Retinal location of the preferred retinal locus relative to the fovea in scanning laser ophthalmoscope images.

Purpose: It is difficult to determine the position of a preferred retinal locus (PRL) relative to the fovea in scanning laser ophthalmoscope (SLO) images as a result of disease-related retinal morphologic changes that obscure the fovea. To overcome this problem, we developed a method for determining retinal foveal position based on normal fixation position relative to the optic disk. The normal foveal position measurements can then be used to estimate the distance between a PRL and the fovea. Methods: Using the SLO, foveal position was determined for 50 normal subjects by measuring the retinal locus of fixation relative to the optic disk in undistorted SLO images. The resulting normal foveal fixation area is described by a bivariate normal ellipse that can be plotted on any undistorted SLO image. Measurement reliability was assessed by repeated measurements. The PRL relative to the normal foveal fixation area was determined for 24 subjects with macular degeneration and bilateral central scotomas. Results: The normal foveal fixation area based on all 50 subjects is described by a p = 0.9 bivariate ellipse whose centroid is located 12.6° temporal to the temporal optic disk edge and 1.4° inferior to a horizontal line bisecting the disk. PRL area is shown to increase with distance from the foveal fixation ellipse centroid. The shape of the PRL, characterized by the ratio of PRL ellipse major to minor axis, was found to depend on whether the PRL was vertically or horizontally aligned with the foveal fixation centroid. Conclusions: PRL position relative to the fovea can be reliably estimated by plotting the normal foveal fixation bivariate ellipse on undistorted SLO images of retinas in which the fovea is obscured as a result of the disease process.