Fixation monitoring during radiation therapy for subfoveal neovascularization

Abstract 

· Purpose: The aim of the study was to determine movement of the fovea during each irradiation session by monitoring movement of the cornea. Knowing the extent of foveal deviation permits minimization of the field size. · Methods: (1) Eye movement was monitored in 10 patients during irradiation. A TV camera with an attached fixation light was installed 3 cm away from the cornea of the treated eye. The fixation light was positioned at a 10° angle to the TV camera on the opposite side of the gantry, resulting in a 90° angle between the optical axis of the eye and the irradiation beam. (2) The relationship between movement of the anterior and posterior eye segments of 10 volunteers was examined using a scanning laser ophthalmoscope (SLO). Volunteers were asked to fix their gaze on positioning lights installed in the SLO. Gaze movements of the anterior and posterior eye segments were recorded simultaneously. · Results: (1) The patients’ ability to retain fixation differed interindividually. The median corneal deviation during 10 irradiation sessions was 1 mm medio-laterally and 0.7 mm craniocaudally. (2) Deviation of the fovea could be determined by monitoring deviation of the cornea. Measured by SLO, the correlation between movements of the anterior and posterior eye segments was 1:0.9 horizontally and 1:1.5 vertically. · Conclusion: (1) Irradiation field size can be reduced, depending on the patient’s fixation stability. (2) If monitoring reveals a foveal deviation beyond the 95% isodose, irradiation can be interrupted.