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GO8. SUMMARY AND CONCLUSIONS
The significant role of the development of the microscope in the progress of biology and medicine is demonstrated. We have shown the continuity between earlier ocular instruments, such as the slit lamp and the specular microscope, and the current versions of clinical confocal microscopes. Both focal illumination, and point and slit scanning are reoccurring themes in the biomicroscopy of the human eye. The early work of Ridley, Goldmann and others on point illumination and point detection reoccurs in the development of both the scanning laser ophthalmoscope and the clinical confocal microscope.
We have reviewed the optical and mechanical principles of the
clinical confocal microscope. We have presented the practical aspects
for the confocal microscopic examination of the human eye and pointed out
the limitations and practical difficulties. Examples from the Universitäts-Augenklinik,
Inselspital, University of Bern, are presented showing the
normal cornea, the cornea with subclinical changes and the cornea
with known pathologies. We have reviewed the principles of new optical
techniques to examine the eye and compared them with the clinical confocal
microscope. We expect new developments in clinical confocal microscopy
to continue the progress that has been achieved with the current generation
of instrumentation.
Future of Clinical Confocal Microscopy of the Eye
This paper describes the current state of the art of instrumentation, clinical examination techniques, and the clinical analysis and interpretation of the data that are obtained. At the present time, the clinical confocal microscope as its asociated electronic equipment is large and expensive. Another problem is the large amount of digital data that is acquired during each patient's examination and the subsequent data storage, data analysis and data interpretation. In current designs the position of the focal plane in which the digital image is acquired is only approximately determined.
Clearly, clinical confocal microscopy of the anterior segment of the eye is an evolving technology. We envision the continued development of the instrumentation. New instruments will be smaller and less expensive. Solid state devices which incorporate both an array of lasers and a two - dimensional detector may replace the mechanical scanning devices and result in smaller confocal microscopes. The illumination of the cornea with a variety of selective wavelengths would increase the contrast of the digital images. The application of new technologies, such as optical low - coherence reflectometry, could be used to locate the focal plane of digital image acquisition to within a micron. The continued development of a variety of high numerical aperture water immersion microscope objectives would improve resolution and image contrast. As the technology improves we expect the problem of data storage will be mitigated ; through new data storage devices and new types of data compression. The accumulated clinical experience in the use of clinical confocal microscopy will result in new clinical techniques for the biomicroscopy of the living eye.
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