Zeitschrift für Medizinische Physik (Nov 2022)
Intraocular reflectance of the ocular fundus and its impact on increased retinal hazard
Abstract
Purpose: Inside the eye light can be reflected multiple times due to light-tissue interactions and the spherical geometry of the eye. Due to these optical properties, a defined retinal area is not only illuminated by direct light but also by indirect, reflected light from the inner side of the eyewall. During illumination for ophthalmic surgery, this could lead to an unintended increase in intraocular retinal irradiance, which was already discussed in previous studies but without a detailed consideration of spectral differences and a potential influence of pigmentation. In this study this effect is investigated wavelength-dependent to see if different wavelengths lead to different increase in irradiance, with a special focus on the raise in photochemical and thermal hazard to the retina. It is also examined whether this effect is dependent on the pigmentation of the eye. Methods: The reflectance properties of either less or highly pigmented porcine eyes are measured in the wavelength range between 350 and 1100 nm with an integrating sphere and a spectrometer. With these reflectance spectra the wavelength-dependent Sphere Multiplier M of porcine eyes can be calculated, which represents the increase of radiance due to multiple reflections inside a sphere compared to a planar diffuser of the same size. Based on measurements of the emitted irradiance of ophthalmic illumination fibers the increase in photochemical and thermal retinal hazard due to these multiple reflections is calculated for eyes with small and high amounts of pigmentation. Results: The reflectance of the inner eyewall in the range between 350 and 1100 nm is significantly higher for eyes with low pigmentation (between 4.90% and 37.44% reflectance) in comparison to eyes with a high amount of pigmentation (between 4.30% and 28.88% reflectance). The Sphere Multiplier for the inner side of the eyewall (sclera, choroid and retina) ranges between 1.13 and 1.59 and between 1.13 and 1.48 for eyes with low and high pigmentation, respectively, in the range between 350 and 1100 nm. The reflectance, as well as the Sphere Multiplier, is strongly wavelength-dependent due to the absorption spectra of melanin and hemoglobin, which are located in the eye. With increasing wavelength, the reflection properties and the Sphere Multiplier also increases. With this, the photochemical retinal hazard of highly pigmented eyes increases by (14.11 ± 0.09)% and of lightly pigmented eyes by (16.75 ± 0.35)% compared to if the reflection properties are not considered. The thermal retinal hazard increases by (14.30 ± 0.07)% for highly pigmented eyes and by (19.65 ± 0.17)% for low pigmented eyes. Conclusion: This study demonstrates that the anatomy and pigmentation of the eye plays an important role for the reflectance properties of the eye and for the photochemical and thermal hazard to the retina.
