Abstract
A major opportunity with the improvement in retinal imaging technologies is the possibility to study the transition between the anatomically pristine retina and early retinal disease. Building understanding of differences in changes associated with normal healthy ageing compared with early pathology will allow for diagnoses long before symptoms appear. It may also allow us to predict those at risk before pathology develops. We use adaptive optics scanning light ophthalmoscopy to image individual photoreceptor cells and individual retinal pigment epithelial cells, with an aim to map their respective cell mosaics with procedures that can be repeated as needed. This to prospectively study the earliest phases of retinal disease such as AMD. AMD develops through a long and silent phase. The first signs are drusen, but the understanding of early AMD is limited by most studies having focused on elderly and fundus photography. Small hard drusen and their relation to AMD has been documented and the lesions are highly influenced by hereditary factors. Using AOSLO we can now begin to understand how drusen form in-vivo through coalescence of small hard drusen, how these lesions affect photoreceptors and their association with RPE cells.