Seeing Invisible Light: 2-photon Microperimetry to Measure Visual Function

Purpose: The accuracy of conventional visual function tests, which emit visible light, decreases in patients with corneal scars, cataracts, and vitreous hemorrhages. In contrast, infrared (IR) light exhibits greater tissue penetrance than visible light and is less susceptible to optical opacities. We therefore compared visual function results obtained using conventional visual function tests and infrared 2-photon microperimetry (2PM-IR) in a subject with a brunescent nuclear sclerotic and posterior subcapsular cataract before and after cataract surgery. Methods: Visual function testing using the cone contrast threshold (CCT) test, conventional microperimetry (cMP), visible light microperimetry from a novel device (2PM-Vis), and 2PM-IR were performed before and after cataract surgery. Results: Cone contrast threshold testing improved for the S-cone, M-cone, and L-cone by 111, 14, and 30. Retinal sensitivity assessed using cMP, 2PM-Vis, and 2PM-IR improved by 18 dB, 17.4 dB, and 3.4 dB, respectively. Conclusions and Importance: 2PM-IR, unlike conventional visual function tests, showed minimal variability in retinal sensitivity before and after surgery. Thus, IR visual stimulation introduces a paradigm shift for measuring visual function in the retina and posterior visual pathways by circumventing optical media opacities.