The multifocal electroretinogram (mfERG) provides spatial and temporal information on the retina’s function in an objective manner, making it a valuable tool for monitoring a wide range of retinal abnormalities. Analysis of this clinical test can however be both difficult and subjective, particularly if recordings are contaminated with noise, for example muscle movement or blinking. This can sometimes result in inconsistencies in the interpretation process. An automated and objective method for analysing the mfERG would be beneficial, for example in multi-centre clinical trials when large volumes of data require quick and consistent interpretation. The aim of this thesis was therefore to develop a system capable of standardising mfERG analysis. A series of methods aimed at achieving this are presented. These include a technique for grading the quality of a recording, both during and after a test, and several approaches for stating if a waveform contains a physiological response or no significant retinal function. Different techniques are also utilised to report if a response is within normal latency and amplitude values. The integrity of a recording was assessed by viewing the raw, uncorrelated data in the frequency domain; clear differences between acceptable and unacceptable recordings were revealed. A scale ranging from excellent to unreportable was defined for the recording quality, first in terms of noise resulting from blinking and loss of fixation, and secondly, for muscle noise. 50 mfERG tests of varying recording quality were graded using this method with particular emphasis on the distinction between a test which should or should not be reported. Three experts also assessed the mfERG recordings independently; the grading provided by the experts was compared with that of the system. Three approaches were investigated to classify a mfERG waveform as ‘response’ or ‘no response’ (i.e. whether or not it contained a physiological response): artificial neural networks (ANN); analysis of the frequency domain profile; and the signal to noise ratio. These techniques were then combined using an ANN to provide a final classification for ‘response’ or ‘no response’. Two methods were studied to differentiate responses which were delayed from those within normal timing limits: ANN; and spline fitting. Again the output of each was combined to provide a latency classification for the mfERG waveform. Finally spline fitting was utilised to classify responses as ‘decreased in amplitude’ or ‘not decreased’. 1000 mfERG waveforms were subsequently analysed by an expert; these represented a wide variety of retinal function and quality. Classifications stated by the system were compared with those of the expert to assess its performance. An agreement of 94% was achieved between the experts and the system when making the distinction between tests which should or should not be reported. The final system classified 95% of the 1000 mfERG waveforms correctly as ‘response’ or ‘no response’. Of those said to represent an area of functioning retina it concurred with the expert for 93% of the responses when categorising them as normal or abnormal in terms of their P1 amplitude and latency. The majority of misclassifications were made when analysing waveforms with a P1 amplitude or latency close to the boundary between normal and abnormal. It was evident that the multilayered system has the potential to provide an objective and automated assessment of the mfERG test; this would not replace the expert but can provide an initial analysis for the expert to review.

The ability to examine the appearance of the retina is of paramount importance for the diagnosis and monitoring of ophthalmic disease and for the evaluation of treatment outcomes. Direct cross-sectional imaging of retinal structure could be useful for early diagnosis and more sensitive monitoring of a variety of retinal conditions such as macular oedema and glaucoma. The view of the fundus given by ophthalmoscopy provides very limited depth information and clinicians will often have to resort to additional techniques such as flourescein angiography or visual field testing for information on structural abnormalities within the retina. Other currently available imaging techniques do not provide sufficient depth resolution to produce useful cross-sectional images of retinal structure. Optical coherence tomography (OCT) is a new imaging technique which is capable of producing cross-sectional images of the retina with a resolution that surpasses that of conventional imaging techniques. This new technique has axial resolution of around 1 O.tm and can resolve individual retinal layers, thus providing information on retinal structure. In principle, OCT is very similar to ultrasound however it makes use of a light source rather than an acoustic one. The technique is non-contact and non-invasive and is generally well tolerated by patients. This thesis describes the evaluation of this new imaging technique with regards to its potential within routine clinical practice. A number of investigations were performed to fuffil this evaluation. Tests were carried out to experimentally measure the system's resolution and the accuracy and precision of measurements made from the OCT scans. A number of factors that could affect the quality of the scans were identified and their effects were minimised wherever possible. The software provided with the system was rigorously tested and potential sources of error were identified. Various studies were undertaken to quantify the repeatability and reproducibility of measurements made from scans and normative values were established. These results were used to assess the ability of the technique to detect and quantify several retinal disorders. The potential of the technique for corneal imaging was investigated - a scanning protocol was established and customised software for processing cornea! scans was developed. The relationship between OCT bands and retinal morphology was investigated by correlating scans from canine retina with corresponding light microscopy images and by observing the position of retinal abnormalities on scans from patients with a variety of conditions that affected different parts of the retina. Finally the clinical potential of OCT was investigated by carrying out various studies on a number of retinal conditions. Further clinical studies which combine anatomical information from OCT with functional information from electrophysiology are currently underway. Current developments are aimed at improving the imaging processing features and user interface so as to provide a more robust, user-friendly system for routine clinical use.