page_title: Birefringence
section_title: Medicine
hierarchical_section_title: Birefringence / Applications / Medicine
caption_attribution_description: English: Spiked rods of monosodium urate crystals photographed under polarized light from a synovial fluid sample. Formation of en: monosodium urate crystals in the joints are associated with gout. Español: Cristales de ácido úrico de una muestra de líquido sinovial visto con luz polarizada. La formación de cristales de ácido úrico en las artiulaciones se asocia con una enfermedad llamada gota.
context_page_description: Birefringence is the optical property of a material having a refractive index that depends on the polarization and propagation direction of light. These optically anisotropic materials are said to be birefringent. The birefringence is often quantified as the maximum difference between refractive indices exhibited by the material. Crystals with non-cubic crystal structures are often birefringent, as are plastics under mechanical stress.
  Birefringence is responsible for the phenomenon of double refraction whereby a ray of light, when incident upon a birefringent material, is split by polarization into two rays taking slightly different paths. This effect was first described by the Danish scientist Rasmus Bartholin in 1669, who observed it in calcite, a crystal having one of the strongest birefringences. However, it was not until the 19th century that Augustin-Jean Fresnel described the phenomenon in terms of polarization, understanding light as a wave with field components in transverse polarization.
context_section_description: Birefringence is utilized in medical diagnostics. One powerful accessory used with optical microscopes is a pair of crossed polarizing filters. Light from the source is polarized in the x direction after passing through the first polarizer, but above the specimen is a polarizer (a so-called analyzer) oriented in the y direction. Therefore, no light from the source will be accepted by the analyzer, and the field will appear dark. However, areas of the sample possessing birefringence will generally couple some of the x-polarized light into the y polarization; these areas will then appear bright against the dark background. Modifications to this basic principle can differentiate between positive and negative birefringence.
  For instance, needle aspiration of fluid from a gouty joint will reveal negatively birefringent monosodium urate crystals. Calcium pyrophosphate crystals, in contrast, show weak positive birefringence. Urate crystals appear yellow, and calcium pyrophosphate crystals appear blue when their long axes are aligned parallel to that of a red compensator filter, or a crystal of known birefringence is added to the sample for comparison.
  Birefringence can be observed in amyloid plaques such as are found in the brains of Alzheimer's patients when stained with a dye such as Congo Red. Modified proteins such as immunoglobulin light chains abnormally accumulate between cells, forming fibrils. Multiple folds of these fibers line up and take on a beta-pleated sheet conformation. Congo red dye intercalates between the folds and, when observed under polarized light, causes birefringence.
  In ophthalmology, binocular retinal birefringence screening of the Henle fibers (photoreceptor axons that go radially outward from the fovea) provides a reliable detection of strabismus and possibly also of anisometropic amblyopia. Furthermore, scanning laser polarimetry utilises the birefringence of the optic nerve fibre layer to indirectly quantify its thickness, which is of use in the assessment and monitoring of glaucoma.
  Birefringence characteristics in sperm heads allow the selection of spermatozoa for intracytoplasmic sperm injection. Likewise, zona imaging uses birefringence on oocytes to select the ones with highest chances of successful pregnancy. Birefringence of particles biopsied from pulmonary nodules indicates silicosis.
  Dermatologists use dermatoscopes to view skin lesions. Dermoscopes use polarized light, allowing the user to view crystalline structures corresponding to dermal collagen in the skin. These structures may appear as shiny white lines or rosette shapes and are only visible under polarized dermoscopy.
caption: Urate crystals, in which their large refractive index is parallel with the long axis of the crystal is seen as additive (blue retardation color) when aligned parallel or subparallel to the slow direction of a red compensator. Crystals oriented with the fast ray parallel to the slow direction of the compensator appear as yellow retardation colors, and are thereby subtractive.
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