Device and method for examining the retinal vascular endothelial function

Abstract

The invention relates to a device and a method for examining the retinal vascular endothelial function of the vessels of the retina at the fundus (F) of a patient's eye. Using a fundus camera, the vessels of the retina are stimulated with flicker light during a stimulation phase and sequences of images of areas of the fundus (F) are recorded, from which vascular parameters are derived which describe the retinal vascular endothelial function of the vessels. By imaging a macula stop (MB), which covers the macula, onto the fundus (F), the fundus (F) can be illuminated with a higher light intensity, which improves the stimulation effect and the image quality and/or reduces the strain on the patient.

Claims

1. A device for examination of retinal vascular endothelial function of vessels of a retina at a fundus (F) of an eye (A), said device comprising: a fundus camera defining an observation beam path, the fundus camera comprising a digital image sensor designed to record image sequences of images of areas of the fundus (F), the digital image sensor comprising a reception surface, the observation beam path focusing onto the fundus (F), and defining an illumination beam path; an illumination unit being arranged in a plane (AP″) conjugated to a pupil (AP) of the eye (A) in the illumination beam path, the illumination unit serving to illuminate the fundus (F) with a measuring light and a flicker light within a light field (LF) on the fundus (F), wherein a field stop (FB) is arranged in a plane (F″) conjugated to the fundus (F) in the illumination beam path and an image of the field stop (FB) limits the light field (LF) on the fundus (F) illumination beam path; and a macula stop (MB) being arranged in the plane (F″) conjugated to the fundus (F) in the illumination beam path, said macula stop (MB) being provided with a respective fixation mark (FM) so that the macula stop (MB) covers a macula (M) on the fundus (F) when the eye (A) fixates on the fixation mark (FM) of the macula stop (MB), wherein the macula stop (MB) is formed on the field stop (FB) such that the fixation mark (FM) is located within the field stop (FB) in a manner abutting an inner edge of the field stop (FB), and wherein the field stop (FB) is rotatable about an optical axis of the illumination beam path to illuminate different selected areas of the fundus (F) by the light field (LF) and to record sequences of images of the different selected areas of the fundus (F).

2. The device according to claim 1, wherein the macula stop (MB) is a mechanical stop.

3. The device according to claim 1, wherein the macula stop (MB) is an optoelectronic stop.

4. The device according to claim 3, wherein the macula stop (MB) is a transmission display.

5. The device according to claim 2, wherein the fixation mark (FM) is a punctiform opening in an area center (FMP) of the macula stop (MB).

6. The device according to claim 5, further comprising a partly transparent web (ST) abutting the only one macula stop (MB), said web (ST) being radially aligned to the area center (FMP) of the only one macula stop (MB), the web (ST) serving to cover the papilla (P) at the fundus (F), so that the radiation intensity of an image of the papilla (P) can be adapted to a dynamic range of the digital image sensor designed for the radiation intensity of an image of the areas of the fundus (F) surrounding the papilla (P).

7. The device according to claim 6, further comprising another partly transparent stop being adjustable in transparency and serving to cover the papilla (P).

8. The device according to claim 6, wherein the macula stop (MB) is movable in the plane (F′″) conjugated to the fundus (F) in the illumination beam path, the area center (FMP) of the macula stop (MB) remaining located within the field stop (FB) to illuminate different selected areas of the fundus (F) by the light field (LF) and to record image sequences of images of the different selected areas of the fundus (F).

9. A device for examination of retinal vascular endothelial function of vessels of a retina at a fundus (F) of an eye (A), said device comprising: a fundus camera defining an observation beam path, the fundus camera comprising a digital image sensor designed to record image sequences of images of areas of the fundus (F), the digital image sensor comprising a reception surface, the observation beam path focusing onto the fundus (F), and defining an illumination beam path; an illumination unit being arranged in a plane (AP″) conjugated to a pupil (AP) of the eye (A) in the illumination beam path, the illumination unit serving to illuminate the fundus (F) with a measuring light and a flicker light within a light field (LF) on the fundus (F), wherein a field stop (FB) is arranged in a plane (F′″) conjugated to the fundus (F) in the illumination beam path and an image of the field stop (FB) limits the light field (LF) on the fundus (F) illumination beam path; and four macula stops (MB) arranged in the plane (F′″) conjugated to the fundus (F) in the illumination beam path, said four macula stops (MB) being provided with a respective fixation mark (FM) so that the four macula stops (MB) cover a macula (M) on the fundus (F) when the eye (A) fixates on the respective fixation mark (FM), wherein said four macula stops (MB) are formed in diagonally opposite pairs on the field stop (FB) such that the respective fixation mark (FM) is located within the field stop (FB) in a manner abutting an inner edge to illuminate different predetermined areas of the fundus (F) by the light field (LF) and to record sequences of images of the different predetermined areas of the fundus (F).

10. The device according to claim 1, wherein the illumination unit is formed by an adaptive, structurable arrangement of light sources to implement different illumination structures in the plane (AP″) conjugated to the pupil (AP), the light sources being switchable on and off and/or capable of modulation together or separately of their intensity, spectrum, and time regardless of their location.

11. The device according to claim 1, wherein an image of the field stop (FB) arranged in the illumination beam path has a smaller cross-section on the reception surface of the digital image sensor than the cross-section of the reception surface of the digital image sensor, and wherein a brightness distribution in a resulting differential area is used to determine a scattered light distribution by which the images of the image sequences can be corrected.

12. The device according to claim 9, wherein at least one macula stop (MB) is a mechanical stop.

13. The device according to claim 9, wherein at least one macula stop (MB) is an optoelectronic stop.

14. The device according to claim 13, wherein the at least one macula stop (MB) is a transmission display.

15. The device according to claim 9, wherein the illumination unit is formed by an adaptive, structurable arrangement of light sources to implement different illumination structures in the plane (AP″) conjugated to the pupil (AP), the light sources being switchable on and off and/or capable of modulation together or separately of their intensity, spectrum, and time regardless of their location.

16. The device according to claim 9, wherein an image of the field stop (FB) arranged in the illumination beam path has a smaller cross-section on the reception surface of the digital image sensor than the cross-section of the reception surface of the digital image sensor, and wherein a brightness distribution in a resulting differential area is used to determine a scattered light distribution by which the images of the image sequences can be corrected.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) The invention will be explained in more detail with reference to the following exemplary embodiments with the help of drawings, wherein:

(2) FIG. 1 shows a block diagram of a device according to the invention;

(3) FIG. 2 shows an optics diagram of a fundus camera according to the invention;

(4) FIG. 3 shows an area (light field) of the fundus of an eye illuminated in a manner limited by the image of a field stop;

(5) FIG. 4A shows a macula stop imaged centrally on the fundus;

(6) FIG. 4B shows a macula stop imaged eccentrically on the fundus;

(7) FIG. 5A shows a macula stop formed on the field stop and imaged on the fundus;

(8) FIG. 5B shows four macula stops formed on the field stop and imaged on the fundus;

(9) FIG. 6 shows the images of the field stop as well as of the macula stop on the reception surface of the digital image sensor;

(10) FIG. 7A shows a first embodiment example of an illumination unit as an adaptive, structurable arrangement of light sources;

(11) FIG. 7B shows a second embodiment example of an illumination unit as an adaptive, structurable arrangement of light sources;

(12) FIG. 7C shows a third embodiment example of an illumination unit as an adaptive, structurable arrangement of light sources;

(13) FIG. 7D shows a fourth embodiment example of an illumination unit as an adaptive, structurable arrangement of light sources, and

(14) 7E shows a fifth embodiment example of an illumination unit as an adaptive, structurable arrangement of light sources.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

(15) An embodiment of a device according to the invention is shown as a block diagram in FIG. 1. Similar to a device known from the prior art, the device according to the invention comprises a fundus camera 1 with a digital image sensor 2 and an illumination unit 3, a control unit 4, a data and image processing unit 5, a unit for generating diameter signals 6, a signal analysis unit 7, a result and presentation unit 8 and an input and output unit 9. The device differs from a prior art device of the same generic type essentially in the design of the fundus camera 1 and advantageously in the design of the illumination unit 3.

(16) FIG. 2 shows an optics diagram of a fundus camera 1. The latter includes an illumination beam path 1.1 and an observation beam path 1.2 (imaging beam path).

(17) In the simplest case, the observation beam path 1.2 has two lenses, namely an ophthalmoscope lens OL and an objective lens CO, via which the fundus F of the eye A, on which the fundus camera 1 has been focused, is imaged into a plane F″, which is conjugated to the fundus F and located on a reception surface 2.1 of the digital image sensor 2.

(18) The illumination beam path 1.1 is coupled into the observation beam path 1.2 by a pinhole stop LB and, in the simplest case, includes a collimator lens KL and a field lens FL. The illumination unit 3 is arranged in a plane which is conjugated to the pupil AP and located in the illumination beam path 1.1 and is imaged into the pupil AP. The field stop FB, which is arranged in a plane F′″ conjugated to the fundus F in the illumination beam path 1.1, is imaged sharply on the fundus F and on the reception surface 2.1 of the digital image sensor 2.

(19) It is essential to the invention that a macula stop MB is present, in addition, in the illumination beam path 1.1. The macula stop MB is preferably arranged in a same plane as the field stop FB, but both may also be arranged in different planes conjugated to one another. In this case, the macula stop MB may be arranged in a fixed or movable manner within the field stop FB, which is typically formed by a ring. Various advantageous embodiments will be explained with reference to exemplary embodiments.

(20) According to a first exemplary embodiment shown in FIG. 4A, the macula stop MB is circular, arranged centrally, i.e. its area center FMP is located on the optical axis of the illumination beam path 1.1, and is imaged onto the fundus F at a field angle of 15°. For internal fixation, the macula stop MB has a small opening as a fixation mark FM around its area center FMP. As an alternative, instead of using the opening as a fixation mark FM, small light sources, e.g. LEDs, structured as points, rings or crosses, may be reflected as luminous fixation marks FM in temporally, geometrically and spectrally different manners, controllable via the control unit 4. On the one hand, this allows different adjustments to be made of the fundus F with respect to the macula stop MB, due to said geometric structuring. On the other hand, flashing fixation marks FM or color changes may increase the patient's attention or may be adapted to the visual capacity of the patient's eye. The eye A to be examined may also be fixed by external fixation, so that no fixation mark FM is required within the fundus camera 1. In particular, if the visual capacity of the eye A to be examined is so low that it cannot fixate on a fixation mark FM, it makes sense to provide to the eye A not to be examined a fixation mark FM which is located outside the fundus camera 1 and is positioned to match the location of the macula stop MB.

(21) FIG. 4B shows the macula stop MB in a position shifted with respect to FIG. 4A. Accordingly, a different area of the fundus F is now located within the light field LF, which is limited by the image of the field stop FB on the fundus F.

(22) FIG. 3 schematically shows a structure of the fundus F of an eye A for easy understanding. It also shows, in addition to large arteries A.sub.V (light gray) and large veins V.sub.V (dark gray): the macula M, the area with the highest density of photoreceptors (yellow spot) and, thus, the most light-sensitive area of the fundus F, the foveola V, the fovea centralis at the center of the macula M, by which the eye A fixates on a fixation mark FM, and the papilla P (optic nerve head, blind spot), the exit point of the optic nerve from the envelope of the eyeball, which is supplied with relatively little blood.

(23) The field stop FB and the macula stop MB are axially movable together in the illumination beam path 1.1, allowing the macula stop MB to be imaged onto the fundus F so as to be sharply visible for the patient.

(24) Advantageously, a web ST is present, which is radially aligned with the area center FMP, said web ST serving as a mechanical holder for the macula stop MB and being rotatable by 180° against the light field center when changing the eye A to be examined from the right eye A to the left eye A.

(25) In an advantageous alternative embodiment, the web ST may be so wide and transparent that it covers the papilla P in order for the intensity of the measuring light reflected in the area of the papilla P to be adjusted to the surrounding retina and, thus, to the dynamic range of the digital image sensor 2.

(26) In an advantageous design of the exemplary embodiment for further medical examinations, means are provided which allow the macula stop MB to be moved radially in the light field LF. Due to the fact that, by following the fixation mark FM, the eye A to be examined follows the macula stop MB such that the macula M is always covered by the macula stop MB, the papilla P and individual selected retinal vessel trees are arranged more centrally in the light field LF for measurements and can be examined.

(27) Another advantageous embodiment is the stationary arrangement of one or more macula stop MB on the inner edge of the field stop FB. The advantage of such an embodiment is the fast, easy adjustment of the fundus F or of the measuring points, respectively, in a manner which is standardized for different eyes and which is reproducible for repeat measurements.

(28) FIG. 5A shows an embodiment in which a macula stop MB is firmly connected to or designed monolithically with the field stop FB. By rotating the field stop FB about its center, which is located on the optical axis of the illumination beam path 1.1, the eye A is maximally deflected in a circulatory movement, allowing a maximum overall area of the fundus F to be sequentially illuminated, imaged and, consequently, examined.

(29) FIG. 5B shows an embodiment in which four macula stop MB are formed on the inner edge of the field stop FB in opposite pairs or offset by 90° with respect to each other, respectively. For this case, it is envisaged for the patient's eye A to fixate sequentially on at least the fixation marks FM of two opposite macula stops MB, by which predetermined areas of the fundus F are illuminated and imaged.

(30) The data and image processing unit 5 is preferably configured such that the image of the macula stop MB, optionally with the web ST, in the image provided to the examiner is cleanly blocked out electronically by software.

(31) The field stop FB, which limits a light field LF on the fundus F, is preferably imaged on the reception surface 2.1 of the digital image sensor 2 with a smaller cross-section than the cross-section of the reception surface 2.1. In contrast to the prior art, where the size of the image of the field stop FB is regularly adapted to the size of the reception surface 2.1 of the digital image sensor 2 and, thus, the reception surface 2.1 is fully illuminated, this generates a differential area 2.2 outside the image of the fundus F, which can be used to compute the scattered light distribution as well as to monitor the non-reflecting and low-scatter adjustment of the fundus camera 1 to the eye A. In this case, it does not matter whether parts of the differential area 2.2 are made accessible to the examiner as adjustment aids or are used for automatic adjustment processes. The data and image processing unit 5 determines the brightness distribution on the reception surface 2.1 of the digital image sensor 2 within the image of the macula stop MB and in the differential area 2.2, thereby computing the scattered light distribution in the image of the fundus F on the digital image sensor 2 via an approximation algorithm and correcting the image accordingly.

(32) The illumination beam path 1.1 further includes, as the illumination unit 3 according to the invention, a preferably adaptively structurable circular or annular arrangement of small light sources, e.g. three groups of LEDs with different spectral properties, preferably in the blue, green and red spectral ranges, said groups of LEDs being arranged in the illumination beam path 1.1 in a plane AP″ conjugated to the plane of the pupil AP. By differentiated control of the LEDs, the respectively controlled (active) LEDs form an adaptive illumination structure.

(33) Said LEDs are controlled via the adaptive control unit 4 such that the LED light intensities of the different-colour LEDs are modeled separately and independently of each other. The modulation of the LED light is intended to enable both the adjustment of the intensity of continuous light as measuring light and the adjustment of stimulation light alternating between high and low intensity, with adjustable parameters of the frequency, the modulation depth and the alternating light shape (e.g. wave-shaped to step-shaped, symmetrical or asymmetrical change between bright and dark phases). Also, the illumination structure, which is respectively determined by the temporally controlled (active) LEDs of a group or of a spectral range, respectively, can be adjusted to the requirements for different examinations. For instance, the illumination structure may be formed by the temporally and locally controlled active LEDs as temporally changing narrower or wider rings, half rings, ring segments or points, which can be used to reduce scattered light and reflection light and to adapt the opening of the pupil AP.

(34) The opening of the pupil may differ individually to a great extent, depending on whether the examination is performed in the non-mydriatic or mydriatic mode, also depending on the light conditions and on the patient. In order to reduce the patient's exposure to light and to provide optimal conditions for imaging and measurement, an external diameter d.sub.a of the illumination structure is adapted to the opening of the pupil AP. An internal diameter d.sub.i of the illumination structure is adapted to the size of the image AB′ of an aperture stop AB arranged in the observation beam path 1.2 in a plane AP″ conjugated to the pupil AP. Advantageously, the internal diameter d.sub.i of the illumination structure is greater than the diameter of the image AB′ of the aperture stop AB. Adapting this radiation-free space between the illumination light and the imaging light allows the influence of reflections or scattered light to be reduced as a function of the individual conditions of the patient's eye.

(35) Also, a structural change rotating during the examination or differentiated local control of the LEDs, respectively, may be used to capture image sequences with different illumination structures, allowing the angle at which the illumination radiation is incident on a fundus object (e.g. vessels) to be varied such that vascular reflections are reduced and local image contrasts are increased.

(36) The adaptive adjustment, in particular of the external diameter d.sub.a of the illumination structure, also allows the dynamic vessel analysis in the mydiatric mode to be switched very quickly to the mode of non-mydriatic static vessel analysis, and vice versa. At the same time, said adaptivity also allows the fundus F to be focused via the principle of Scheiner apertures.

(37) FIGS. 7A to 7E show examples of different embodiments of the illumination unit 3 as an adaptive, structurable arrangement of light sources.

(38) Each of said figures shows an image of the illumination unit 3 in the plane of the pupil AP together with an image AB′ of the aperture stop AB arranged in the observation beam path 1.2. The illumination unit 3 advantageously represents a circular or annular arrangement of LEDs in a ring shape.

(39) FIGS. 7B and 7D show comparative views of pupils AP with a large and a small opening, respectively. The illumination structure, formed by activated LEDs, which are represented by different types of hatching, and the aperture stop AB, which is embodied, for example, as an iris with a variable diameter, are adapted such that an optimal luminous flux enters the eye A or an optimal diameter of the aperture stop AB is set for high image resolution. Also, when changing the external diameter d.sub.a of the illumination structure and accordingly adapting the internal diameter d.sub.i, the area of the illumination structure can be kept constant so as to keep the incident luminous flux stable by compensation. In this case, the external diameter d.sub.a is optimally adapted to the opening of the pupil AP or of the iris, respectively.

(40) FIGS. 7A and 7B show, in comparative views, that the internal diameter d.sub.i is opened wide while the opening of the pupil AP remains the same. This produces either a large radiation-free space between the illumination beam, internally limited by the internal diameter d.sub.i, and the observation beam, limited by the image AB′ (continuous line in FIG. 7B) of the small aperture stop AB, thus achieving a reduction of scattered light, especially in older patients. Or, for a large aperture stop AB (AB′ as a dashed/dotted line in FIG. 7B), the imaging properties are comparatively improved and more light is provided to the digital image sensor 2.

(41) In conventional illumination units, there is the frequent problem that the illumination beam path is cut off by drooping eyelids, long eyelashes or a slanted eye shape, thereby allowing less light into the eye A, which causes the image quality to deteriorate and may even result in the examination being aborted. By activating and deactivating LEDs, as shown in FIG. 7E, an illumination structure can be created, which evades cutoffs. Also, in older patients there is the frequent problem of cataracts considerably affecting image quality. Even in this case, by changing the location of the illumination structure, as shown by way of example in FIG. 7D, the illumination beam path can be made to bypass more heavily clouded areas of the eye lens. For this purpose, for example by controlling such an illumination structure in a rotary manner, the position of the illumination beam path can be optimized.

(42) Advantageously, also in order to remove irritating vascular reflections on the ocular fundus or to allow the higher-contrast representation of vessels and other objects on the ocular fundus, the beam direction of illumination beams incident on the ocular fundus may be changed by differentiated control of the LEDs.

(43) FIG. 7C shows, by way of example, that only the green and red LEDs are activated which generate the measuring light in the exemplary embodiment.

(44) Another advantageous alternative embodiment of a digital image sensor 2 is a monochromatic image sensor recording color images. For this purpose, three monochromatic images are respectively combined in quick succession, each of said three monochromatic images being assigned a different LED color for illumination. The three images are each subsequently combined into one color image (image with three assigned color channels).

(45) The adaptive control unit 4 is connected to a data and image processing unit 5, which is in turn connected to the digital image sensor 2. The frequency of the flicker light (change between bright and dark) is controlled by a synchronization signal which, in this exemplary embodiment, is generated by the digital image sensor 2 and is transmitted to the control unit 4, and is synchronized in order to synchronize all signals formed during the process steps with the image sequence recorded by the digital image sensor 2. For the invention, it does not matter whether the synchronization signal is given by the digital image sensor 2 or by the data and image processing unit 5 and controls the recording of the images of the image sequence.

(46) The digital image sensor 2 records images of the fundus F at an imaging frequency of preferably 25 Hz, which preferably results in a flicker frequency of 12.5 Hz. However, according to the invention, any other imaging frequency synchronized with a flicker frequency may be used for the device and the method. In this case, a variable imaging and flicker frequency may also be used to address different questions.

(47) The data and image processing unit 5 selects the papilla P, the image of the macula stop MB, optionally with the web ST, as well as arterial and venous large vessels of the retina in each image, records the movement coordinates of the fundus F following the fixation mark FM and uses them for movement correction of the images of the image sequence or of the measurement data and signals, respectively.

(48) Furthermore, a unit for generating diameter signals 6 is provided, which determines the vessel diameters in the selected vascular segments and generates, for each vascular segment, as a function of time and location, diameter signals D(t,x,y) for an image sequence and transmits these signals to the signal analysis unit 7. There, the signals of the vascular segments are used to form averaged diameter signals D(t,x,y) for entire vascular sections by averaging after combining several vascular segments, said signals being graphically displayed and output to the examiner for presentation. In the signal analysis unit 7, typical parameters of the vessels, describing the endothelial function, such as, for example, the maximum flicker dilation FD.sub.max in the stimulation phase SP, are also computed and output via the result and presentation unit 8 and the input and output unit 9. The result and presentation unit 8 additionally serves to generate mapping images.

(49) The method according to the invention will be explained below with reference to an exemplary embodiment.

(50) Step 0:

(51) An examination program menu for different examinations relating to different medical questions is presented to the examiner. The selection of examination parameters serves to adjust the arrangement of the at least one macula stop MB, the parameters of the fixation light, provided the fixation mark FM is formed by a self-luminous mark, the parameters of the measuring light and the parameters of the flicker light.

(52) The examiner can choose between adjusting

(53) 0-1: freely selected parameters (free parameter selection),

(54) 0-2: comparative parameters (comparative mode), and

(55) 0-3: repetition parameters (repeat mode),

(56) as described in the following process steps:

(57) Step 0-1: Free parameter selection

(58) For questions in research, free parameter selection is often useful. The following parameters are preferably presented to the examiner for automatic pre-selection, and after selection the set of parameters is stored as a new program for comparative and repeat examinations under a name to be assigned by the examiner.

(59) Step 0-1-1: Adjustment of the type and location of the macula stop MB as well as of the fixation point (fixation parameters)

(60) The type and location of the one or more macula stops MB and, optionally, of the web ST are displayed to the examiner as an image for manual adjustment or preset automatically.

(61) The examiner then selects the type of fixation by setting the following fixation parameters for the fixation mark FM: spectral determination of the geometric fixation structure (cross, point, ring . . . ) determination of the fixation color determination of the fixation intensity determination of the temporal changes in fixation intensity (e.g. flash frequency) or use of an opening in the macula stop MB as a fixation mark FM, which is illuminated by the flicker and measuring light

(62) Step 0-1-2: Adjustment of the measuring light (measuring light parameters) determination of the spectral range (preferably green); for special issues, measuring light from different spectral ranges may also be used determination of the intensity (manually or automatically re-adjustable, controlled by image brightness) determination of the time response during the stimulation phase SP

(63) In this manner, the flicker light for stimulation and the measuring light may be synchronized with each other, independently, for the medical issue.

(64) Step 0-1-3: Adjustment of the flicker light parameters Adjustment to luminance flicker or color flicker

(65) For luminance flicker, the defined spectral range of the flicker light is modulated only in accordance with the other flicker parameters. In the case of color flicker, the flicker light only changes the spectral range with the flicker frequency, which means mutual switching of the different-color LEDs. the adjustment of the spectral ranges of the color LEDs is performed in accordance with the flicker type, e. g. in the case of color flicker, the flicker light is set to change from a blue LED to a green LED adjustment of the modulation of the flicker light (modulation parameters)

(66) In the present example, the examiner may define the form of stimulation for each half-period of the flicker light with the following parameters: intensity maximum

(67) intensity minimum

(68) modulation depth intensity increase intensity decrease duration of the intensity maximum wave-shaped or step-shaped modulation

(69) Step 0-1-4: Adjustment of the examination phases (phase parameters) this involves adjustment of the duration of the examination phases: baseline phase BP, stimulation phase SP, and posterior phase NP in the case of an adaptive stimulation phase SP, adjustment is performed: of a minimum duration of the stimulation phase SP of a maximum duration of the stimulation phase SP and of the abort parameters for the stimulation period

(70) Step-0-1-5:

(71) All freely selected parameters are combined in a set of parameters and stored with a special examination name and presented upon renewed selection of the examination menu

(72) Step 0-2: Comparative mode (ensures the same examination conditions for different eyes A for the same medical question)

(73) The desired examination program for the medical question is selected from the examination menu and the respective set of parameters for the selected examination program is loaded. The LEDs of the device are controlled accordingly via provided control algorithms, thereby adjusting the measuring light and the flicker light to the selected examination program in a variable and adaptive manner.

(74) Step 0-3: Repeat mode (ensures the same examination conditions in follow-up sessions for the same eye A) with reference measurement locations

(75) The eye A already examined previously is selected from the patient-related database, with both the data sets stored for the selected vessels and the set of parameters of the examination performed being preset.

(76) During the adjustment of the device to the eye A, the movement correction ensures an exact match of the recorded areas of the fundus F between the sessions.

(77) After adjustment of all parameters, the examination procedure begins.

(78) Step 1:

(79) The patient's head is held in place by a head and chin rest. The patient is asked to look at the fixation mark FM on the dark macula stop MB.

(80) Step 2:

(81) The device is adjusted to the eye A to be examined, by means of a cross table so as to result in a low-scatter and non-reflecting image of the fundus F.

(82) Step 3:

(83) The image of the fundus F and the macula stop MB are focused, and by rotating the web ST, the web ST of the macula stop MB is positioned such that it covers the papilla P of the eye A to be examined.

(84) Step 4:

(85) The measuring process of the examination is started as soon as recording of an image sequence begins during the baseline phase BP, wherein only measuring light, and no flicker light, is used.

(86) Step 5:

(87) By algorithms: 5.1: the position of the web ST in the light field LF is detected and, thus, the examined eye A (right or left) is automatically identified. 5.2: the central residual reflections of the ophthalmoscope lens OL are detected centrally and blocked out electronically. 5.3: the image of the first field stop FB of the illumination beam path 1.1 of the fundus camera 1 is identified on the fundus F. 5.4: the scattered light distribution outside the light field LF and in the area not blocked out by the macula stop MB is computed and subtracted from the recorded image of the fundus F. 5.5: the images are movement-corrected with respect to the eye movements. 5.6: the papilla P is selected and blocked out, e.g. for applications in static vessel analysis. 5.7: the large arterial and venous vessels of the uncovered retina are selected and stored.

(88) Step 6:

(89) Algorithms for diameter measurement are used to determine vessel diameters along the selected vessels, one vascular segment after another, stored in location-corrected form and assigned to the synchronization signal and, consequently, to the individual images of the image sequence. Based on this data, diameter signals D(t,x,y) are formed for each vascular segment.

(90) Step 7:

(91) First, the baseline phase BP is started with a baseline time. This is automatically followed by the stimulation phase SP with the stimulation time (flicker period) and the set of parameters provided for the flicker light.

(92) Step 8:

(93) During the stimulation phase SP, all vascular signals are normalized to their respective average baseline value (determined on the basis of the baseline phase BP) on a percentage basis. The flicker-induced changes in all vascular signals during the stimulation phase SP are averaged separately for arteries A.sub.V and veins V.sub.V and evaluated with respect to their scatter and dilation. According to the invention, when selecting the adaptive stimulation phase SP, the stimulation time is made dependent on the examination result. If the increase in flicker dilation and the scatter of the average flicker dilation is below a predetermined threshold value after 20s, the stimulation phase SP is terminated.

(94) The average flicker dilation of all arterial and venous vascular segments is output separately.

(95) Step 9:

(96) After terminating the stimulation phase SP, the posterior phase NP of the examination begins, the flicker light is deactivated and the continuous measurements are continued until the posterior phase NP is terminated after the preset time. The posterior phase NP may also be configured to be adaptive by terminating it when the average signal changes and the scatter of the signal values are below a threshold value or another criterion is used for termination. The stimulation phase SP and the posterior phase NP may be repeated alternately several times, preferably three times, for averaging the signals.

(97) Step 10:

(98) Further average parameters, such as e.g. average parameters of vasomotion in the baseline or the constriction following the decrease in dilation, are formed from the diameter signals D(t,x,y) over all vascular segments, separately for arteries A.sub.V and veins V.sub.V.

(99) Step 11:

(100) An average arterial and an average venous vascular signal D=f(t) are formed over all vascular segments and output as an examination result together with the average parameters in an examination report.

(101) Step 12:

(102) For each parameter, in particular for the maximum flicker dilation FD.sub.max of the arterial and venous vascular segments, the values have colors assigned to them, which are then represented as functional imaging in the image of the fundus F, superimposed in the correct position. Red segments identify a missing maximum flicker dilation FD.sub.max and green segments identify a healthy maximum flicker dilation FD.sub.max.

(103) It does not matter for the method according to the invention if the adjustment and certain process steps of the evaluation are performed manually or automatically.

(104) An advantageous embodiment of the device and method according to the invention is the optoelectronic realization of the macula stop MB and further stops in the plane F′″ conjugated to the fundus F in the illumination beam path 1.1, e.g. by a transmission display whose pixels are independently electronically adjustable in their transmission. During the method of the invention, the display is then controlled by software in accordance with the individual process steps, analogous to the adjustment of a mechanical macula stop MB.

LIST OF REFERENCE NUMERALS

(105) NVK neurovascular coupling RVA Retinal Vessel Analyzer from Imedos DVA Dynamic Vessel Analyzer from Imedos D(t,x,y) diameter signal as a function of time and location x, y on the fundus F FD.sub.max maximum flicker dilation BP baseline phase (recording of the signals without stimulation) SP stimulation phase (recording of the signals during stimulation) NP posterior phase (recording of the signals after stimulation) 1 fundus camera 1.1 illumination beam path 1.2 observation beam path 2 digital image sensor 2.1 reception surface 2.2 differential area 3 illumination unit 4 control unit 5 data and image processing unit 6 unit for generating diameter signals 7 signal analysis unit 8 result and presentation unit 9 input and output unit A eye F fundus M macula P papilla V foveola V.sub.V vein A.sub.V artery AP pupil MB macula stop FMP area center of the macula stop FM fixation mark ST web FB field stop KL collimator lens FL field lens OL ophthalmoscope lens CO objective lens LB pinhole stop AB aperture stop in the observation beam path 1.2 AB′ image of the aperture stop AB in the pupil AP F′″ plane conjugated to the fundus F in the illumination beam path 1.1 F′, F″ planes conjugated to the fundus F in the observation beam path 1.2 AP″ plane conjugated to the pupil AP in the illumination beam path 1.1 AP′ plane conjugated to the pupil AP in the observation beam path 1.2 LF light field d.sub.i internal diameter of an illumination structure d.sub.a external diameter of an illumination structure