that have numerous small flat discs called outer segments. These outer segments are composed of retinoids used in the actual detection of light, proteins, and polyunsaturated fatty acids. Normal retinal function leads to the accumulation of autofluorescent fluorophores. These molecular components are capable of being damaged by light and oxygen. The photoreceptors shed the outer segments and the shed outer segments are phagocytized by the retinal pigment epithelium. The undamaged fatty acids and retinoids are removed from the outer segments and are recycled by the retinal pigment epithelium. However, a portion of the material within the outer segments is damaged. Some of this material proves to be very difficult for the retinal pigment epithelial cell to digest. This material is segregated by the cell into structures known as liposomes which contain the material lipofuscin. One important component of lipofuscin in retinal pigment epithelial cells is a molecule called A2E, which is formed from two molecules of trans-retinal and one molecule of phosphatidlyethanolamine. 8  The composition of lipofuscin in retinal pigment epithelial cells is somewhat different than lipofuscin found in other cells of the body because of the unique job of the retinal pigment epithelium in processing the photoreceptor outer segments. Components of lipofuscin inhibit lysosomal protein degradation, 4  are photoreactive, 5  are capable of producing a variety of reactive oxygen species and other radicals, 5  are amphiphilic, may induce apoptosis of the RPE, 9  and mediates blue light induced RPE apoptosis. 10    
         [0007]    There are sources of autofluorescence (i.e., fluorophores) within the eye other than lipofuscin. Precursors of A2E, such as A2PE-H2, A2PE, and A2-rhodopsin, all of which are autofluorescent, form in outer segments prior to phagocytosis by the RPE, 11,12  There is not a significant accumulation of the autofluorescent material within the retina unless there is some disease process that limits the retinal pigment epithelium&#39;s ability to phagocytize the outer segments. 13,14  The fluorescence spectra for the precursors of A2E peaks at wavelengths longer than A2E. The accumulation of autofluorescence within the ocular fundus occurs from fairly predictable mechanisms. By imaging the autofluorescence we can obtain not only anatomic information from the lipofuscin that is in retinal pigment epithelial cells, but we can make inferences about functional aspects of these retinal pigment epithelial cells as well. 
       Imaging Autofluorescence 
       [0008]    Lipofuscin can be made to fluoresce and has a broad emission band ( 105  in  FIG. 1 ) ranging from about 500 to beyond 750 nm. 1  In opthalmology this intrinsic fluorescence is called autofluorescence to differentiate this process from that seen from administered dyes like fluorescein or indocyanine green. The intensity of fundus autofluorescence parallels the amount and distribution of lipofuscin. 1, 15,16    
         [0009]    If we shine excitation light into the eye to excite the lipofuscin, the resultant fluorescence can be detected. The major problem with such an approach is that there are structures in the eye in front of the retina that also fluoresce. The main culprit in this regard is the crystalline lens, which has a broad band of fluorescence ( 106  in  FIG. 1 ) secondary to principally blue, but also green fluorophores especially as it develops nuclear sclerosis with age. The fluorescent emission from the crystalline lens varies with the excitation light used, the age of the patient, the amount of nuclear sclerosis, and the concurrent diseases that may be present such as diabetes. The lens fluorescence has a broad peak ranging from 500 to about 550 nm for the commonly used wavelengths for autofluorescence photography of the fundus. Therefore autofluorescence of the crystalline lens overlaps the fluorescence produced by fluorescein. Crystalline lens autofluorescence causes fluorescein angiograms to look washed out when taken of an eye with nuclear sclerosis—the autofluorescence of the lens adds to the fluorescence coming from the fundus to produce an image with low contrast. To produce useful autofluorescence images we need to be able to either reject or bypass the fluorescence of the lens. 
         [0010]    Scanning laser opthalmoscopes have a confocal capability where only conjugate points on the fundus are imaged. Points not lying on the conjugate planes are rejected. So the autofluorescence of the lens can be rejected by a scanning laser opthalmoscope. This allows confocal scanning laser opthalmoscopes to use excitation  201  and barrier  202  filters (as represented in  FIG. 2 ) similar to that used in fluorescein angiography to obtain autofluorescence photographs. The gain is turned up and usually a number of images are taken and then averaged to obtain a final image with less noise. However, autofluorescent images cannot be taken if a patient has previously received fluorescein dye. Increasing attenuation of the excitation light occurs with increasing nuclear sclerosis. The photographs obtained with a scanning laser are quite noisy and it is customary to average several images together to reduce the noise present. The software routines that perform this function commonly normalize the image, changing the grayscale values in the process. This makes objective measurement of grayscale values with the commercially available scanning laser impossible. The wavelengths commonly used for autofluorescence determination by the commercially available scanning laser opthalmoscope are absorbed by the macular pigment, which limits its ability to accurately image the central macula. 
         [0011]    Delori, et al. used a 550 nm excitation filter with a glass absorbing filter centered at 590 nm. The camera system used a CCD camera cooled to −20 degrees C. and had a restricted field of view of 13 degrees “ . . . to minimize the loss in contrast caused by light scattering and fluorescence from the crystalline lens.” This system was capable of imaging autofluorescence, but the published images had low contrast and a 13 degree field of view is not acceptable for clinical practice. 17    
         [0012]    The details of a fundus camera system that I previously developed for photographing autofluorescence in the retina are published. 18  The applicable spectral characteristics are illustrated in  FIG. 3 , including the corresponding curves  301 ,  302  for the excitation and barrier filters, respectively, of that publication. This camera system used a bandpass filter centered at about 580 nm (yellow-orange) for excitation and a bandpass filter centered at about 695 nm (near infrared that extended into the infrared wavelengths) as a barrier filter. The wavelengths used are not expected to show much attenuation from nuclear sclerosis. Since the lens fluorescence occurs with wavelengths shorter than the upper cut-off of the barrier filter, lens autofluorescence is usually not much of a problem, unless the patient has severe degrees of nuclear sclerosis. The limitations of this system for autofluorescence include all of those a typical fundus camera would face, particularly for patients with small pupils. The absorption of fluorescein extends to at least 530 nm and thus the published filter stimulates fluorescein. The excitation filter used a metal dielectric coating to block the far infrared portions of the spectrum, which caused a reduction in the transmission of the desired wavelengths by about one-half. The barrier filter was placed into the near infrared region, which has some disadvantages. The first is that this range of wavelengths is on the far, declining, edge of the fluorescence spectrum of lipofuscin. The second is that the optical performance of the camera and the eye is better adapted to visible wavelengths. The third disadvantage of this filter system was that the far infrared portion of the returning light was not blocked by the barrier filter. Longer wavelengths of light can penetrate through tissue to greater extent than shorter wavelengths. Longer wavelength fluorescence originating from deeper levels of tissue can decrease the contrast of the images acquired from more proximal layers of interest, thus degrading the image. The fourth problem was that the design goal of the older filters was to have less than 1% transmission at the crossover wavelengths between the lower boundary of the excitation filter and the upper boundary of the blocking filter. This still provided for the opportunity to have a significant cross-talk. 
         [0013]    Thus, in view of the disadvantages and limitations of the current approaches, there remains a need for better methods and apparatus for autofluorescence imaging in the eye. 
         [0014]    The state of the art is summarized in the references shown in Table I. 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE I 
               
               
                   
               
               
                 REFERENCES 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 1 
                 Delori FC, Dorey CK, Staurenghi G, et al. In vivo fluorescence of the ocular 
               
               
                   
                 fundus exhibits retinal pigment epithelium lipofuscin characteristics. Invest 
               
               
                   
                 Ophthalmol Vis Sci 1995; 36: 718- 
               
               
                 2 
                 von Ruckmann A, Fitzke FW, Bird AC. Distribution of fundus autofluorescence 
               
               
                   
                 with a scanning laser ophthalmoscope. Br J Ophthalmol 1995;; 79: 407–12. 
               
               
                 3 
                 Eldred GE, Katz ML. Fluorophores of the human retinal pigment epithelium: 
               
               
                   
                 separation and spectral characterization. Exp Eye Res 1988; 47: 71–86. 
               
               
                 4 
                 Eldred GE. Lipofuscin fluorophore inhibits lysosomal protein degradation and 
               
               
                   
                 may cause early stages of macular degeneration. Gerontology 1995; 41 (Suppl 2): 15–28. 
               
               
                 5 
                 Gaillard ER, Atherton SJ, Eldred G, Dillon J. Photophysical studies on human 
               
               
                   
                 retinal lipofuscin. Photochem Photobiol 1995; 61: 448–53. 
               
               
                 6 
                 Li W, Yanoff M, Li Y, He Z. Artificial senescence of bovine retinal pigment 
               
               
                   
                 epithelial cells induced by near-ultraviolet in vitro. Mech Ageing Dev 1999 
               
               
                   
                 22; 110: 137–55 
               
               
                 7 
                 Yin D. Biochemical basis of lipofuscin, ceroid, and age-pigment-like 
               
               
                   
                 fluoreophores. Free Radic Biol Med 1996; 21: 871–888. 
               
               
                 8. 
                 Reinboth JJ, Gautschi K, Munz K, Eldred GE, Reme CE. Lipofuscin in the retina: 
               
               
                   
                 quantitative assay for an unprecedented autofluorescent compound (pyridinium 
               
               
                   
                 bis-retinoid, A2-E) of ocular age pigment. Exp Eye Res. 1997; 65: 639–43. 
               
               
                 9 
                 Suter M, Reme C, Grimm C, et al. Age-related macular degeneration. The 
               
               
                   
                 lipofuscin component n-retinyl-n-retinylidene ethanolamine detaches proapoptotic 
               
               
                   
                 proteins from mitochondria and induces apoptosis in mammalian retinal pigment 
               
               
                   
                 epithelial cells. J Biol Chem 2000 15; 275: 39625–30. 
               
               
                 10 
                 Sparrow JR, Nakanishi K, Parish CA. The lipofuscin fluorophore A2E mediates 
               
               
                   
                 blue light-induced damage to retinal pigmented epithelial cells. Invest Ophthalmol 
               
               
                   
                 Vis Sci. 2000; 41: 1981–9. 
               
               
                 11 
                 Liu J, Itagaki Y, Ben-Shabat S, Nakanishi K, Sparrow JR. The biosynthesis of 
               
               
                   
                 A2E, a fluorophore of aging retina, involves the formation of the precursor, A2- 
               
               
                   
                 PE, in the photoreceptor outer segment membrane. J Biol Chem. 2000 
               
               
                   
                 22; 275: 29354–60. 
               
               
                 12 
                 Fishkin N, Jang YP, Itagaki Y, et al. A2-rhodopsin: a new fluorophore isolated 
               
               
                   
                 from photoreceptor outer segments. Org Biomol Chem. 2003 7; 1: 1101–5. 
               
               
                 13 
                 Spaide RF, Klancnik Jr JM. Fundus autofluorescence and central serous 
               
               
                   
                 chorioretinopathy. Ophthalmology 2005; 112: 825–833. 
               
               
                 14 
                 Spaide, RF, Noble K, Morgan A, Freund KB. Vitelliform macular dystrophy. 
               
               
                   
                 Ophthalmology 2006; 113: 1392–400. 
               
               
                 15 
                 Wing GL, Blanchard GC, Weiter JJ. The topography and age relationship of 
               
               
                   
                 lipofuscin concentration in the retinal pigment epithelium. Invest Ophthalmol Vis 
               
               
                   
                 Sci 1978; 17: 601–7 
               
               
                 16 
                 von Ruckmann A, Fitzke FW, Bird AC. Distribution of fundus autofluorescence 
               
               
                   
                 with a scanning laser ophthalmoscope. Br J Ophthalmol 1995; 79: 407–12 
               
               
                 17 
                 Delori FC, Fleckner MR, Goger DG, et al. Autofluorescence distribution 
               
               
                   
                 associated with drusen in age-related macular degeneration. Invest Ophthalmol Vis 
               
               
                   
                 Sci. 2000; 41: 496–504. 
               
               
                 18 
                 Spaide RF. Fundus autofluorescence and age-related macular degeneration. 
               
               
                   
                 Ophthalmology 2003; 110: 392–9. 
               
               
                   
               
             
          
         
       
     
       SUMMARY OF THE INVENTION 
       [0015]    The present invention concerns methods of taking autofluorescence images with a fundus camera capable of a field of view of at least 30 degrees and preferably 50 degrees or more using high quality thin film optical interference filters. In one embodiment, autofluorescence photographs are taken by exciting the lipofuscin present in the eye by shining an excitation light onto the eye through an excitation filter; detecting the resulting fluorescence of the lipofuscin through a barrier filter; and recording the autofluorescent image. 
         [0016]    Preferably, the filters employed are interferometric band-pass filters with steep cut-on, cut-off and flat transmission band. Preferably, the excitation filter has a band-pass range of about 535-585 nm and the barrier filter has a band-pass range of about 605-715 nm. To improve the signal-to-noise ratio, the excitation and barrier filters should preferably meet tight transmission and blocking tolerances with a rejection of greater than 10 7 . In practice, the filter specifications for bandwidth are nominal and actual values can vary within manufacturing tolerances. This is a practical limit on the proximity of the lower cut-off for the excitation and the upper cut-on of the barrier filter. 
         [0017]    The invention may be applied to taking images using low flash illumination, and may be used to estimate the amount of macular pigment. The wavelengths used for the barrier filter are suitable for imaging the lipofuscin precursors as they accumulate in the retina. 
         [0018]    The invention also concerns the use of a photographic system comprising a fundus camera, certain filters, a CCD camera which does not necessarily have to be cooled, and a computer system for processing, saving, and displaying the resultant images as more fully described in the detailed description. 
         [0019]    Other features and advantages of the invention will be apparent from the description of the drawings and the detailed description which follow. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]      FIG. 1  shows illustrative spectra for lipofuscin, fluorescein and indocyanine green excitation and emission spectra, an example spectrum for lens autofluorescence. 
           [0021]      FIG. 2  shows the illustrative spectra of  FIG. 1 , but with illustrative spectra for the commercially available scanning laser opthalmoscopic system&#39;s excitation and barrier wavelengths. 
           [0022]      FIG. 3  shows the illustrative spectra of  FIG. 1 , but with the excitation and barrier filters for autofluorescence detection as previously described by Spaide (Opthalmology 2003). 
           [0023]      FIG. 4  is a simplified schematic diagram showing a fundus camera-based system for practicing the present invention. 
           [0024]      FIG. 5  shows the illustrative spectra of  FIG. 1 , but with the excitation and barrier filters of the present invention, and in which the dotted line represents the estimated lens autofluorescence as induced by the excitation wavelengths used in the new filter set. 
           [0025]      FIG. 6  is an example of an autofluorescence photograph taken with the new system of a patient with Stargardt disease. 
       
    
    
     DETAILED DESCRIPTION 
       [0026]    The following is a description of several preferred embodiments of various aspects of the invention. These embodiments are illustrative only. The invention is limited only by the scope of the claims which are appended hereto, and is by no means limited to particular examples described below. 
         [0027]    The newly developed fundus camera-based system for autofluorescence photographs uses filters designed to avoid autofluorescence from the lens. 
         [0028]    One embodiment of a fundus camera-based system for practicing the methods of the present invention is shown in  FIG. 4 .  FIG. 4  is a simplified schematic diagram showing a fundus camera-based system for practicing the present invention, and an exemplary placement of the filters used for autofluorescence. In  FIG. 4 ,  401  is the light source, which is generally a halogen light for viewing and a xenon flash lamp for photography. Light produced travels through condenser  402  and relay  403  lenses to reach the exciter filter at  404 . This filter can be shifted into the optical path as need for green monochromatic or autofluorescence photography. The light is reflected by mirror  405  through relay lens  406  to the holed or fenestrated mirror  407 . This directs light toward the eye through objective lens  408  into the eye  409 . Light returning from the eye is focused by the objective lens through the hole in mirror  407 . The barrier filter  410  is positioned such that it can be brought into position for autofluorescence or deep-red photographs. The light passes through focusing  411  and imaging lenses  412  and passes through the area occupied by a switching mirror  413 . When the operator is viewing the fundus light is directed to mirrors  414  and  415  through the eyepiece  16  to the operator&#39;s eye  417 . When a photograph is taken the switching mirror position drops down and light is reflected to mirror  418  through relay lens  419  to the image-recording device  420 . While this conceivably could be a film camera, in practical use it is a CCD camera connected electronically  421  to a computer and display  422 . Images can be recorded digitally by frame capture. 
         [0029]    The present approach provides the ability to take autofluorescence images with a fundus camera using high quality thin film optical interference filters. This new filter set, the spectral characteristics of one embodiment of which are shown in  FIG. 5 , is much improved over my previously published apparatus, described in reference  15  and shown in  FIG. 3 . The excitation filter has been selected to mimic the function of a green monochromatic filter. Lipofuscin can absorb a range of 300 nm. to more than 750 nm, however many ranges of these wavelengths occupy regions used for other types of ocular imaging. The wavelengths of the excitation filter are 535 to 585 nm ( 501 ), not within the absorption curve of fluorescein, so that autofluorescence photography can be performed on a patient who has had fluorescein angiography. The wavelengths selected are not efficient at causing crystalline lens autofluorescence, a potential source of signal degradation. In  FIG. 5  the dotted line represents the lens autofluorescence expected with the new excitation filter. The barrier filter was selected to avoid any crosstalk with the excitation filter. There is a variation in the manufacture of filters and while the transitions between blocking and transmission is steep for modern filters, there still is a slope. The top portion of the curves often extend 10 nm greater than the specified bandwidth, but the transmission is attenuated in these regions by greater than 3 OD. This limits placing the lower edge of the excitation filter much less than about 20 nm from the upper edge of the barrier filter to avoid any cross-talk between the filters. The barrier filter is therefore designed to allow passage of wavelengths starting around 605 nm ( 502 ). With this separation it is estimated that there less than 10 −7  of the reflected light from excitation filter coming from the fundus through the barrier filter. The lower portion of the bandpass is limited by the diminishing amount of light available from the fluorescence of lipofuscin and the decrease in resolution and optical performance as the wavelength increases. The barrier filter also blocks passage of longer wavelength infra-red light to avoid image degradation. 
         [0030]    The previously published filter set required the camera to be set to have a flash of 300 watt-seconds and a gain on the CCD had to be set to a maximum of 24 dB. With these settings the images were quite dim. The embodiment of the present invention described above requires 200 watt-seconds the flash exposure with the gain set at 20 dB. This results in less patient discomfort and also less noise in the images. The images also are much brighter. Since the camera is optimized for the visible spectrum, shifting the recorded wavelengths up into the visible spectrum improves the optical performance. 
         [0031]    The filter selection in the preferred embodiment has important additional benefits. Because of the increased brightness of the image a non-cooled CCD camera can be used, which costs less than a cooled camera. The present system is able to obtain images with a 50 degree field of view and so represents the only system available with a field of view of 30 degrees or greater. Wide-angle imaging allows evaluation of greater expanses of the ocular fundus. Many diseases are recognized and graded on their effects on the fundus. The ability to image larger areas without the need for post-imaging processing and “stitching” of images allows for improved diagnostic capabilities. The wide-angle imaging, along with the ability to image fluorophores in the retina allow for a use of the camera system for “mapping” fundus abnormalities. In diseases causing retinal detachment, such as central serous chorioretinopathy the topographic distribution of areas of detachment can accurately be mapped using the present embodiment. Areas of atrophy or other abnormalities of the retinal pigment epithelium can be mapped topographically as well. Because the wavelengths used in the present embodiment are not influenced by macular pigment, accurate imaging of changes, particularly geographic atrophy, may be performed of the central macula. 
         [0032]    The use of a flash to instantaneously record the image is easier for the patient. With the commercially available scanning laser opthalmoscopic system the patient must endure many seconds of uncomfortably bright light for the system to acquire an image. 
         [0033]    Monochromatic light (usually green) is used to image the eye. This is usually accomplished by using a green piece of glass as the filter. The green light used is absorbed by blood and enables improved contrast when imaging the retina. The new excitation filter used in this system is green in color and can be used to replace the green filter. The barrier filter is deep red in color. Imaging the fundus with deep red wavelengths provides the ability of imaging subretinal structures. To perform monochromatic photographs the excitation filter is used, for deep-red the barrier filter is used, and for autofluorescence photography both are used. 
         [0034]    Fundus cameras have a limited number of filter slots, making implementation of this system easy for many models of fundus cameras. The previously published filter arrangement had an excitation filter that had no other use. Fundus cameras often have no open slot for excitation filters, which meant that to add autofluorescence to a fundus camera the owner had to give up some other function, such as either fluorescein or indocyanine green angiography. Autofluorescence imaging can also be used to estimate the amount of macular pigment. An autofluorescent photograph is taken with the filter set described. An additional photograph is taken with a blue filter with a bandpass of about 450-490 nm. The normal autofluorescent photograph is divided by the autofluorescent photograph taken through the blue filter. This gives an image where the grayscale value is proportional to the amount of lipofuscin present. The graphical display of the resultant image is then done in a process similar to that described in my copending U.S. patent application entitled “Reflectance Measurement of Macular Pigment Using Multispectral Imaging,” App. Serial No. U.S. 60/913,885, which is incorporated herein by reference. 
         [0035]      FIG. 6  is an example of an autofluorescence photograph taken with the new system. Stargardt disease is caused by a mutation in the ABCA4 gene and causes visual acuity loss with age. Autofluorescence photography shows increased background autofluorescence and hyperautofluorescence of the yellow flecks commonly found in this disorder. With time patchy atrophy develops in the fundus and geographic atrophy occurs in the central macula. The geographic atrophy can lead to profound vision loss. The areas of cell death, which are very difficult to appreciate with ordinary opthalmoscopic examination or color photography, are black because of the lack of cells containing lipofuscin. 
         [0036]    There are several other improvements over prior art for autofluorescence imaging with a fundus camera. Because the specified wavelengths of the exciter filter is green in color the excitation filter can be used in the filter slot ordinarily reserved for the commonly used green filter used in monochromatic fundus photography. The barrier filter transmission band is placed in a zone closer to the peak emission of lipofuscin. The filters used have high levels of transmission in the passband and rejection of wavelengths outside of the region selected. Because of these factors other image brightness is approximately an order of magnitude greater than the previously published filter set (Spaide R F, Opthalmology 2003). Because of the greater brightness less excitation light is needed, a lower gain can be used for the camera, and a non-cooled CCD can be employed, and wide-angle imaging can be utilized. There is an increased safety profile of the excitation light used in the present embodiment as compared with that used in commercially available scanning laser opthalmoscopic system, which uses excitation wavelengths shorter than 530 nm., which are known to excite photochemical reactions of lipofuscin. The excitation filter as specified does not stimulate fluorescein, allowing greater flexibility in the workflow of an opthalmologist&#39;s office in that autofluorescence photographs can be taken as needed, both before and after fluorescein angiography. The wavelengths used for excitation are not absorbed by macular pigment providing a method to evaluate the central macula. 
         [0037]    While the presently preferred embodiments have been described in detail, it will be apparent to those skilled in the art that the principles of the invention are realizable by other devices and methods without departing from the scope and spirit of the invention, as defined in the following claims.