The aims of this study were to: i) optimize multi–photon imaging of retinosomes; ii) use multi–photon spectroscopy to distinguish among retinal fluorophores; and iii) examine the use of noninvasive multi–photon spectroscopy to monitor changes in the retina caused by inherited visual disorders and aging.
Our study reveals that auto–fluorescent images of the retina, specifically the RPE, can be obtained at two excitation wavelengths, namely one at ~730 nm and the other at ~910 nm. Excitation with ~ 730 nm photons clearly images retinosomes in the two–photon mode, whereas ~910 nm photons primarily excite fluorophores related to the condensation of all–
trans–retinal, e.g. A2E, A2DHP–PE and retinal dimers
16. Only under special circumstances can retinosomes be imaged with ~910 nm photons, as in
Rpe65−/− mice where they are enlarged. In such cases, nearly simultaneous absorption of two– and even three photons can take place. These findings are consistent with maximal absorption of all–
trans–retinyl esters or all–
trans–retinol at 326 nm (
Supplementary Fig. 5), and A2E at ~440 nm
16. There are several differences between retinosomes and retinoid–condensation products: i) retinosomes are located close to the plasma membrane and surrounded by adipose differentiation–related protein
12, whereas condensation products are spread throughout the cell; ii) each displays a fluorescence emission spectrum unique to its chemical and cellular structures; and iii) all–
trans–retinal condensation products not only accumulate with age but they also are either highly elevated or absent in mice with certain deletions of genes encoding enzymes of the visual cycle. Condensation products are proposed to be generated in photoreceptors and accumulated in lysosomes of the RPE, and the distribution of condensation products observed here (, ) fits this description
13.
In the RPE, levels of all–
trans–retinal condensation products increase with age
16 because each day about 10% of our rod outer segments, where these products are formed, are shed and phagocytosed by RPE cells
29. These conjugates accumulate within the RPE because their breakdown is either slow or non–existent in mammals. Even though fluorescent retinosomes were clearly observed in mice when fluorescence was measured upon excitation at 730 nm and 910 nm, emission from condensation products dominated upon 910 nm excitation. Thus, it appears that the emission fluorescence ratio after excitation at these two wavelengths, i.e. the 910 nm/730 nm ratio, might be used to monitor the health of the retina and evaluate the efficacy of therapeutic agents, at least in mice.
The total background autofluorescence of the fundus examined by scanning laser ophthalmoscopy (SLO) at the same laser power (sensitivity at 100) also reflected the amounts of A2E in mice (
Supplementary Fig. 8, ). However, because adjustments in laser power are required for each individual to compensate for different eye conditions such as cataracts, direct comparison of SLO values between individuals and time points poses potential problems. Moreover, the infrared laser of current SLO cannot cause two–photon excitation. Therefore, the 910 nm/730 nm excitation ratio of TPM offers a greater advantage in assessing the health of the retina.
TPM provides several advantages over single photon microscopy in monitoring the human eye. The human lens and macular pigments are highly opaque to UV and blue light, respectively. Therefore, it is especially difficult to deliver excitation light safely and efficiently to UV–blue absorbing fluorophores existing in the macula. Instead of using short wavelength excitation, TPM takes advantage of infrared illumination to excite UV–blue absorbing fluorophores such as retinyl esters and A2E, whose dynamics and quantities change in the macula of pre–AMD patients. In AMD, increasing RPE fluorescence is one of the earliest changes observed
30. A recent large–scale prospective study of patients with geographic atrophy (GA) showed that fundus autofluorescence at the margins of GA was the best predictor of GA progression. The unique ability of our TPM to simultaneously image intermediates and byproducts of the visual cycle in the intact eye, enables monitoring formation of all–
trans–retinal condensation products
in vivo by comparing the ratio of fluorescence excited with 730 nm to 910 nm. Moreover, as observed by us and others, all–
trans–retinal levels required to produce toxicity in vitro (5 μM) are also found
in vivo, especially after bright light exposure. A lifetime of light exposure has been proposed as one of several risk factors for advanced AMD
18,31.
Other advantages of TPM include less light scattering with resultant deeper penetration, intrinsic three–dimensionality and a decreased risk of photobleaching and phototoxicity. TPM is also a growing technology with potential applications to both basic science and clinical research
32. However most current TMP applications employ exogenous fluorescent markers rather than endogenous fluorophores and most other procedures involving larger organisms are invasive.
By taking advantage of an animal model for Leber congenital amaurosis (the
Rpe65−/− mouse) we quantitatively determined that three–photon microscopy can generate a fluorescent image characteristic of this disease. Three–photon microscopy requires three photons to be absorbed per fluorescent event and the excitation is proportional to the instantaneous intensity of incident laser light (
I) to the third power. If imaging conditions are identical, the ratio of three–photon excited fluorescence to two–photon excited fluorescence is proportional to
δ3·
I/δ2, where
δ2 is the two–photon excitation cross section and
δ3 is the three–photon excitation cross section
11. We are not aware of any data directly dealing with two or three–photon excitation cross sections as a function of wavelength for all–
trans–retinyl esters, so we used existing data for retinol instead
33. Based on several assumptions, we calculated whether three–photon excitation of retinyl esters might occur at 910 nm. We assumed that i) the two– and three–photon fluorescence quantum yields (η) are the same; and ii) the three–photon excitation cross section spectrum is offset from the two–photon excitation cross section spectrum by a factor of 10
−33
11, and that it parallels the two–photon excitation spectrum if the wavelengths are set to 3/2 times the corresponding two–photon process wavelengths. Then, using data for the wavelength-dependent two-photon fluorescence action cross section of retinol (η·
δ2), we estimate that at 910 nm η·
δ2≈8.8·10
−56 cm
4s per photon, and, taking into account that maximum absorption of retinol is at 326 nm (
Supplementary Fig. 5), we estimate that three-photon cross section extrapolates to η·
δ3 1.8·10
−86 cm
6s
2 per photon
2. Using these numbers and the intensity at 910 nm,
where c is the speed of light, h is Planck’s constant, NA is the numerical aperture, p
o is the average incident power, τ
p is the pulse duration, f
p is the pulse repetition frequency, and λ is the pulse center wavelength
34,we calculate that at 910 nm the ratio
δ3·
I/δ2≈0.3. Following the same methodology but now at 730 nm, we calculated
I730≈1.9·10
30 photons per cm
2s, η·
δ2≈3·10
−52 cm
4s per photon, η·
δ3 9.2·10
−89 cm
6s
2 per photon
2 and
δ3·
I/δ2≈6·10
−7. These estimates suggest that three photon excitation of retinyl ester is feasible at 910 nm but not at 730 nm, supporting our experimental demonstration. Thus the three–photon effect has been demonstrated, perhaps for the first time, in a biological system, namely the intact, unfixed fresh eye.
In summary, TPM of endogenous fluorophores including retinyl esters, all–
trans–retinol, and A2E provides a powerful way to monitor the visual cycle
15 directly and contribute to understanding the pathology of human retinal diseases. If we could visualize and understand early aberrations of these pathways in live human eyes, we would be better able to devise and monitor effective therapies for blinding retinal diseases.