High-Resolution, Adaptive Optics Imaging of the Human Trabecular Meshwork In Vivo

PURPOSE: To image the human trabecular meshwork (TM) in vivo using adaptive optics gonioscopy (AOG) with approximately 2-μm lateral resolution. METHODS: An existing Indiana University adaptive optics scanning laser ophthalmoscope was altered by adding a 12-mm button lens to a clinical gonioscopic lens allowing high-resolution imaging of the human iridocorneal angle. First an anatomic model eye was used to refine the imaging technique and then nine participants (7 controls and 2 participants with pigment dispersion syndrome) were imaged. RESULTS: All nine participants were successfully imaged without adverse events. High-resolution imaging of the human TM was achieved allowing for visualization of the TM beams, and presumed endothelial cells. Uveal meshwork beams in controls averaged 25.5 μm (range, 15.2–44.7) in diameter with pores averaging 42.6 μm (range, 22.3–51.4) while the corneoscleral meshwork pores averaged 8.9 μm (range, 7.7–12.1). Differences in appearance of the uveal and corneoscleral meshwork were noted between the two participants with pigment dispersion syndrome and the controls. These included nearly absent spacing between the beams and enlarged endothelial cells with hyperreflective areas. CONCLUSIONS: AOG allows for near cellular level resolution of the human TM in vivo. This may allow for further understanding of age-related changes that occur as well as provide a deeper understanding of medical and surgical alterations for the treatment of glaucoma. TRANSLATIONAL RELEVANCE: Further development of this approach may allow for direct measurements at a micometer level in vivo of changes that occur in the human trabecular meshwork with glaucoma and therapeutic interventions.