Eye care at the microscopic level

Alfredo Dubra, PhD, works to adjust the optics on the next generation of adaptive optics devices.

The retina has millions of light-sensitive cells known as rods and cones that initiate the process by which we visualize the world. Cell loss in diseases such as diabetic retinopathy and macular degeneration lead to irreversible vision loss, so early detection and intervention is critical to prevent blindness.

As part of Stanford’s precision health initiative, Alfredo Dubra, PhD, professor of ophthalmology, aims to improve the early diagnosing and treatment of these diseases by monitoring the anatomy and health of the retina at the cellular scale. His lab uses adaptive optics (AO) to correct the optical imperfections in the eye, and thereby capture retinal images as if seen through a microscope, viewing individual retinal cells.

This year, Dubra and his lab shifted their focus to improve image resolution to see ever smaller details of the retina, and to facilitate the use of the technology by non-experts to accelerate its utility with patients in the clinic. This involved innovations in eye movement tracking, optical design, and image processing. 

“Over this past year, we developed a new generation of AO ophthalmoscopes which will dramatically broaden the number and types of diseases that we can study,” Dubra said. “We have started deploying these advances at premier academic centers, including University of Wisconsin-Madison, Moorfields Eye Hospital/the University College London, and the National Eye Institute Intramural Research Program.”

Over this past year, we developed a new generation of AO ophthalmoscopes which will dramatically broaden the number and types of diseases that we can study.

These new technologies are being advanced through support from three grants funded by the National Institutes of Health. With the first grant, the Dubra lab will develop low-cost, high-bandwidth eye motion stabilization technology and image registration software. A second grant will support the study and correction of optical imperfections in the eye, known as wavefront aberrations, that cause blurred retinal images. The third grant aims to make AO technology more accessible in multi-center studies by improving its accuracy and reproducibility. 

Dubra and his lab also will strengthen existing collaborations: they have plans to build an AO instrument for the Wu Tsai Neurosciences Institute, to use AO technology to help multiple sclerosis patients working with Heather Moss, MD, PhD, associate professor of ophthalmology and neurology, and to image optic disc drusen patients with Joyce Liao, MD, PhD, professor of ophthalmology and neurology. 

“Dr. Dubra has shepherded this amazing technology into reality, and we are now poised to greatly expand its use in diagnosis and treatment of our patients—an amazing step towards precision health and precision medicine,” Moss said.


Kathryn Sill is a web and communications specialist for the Byers Eye Institute in the Department of Ophthalmology, at Stanford University School of Medicine. Email her at ksill@stanford.edu.