Adaptive optics imaging in ophthalmology: Redefining vision research and clinical practice

Adaptive Optics (AO) has emerged as a revolutionary technology in ophthalmology, offering an unprecedented view into the eye's microstructures with high-resolution imaging capabilities. Originally developed for astronomy, AO technology has been adapted to correct the eye’s optical aberrations, enabling the visualization of individual cellular structures such as photoreceptors, retinal pigment epithelium cells, and capillaries within the retinal vasculature. This review provides a comprehensive overview of AO, discussing its historical background, technical principles, and incorporation into existing systems. We explore its transformative impact on ophthalmic research and clinical practice, highlighting its role in enhancing our understanding of ocular physiology, disease progression, and response to therapies. The clinical applications of AO, including early disease detection and monitoring, are examined alongside the patient experience and economic considerations. Despite its potential, AO's widespread adoption is currently limited by factors such as high costs, technical complexity, and patient cooperation challenges. We discuss these barriers and the innovative solutions emerging to overcome them, including system simplification, expanded fields of view, and advanced image analysis techniques. The article concludes by reflecting on the promising future of AO, with its evolving role in disease management, surgical planning, and systemic disease monitoring. As AO technology continues to advance, it promises to reshape the landscape of ophthalmic care, offering deeper insights into eye health and more precise patient care.