from: Markus-Matthias Gellrich, The Slit Lamp.

Springer, 2014 ISBN 978-3-642-39792-9

History of the Slit Lamp

6

6.1 Slit Lamp Construction introducing two convex lenses (Fig. 6.2).
Optically speaking, that was a telescopic lens
Dieter Schmidt with tenfold magnification.
Heinrich Westien also assisted Hermann
Aubert in 1891 (Aubert 1891) to improve upon
6.1.1 Technical Developments the binocular microscope: on the occasion of the
Leading to the Slit Lamp 21st Congress of the Heidelberg Ophthalmological
Society – Aubert reported that it was designed for
6.1.1.1 The Binocular “Corneal Loupe” binocular viewing and was most like the von
by von Zehender and Westien:
The First Ophthalmological
Microscope
Wilhelm von Zehender and the court mechanic
Heinrich Westien constructed the first binocular
microscope in 1887, calling it a “corneal loupe”
(von Zehender and Westien 1887). It was fitted
with an objective and ocular providing tenfold
magnification so that the anterior segments of
the eye could be viewed stereoscopically. Dr.
von Zehender also carried out surgery on the
anterior eye using this instrument. Its height
was adjustable, as was the patient’s chinrest,
which stood separately. There was an “illumi-
nation lens” attached via ball joints so that light
could be aimed onto the eye from different
directions. This was the first binocular micro-
scope to be used in ophthalmology (Schmidt
2001) (Fig. 6.1).
Also in 1887, Ludwig Laqueur (1887) praised
this binocular microscope for its ability to mag-
nify the living eye as a great step forward in
ophthalmology; he found it useful for surgical
interventions. In 1890, Julius Michel (1890) Fig. 6.1 Binocular “corneal loupe” (von Zehender and
also used the Zehender-Westien microscope, Westien 1887)

M.-M. Gellrich, The Slit Lamp, DOI 10.1007/978-3-642-39793-6_6, 189

© Springer-Verlag Berlin Heidelberg 2014
190
Fig. 6.2 von Zehender and
Westien binocular microscope
with two illumination lenses
(After Julius Michel 1890)
Zehender loupe but with stronger magnification.
Aubert’s instrument was capable of 25-fold
magnification and called a “binocular corneal
microscope.”
The talented mechanic Westien kept work-
ing to improve upon his 1887 binocular loupe.
Theodor Axenfeld (1900) described a new
Westien binocular handheld loupe used (via an
adjustable head holder) as a spectacles loupe; it
was highly suitable for surgery. It could be
adjusted to accommodate the distance between
the surgeon’s pupils. The lenticular strength
was adaptable to an operating distance of ca.
25 cm.
Fritz Schanz (1895) introduced a “retinal
telescope” under coaxial illumination in 1895; it
made examination of the retina and other poste-
rior segments possible. Schanz, together with
Siegfried Czapski from Jena, constructed in 1899
(Czapski 1899; Schanz 1898) another instrument
6 History of the Slit Lamp
that had the microscope in a horizontal position
and firmly connected to the laterally situated illu-
mination tube so that the site in question could be
continuously and intensively illuminated from
the side (Figs. 6.3 and 6.4).
Czapski reported that they had made use of the
binocular loupe for quite some time to view the
cornea in the living eye and that it did in fact
facilitate examination of the cornea and allow a
particularly informative binocular and stereo-
scopic view. Yet Czapski also maintained there
was a need for better illumination and greater
magnification, and that triggered the develop-
ment, together with Schanz, of the new Zeiss
instrument (Figs. 6.3 and 6.4). The key difference
to the Zehender instrument was that the new
Schanz appliance (and its successors) used
prisms that invert objects, thus employing
Kepler’s astronomical telescopic principle with
its capacity to increase magnification.
6.1 Slit Lamp Construction
Fig. 6.3 Illumination tube fixed onto the microscope
(Czapski 1899) after the design by Schanz and Czapski.
They were inspired to develop a binocular corneal micro-
scope with electric illumination by Dr. Adolph Barkan (an
ophthalmologist from San Francisco, California), who
had visited Czapski in Jena at the Zeiss factory
6.1.2 Gullstrand’s Slit Lamp and Its
Early Improvements
6.1.2.1 Gullstrand’s Breakthrough:
The Illuminated Slit
Allvar Gullstrand’s introduction of the illumi-
nated slit (Figs. 6.5 and 6.6) in 1911 on the 37th
assembly of the German Ophthalmological
Society in Heidelberg is regarded as the “hour of
birth” of the slit lamp (Gullstrand 1911, 1912;
Holland 2004). The major improvement was that
191
Fig. 6.4 The Schanz-Czapski instrument for stereo-
scopic eye examination (1899)
the illuminated slit created an optical section
through the anterior segment of the eye in which
the refractive media could now be precisely
assessed (Heydenreich 1959).
In 1911, Gullstrand wrote: “…the instrument
basically consists of a closed tube which has at
one of its ends a Nernst lamp of 100 or 220 V …,
while there is an adjustable slit at the other end.
The slit can be adjusted to center the actual image
of a luminous rod via a system of lenses.” The
main function of the slit lamp is the optimal
exploitation of focal illumination methods.
Gullstrand promoted examination with the
binocular Zehender loupe for stereoscopic
assessment.
In 1912, Fritz Ask (Gullstrand 1912) trans-
lated Gullstrand’s lecture: “…to use the light
source for focal illumination, one must have at
hand an aplanatic image achieved with an
aspheric ophthalmoscopic lens by Gullstrand.
This lens is placed at least 30 cm from the slit and
with the axis passing through it. When examining
the cornea with this method, the path of light
through the cornea is beautifully revealed by
employing the Zehender loupe – the result is a
192
Fig. 6.5 The original Gullstrand instrument: the lumi-
nescent Nernst rod was the light source, which was
directed via a condenser system onto the slit area; the illu-
minated slit was then aimed onto the eye via an aspherical
lens (Schmidt 1975, p. 118). Erggelet referred to this as
Gullstrand’s “Nernst focal lamp” as originally manufac-
tured by Carl Zeiss. It was height adjustable and mounted
on a tripod with a ring beneath the instrument base. On the
right is an ophthalmoscopic lens after Gullstrand and
Moritz von Rohr (Figure from Erggelet (1925), p. 158)
Fig. 6.6 Gullstrand’s original model of the illuminated
Nernst slit lamp of 1908, which Gullstrand initially built to
determine the curvature of the posterior corneal surface
stereoscopic view of corneal thickness, and one
can readily determine the depth of corneal
opacity....”
6 History of the Slit Lamp
Fig. 6.7 Allvar Gullstrand (born in Landskrona 5 June
1862, died in Stockholm on 28 July 1930) – first lectured
at the Karolinska Institute in Stockholm (1890–1894) in
clinical ophthalmology and in 1894 was awarded a profes-
sorship in ophthalmology in Uppsala, where he was
research professor for physiology and physical optics from
1914 to 1927. His research focused on astigmatism, mono-
chromatic aberration, lens dioptrics, color of the central
retinal macula, and accommodation (Gullstrand 1907). He
introduced a method to assess corneal astigmatism and a
micrometric technique for determining the exact shape of
the healthy and diseased cornea by documenting reflexes
photographically. In addition to developing the slit lamp,
he designed a reflex-free ophthalmoscope (1911). He also
designed aspherical lenses for eyes with high refractive
anomalies. He was awarded the Nobel Prize in 1911 for his
publication Dioptrics of the Human Eye, and in 1928 the
Graefe medal (Duke-Elder and David 1970)
After Gullstrand’s Nernst lamp with the slit
(Figs. 6.6 and 6.7), impressive technical progress
led to various models with manifold applications.
The physicist Otto Henker (1916, 1920), working
for Zeiss, and the ophthalmologists Leonhard
Koeppe (1918, 1920, 1922) and Alfred Vogt
(1913a, b, 1920, 1921a, b, c, 1925, 1930, 1931,
1942) and later Wilhelm Comberg (1933), Hans
Goldmann (1933, 1938, 1949, 1970), and the
physicist Hans Littmann (1950b) all played key
6.1 Slit Lamp Construction
roles in advancing the construction of the slit
lamp (Gellrich 2011b).
Its construction is based on the following three
principles:
An illumination unit
A binocular microscope
The mechanics that connect the microscope to
the illumination source
6.1.2.2 Advancing from the Nernst to
the “Nitra” to the Arc Lamp
The low-voltage “nitra” lamp (6 V) replaced the
Nernst rod (magnesium oxide-cerium oxide) as the
light source. The Nernst rod was displayed in a slit
aperture via a condenser system. The aperture width
was adjustable (Goldmann 1970). The “nitra” lamp
was a 50-candle half-watt lamp filled with nitrogen.
The nitra lamp was preferred, as it was less
fragile and offered more intense brightness. The
electric arc lamp was superior to all the other
light sources: arc lamps were recommended by
Leonhard Koeppe in Halle and later Alfred Vogt
in Zürich (Meesmann 1927). In 1920, Henker,
and a year later, Vogt, achieved more intensive
illumination when the filament was imaged in the
aperture of the illumination lens rather than the
slit (according to Köhler’s principle).
Fig. 6.8 ZEISS slit lamp with
the long arm introduced by
Henker to affix the illumina-
tion unit (From Schmidt
(1975))
193
In 1916, Otto Henker recommended a large,
swivel-able, horizontal metal arm (Figs. 6.8 and
6.9) upon which the illumination unit with a Nernst
lamp collector system and an adjustable slit with a
condenser lens were attached (Henker 1920). The
condenser lens was designed to concentrate the
light into a narrow, focusable beam (Henker 1916).
6.1.2.3 Slit Lamp Microscopy: A New
Era in Ophthalmology
Alfred Vogt praised the clinical advancements
that Gullstrand’s slit lamp made possible in
diagnosing corneal, iris, lens, and vitreous
anomalies. Important was the improved ability
to determine the depth of pathologies, also
realized thanks to the sharp delineation that the
“bundle of light” revealed (Vogt 1920). Vogt
introduced the “micro arc lamp” to replace the
Nernst lamp, as the former produced brighter
light in which to observe details more clearly.
6.1.2.4 Stronger Illumination
In 1915, Stähli recommended the azo-projection
lamp over the Nernst, as the latter performed
worse during current fluctuations (Stähli 1915).
In 1920–1921, Heinrich Streuli (1920, 1921),
Walter Schnyder (1921), Alfred Vogt (1921a),
194
Fig. 6.9 The Gullstrand slit
lamp. Dozens of improve-
ments have been made to the
slit lamp since Gullstrand’s
was first introduced. A
horizontally positioned arm
bearing a height-adjustable
illumination unit was attached
to a swivel-able vertical
column which was affixed
onto an also-adjustable table
with a glass plate. The slit
beam could be aimed in
different directions on the
patient’s eye. The examiner’s
observation unit (height
adjustable) was a separate
entity on the glass plate
(From Meesmann (1927))
and Rudolf Birkhäuser (1921) recommended use
of a “simple arc slit lamp” to intensify the bright-
ness of the slit image and to facilitate the assess-
ment of lens thickness and vitreous anomalies.
6.1.3 Further Improvements
on the Slit Lamp
6.1.3.1 Major Technical Improvements
by Goldmann and Comberg
In 1933, Hans Goldmann introduced a new, prac-
tically built and sturdy instrument that was easy
to operate (Goldmann 1933); an optical section
or slice of the anterior eye could be viewed in
very sharp focus. Examination of the anterior
segments was simplified thanks to the connection
between the slit arm and microscope on a single
supporting column. Adjustments on the micro-
scope and slit arm were made simultaneously, so
that the optical section stayed in the clinician’s
field of vision. By swiveling the joined slit arm
and microscope, larger areas of the cornea and
lens could be observed. Goldmann noted that a
nitra or arc lamp could also be employed.
The ophthalmologist Wilhelm Comberg had
made suggestions for improvements to Otto
Henker in 1928, then the director of the ophthal-
6 History of the Slit Lamp
mological division at Carl Zeiss, whereupon a
new slit lamp design was constructed under
Hans Hartinger’s supervision. Comberg had
complained of several awkward aspects associ-
ated with Gullstrand’s slit lamp, i.e., the diffi-
culty in altering the light intensity, having to
make subsequent adjustments on the slit arm
and microscope, and changing the slit width.
The Comberg slit lamp thus evolved (Fig. 6.10);
one of its main advantages was that the slit lamp
stood vertical, making the long rods carrying the
illumination unnecessary (Comberg 1933). The
light source was fixed on a vertical arm and the
slit lamp lens could be adjusted horizontally by
turning a knob until the beam was focused on
the eye.
The illumination arm and microscope were
joined on one column, thus on the same axis, level
with the chin rest, so that the microscope and slit
could be centered. Being able to accurately manip-
ulate this unit horizontally and vertically helped
the clinician make fine adjustments. The angle
between the illumination and observation units
was indicated at the base of the column so that
follow-up examinations could be done under the
same conditions. The fact that slit width was
changeable in a split second facilitated substantially
the assessment of pupillary reactions. Another
6.1 Slit Lamp Construction
Fig. 6.10 Zeiss slit lamp after Comberg’s design (1933)
advantage was the capacity to reduce the light
intensity using a Zeiss umbral lens with 75 %
absorption.
6.1.3.2 Design Improvements
Since the 1950s
The Zeiss and Haag-Streit companies made fur-
ther advancements in the slit lamp from which
today’s ophthalmologists continue to benefit
enormously (Figs. 6.11 and 6.12).
Hans Littmann was aware of the advantages
and disadvantages of the slit lamps by Gullstrand
(1911), Comberg (1933), and Goldmann (1933).
He presented Zeiss with a new slit lamp design
on which, by turning a knob, the user could
achieve five different magnifications in the
microscope (Littmann 1950b). The slit beam was
moveable laterally in front of the eye under a
constant stereoscopic view (Fig. 6.11).
Wolfgang Funder and Hans Rotter (1951)
reported on eye examinations involving “sagit-
tal optical sections.” Certain anomalies however
are obviously better served diagnostically by a
horizontal slit beam. A horizontal beam
195
Fig. 6.11 Zeiss slit lamp after Littmann (1950b) – this
model, with its multitude of adjustment possibilities,
revealed enormous technical progress. (Red arrow indi-
cates Hruby lens for fundoscopy). With thanks to the
medical historical collection of Kiel University, Germany
employed in conjunction with a three-part set of
prisms made gonioscopy and fundus assessment
possible.
In 1973, Jörg Draeger’s design (Draeger 1973)
improved the modern slit lamp’s adjustability via
remote control of the head rest and chair height.
(The correct chair height gives the patient ade-
quate leg room.)
The distance between the eye and microscope
must be large enough so that the clinician can
manipulate contact lenses with ease.
The antireflective coating on all the slit lamp’s
lens surfaces increases substantially the bright-
ness of slit illumination. Various light sources are
recommended, ranging from low-voltage bulbs
to halogen lamps. The advantage of a halogen
lamp is its intense, compact light achieved at a
favorable light temperature.
Special examinations can be performed by
inserting various filters into the beam path, i.e., a
196
Fig. 6.12 Haag-Streit slit lamp (From Schmidt 1975, p.
123). This model was easier to manipulate thanks to the
laterally and vertically adjustable observation and illumi-
nation units
green filter increases contrast while a gray filter
reduces the light intensity; an excitation filter is
used to detect fluorescence.
The modern SL 115 Classic and SL 120 slit
lamps by Carl Zeiss offer technical perfection
and handling ease (Fig. 6.13).
6.1.4 Fundus Examination
6.1.4.1 Fundus Examination in
Red-Free Light
Exams under red-free light made the ophthal-
moscopy of minute fundus anomalies possible. In
1910, Rudolf Helmbold was the first to report on
the importance of examining eyes under colored
light (Hembold 1910). Using the Gullstrand’s
6 History of the Slit Lamp
Nernst lamp, he observed that a broad band of
spectral colors was created by carbonate prisms.
Use of green light made even the tiniest blood
vessels visible as very thin lines that were imper-
ceptible under standard exam conditions.
It was Gullstrand in 1907 (Gullstrand 1907)
and Vogt in 1913 and 1921 (Vogt 1913b, 1921c)
who first used blue-green filter lenses in an eye
exam, but such filters did not play a clinical role
until Adolf Affolter (1917), Vogt (1921b), and
Gullstrand in 1918 (Gullstrand 1918). In 1925,
Vogt reported that nerve fibers were easier to dis-
cern, as were niveau differences in the retina
under red-free light than under the usual illumi-
nation with the ophthalmoscope, moreover, the
macula’s yellowish hue was also easier to iden-
tify (Vogt 1925).
6.1.4.2 Fundus Examination with the
Slit Lamp
Wilhelm Wegner introduced in 1929 the poly-
ophthalmoscope made by Carl Zeiss (Wegner
1929); it was also referred to as “nine eyes”
because nine examiners could observe at the
same time (Fig. 6.14).
6.1.4.3 Ancillary Lenses for Slit Lamp
Examination
1. Lenses that do not touch the eye (handheld
lenses) include the Hruby and El Bayadi lenses
as well as the +90 dpt and +78 dpt lenses
2. Contact lenses
6.1.4.4 Handheld Lenses in Fundus
Examination
Handheld lenses are convenient because they
enable the clinician to view the posterior eye seg-
ments without touching the sensitive cornea.
They make simple, quick orientation possible
when examining a fundus anomaly. However,
peripheral posterior pathologies appear in sharper
focus when a contact lens is used, whereas unco-
operative patients, or those whose corneas are
hypersensitive (i.e., after surgery or anterior
inflammation) are better off being examined with
a handheld lens; they are also well suited for very
hypotonic eyes, as a contact lens could exert
pressure on the cornea, causing Descemet folds
that hamper the view of the fundus.
6.1 Slit Lamp Construction
a b
Fig. 6.13 Modern Zeiss slit lamps – while the SL 115 (a)
has three magnifications (8×, 12×, 20×), the SL 120 (b)
ranges from 5× to 32×. The SL 115 is widely used in the
general clinical routine; both lamps employ a 6-V halogen
Ancillary lenses are either concave or convex.
The former makes the eye hyperopic (contact
lenses by Koeppe, Lemoine & Valois) and pro-
duces an upright, virtual image (Lemoine 1923;
Littmann 1950a), while convex lenses (e.g., con-
tact lenses after Adam Zamenhof) produce an
inverted, real image of the posterior eye (Zamenhof
1933). Adam Zamenhof from Warszaw in 1930
recommended that a 32 dpt convex lens be posi-
tioned in front of the slit (Zamenhof 1930). In
1937, Kleefeld improved the Zamenhof method
for vitreous examination and for photographing
ring-shaped vitreous opacities (Kleefeld 1937).
The Hruby Lens
The concave precorneal −55 dpt lens introduced
by the Viennese ophthalmologist Karl Hruby in
1941–1942 was welcomed by many ophthalmolo-
gists as it did not require touching the eye (Hruby
1941, 1942, 1950). The Hruby lens is built into
197
lamp. Brightness in both is adjustable gradually (without
notches). Ocular magnification in both lamps is 10× (with
“high eyepoint” and correction for ametropia of 8 dpt)
many slit lamps. Hruby noted that parts of the
peripheral retina were visible when using his lens
and having the patient look sideways (Fig. 6.15).
Hans Littmann (1950a, b) from Oberkochen
investigated magnification, field of vision, and slit
illumination in stereoscopic fundus microscopy
with the Hruby minus lens on the slit lamp
(Littmann 1950a). The magnification depends on
the eye’s refractive error, increasing with growing
myopia and decreasing with growing hyperopia.
Use of a minus lens makes an emmetropic eye’s
fundus appear upright and on the same plane as
the microscope, like in a telescope. An emme-
tropic eye’s retina is displayed in its actual dimen-
sions when the lens has a refraction of −58.6 dpt.
6.1.4.5 Additional Improvements
in Fundus Examination
John Evans (1932) recommended a plan-convex
lens for fundus examination with the slit lamp
198 6 History of the Slit Lamp

Fig. 6.14 Demonstration of

the polyophthalmoscope built a
by Hans Hartinger at Carl
Zeiss; illumination and
observation beam paths
correspond to Gullstrand’s
slit lamp, thanks to small,
right-angled prisms (some of
which with a semipermeable
silver coating) – a half of
each beam path is diverted
laterally (a) so that the image
is multiplied. Thus, each of
the nine observers has a tube
(b) through which he can
view the patient’s fundus
(Wegner 1929)

(Evans 1932). The slit beam was directed through
a prism and dilated pupil onto the fundus.
Lopez Enriquez (1935–1936) from Madrid
introduced a double mirror in microscopy to
increase the angle between the observation and
illumination systems (Lopez Enriquez 1935,
1936). This succeeded in directing the light in dif-
ferent directions without sacrificing the observa-
tion function. By introducing a plus lens, the
fundus became assessable with the slit lamp.
Hans Rotter (1955) from Vienna discovered that a
diverging lens was useful when examining the
vitreous and fundus (Rotter 1955); conditions
were favorable the more hyperopic (and less so
the more myopic) the patients were. A converging
lens made it easier to examine the posterior vitre-
ous and fundus in severe myopics.
In 1953, George El Bayadi (Fig. 6.16) from
Cairo introduced a +60 dpt lens for fundus exam-
ination on the slit lamp (El Bayadi 1953, 1965).
Claes Lundberg (1985) described an aspherical
biconvex and +60 dpt lens of about 31 mm diam-
eter held approx. 1 cm from the eye (Lundberg
1985). +90 dpt lenses were later introduced suc-
cessfully in many ophthalmological practices.
David Volk recognized early (1988) the advan-
tages of using a +90 dpt lens (Volk 1992). His
“quadraspherical” lens enables a field of vision
of up to 125°. It consists of a condenser and con-
tact lens with double-aspherical surfaces and a
6.1 Slit Lamp Construction
a b
A B
B
C
Fig. 6.15 The Hruby lens is particularly well suited for
examining the posterior pole; peripheral retinal areas can
also be seen, although the extreme periphery cannot. In
1970, Goldmann noted (p. 190) that the Hruby lens
reveals the posterior section in the vertical dimension as
Fig. 6.16 George El Bayadi (1916–1976), pioneer of
modern posterior segment biomicroscopy, with the slit
lamp
refraction of approx. +100 dpt (Barker and Wing
1990). Nicolas Lee (1990) from London recom-
mended a +150 dpt lens with a field of vision of 60°
(Lee 1990): the latter lens creates a magnification
199
c
A B
A
C
far as 30° and the horizontal fundus area up to 60°
(Goldmann 1970). Illustrated are exam procedures with
the Hruby lens for (a) areas close to the axis (A), (b) the
intermediate (B), and (c) the peripheral fundus (C)
about 5.2 times that possible in indirect opthalmos-
copy with 3.0× magnification. (The field of vision
of a +78 dpt lens equals 37°, that of a +90 dpt lens
just 29°). The +150 dpt lens with a diameter of
11 mm contains two +80 dpt double-convex lenses
separated by an approx. 5 mm gap of air.
6.1.4.6 Contact Lenses for Examining
the Posterior Eye
The very first contact lens was described by
Ernst Adolf Coccius (Leipzig) in 1853 after
experimentation with a “small glass bowl”
filled with “lukewarm water” (Coccius 1853).
Fundus examination took place using a “hollow
mirror with a borehole.” Leonhard Koeppe
(1918) developed the first practical contact lens
for use with the Gullstrand-Nernst slit lamp
(Fig. 6.17). The Koeppe contact lens made by
Zeiss had a refraction of −69.4 dpt, reproducing
the retina virtually at a size just 0.04 smaller
than it actually is (Koeppe 1918). The Koeppe
contact lens was not just used in the early twen-
tieth century. It continued to be employed – in a
modified form – well into the 1950s, as it makes
vitreous structures easier to discern than do
other lenses. A further development was Hans
Goldmann’s three-mirror lens in 1949. It has a
power of −64 dpt (Fig. 6.18a), producing an
upright image. When viewed through the lateral
mirrors, the image is reversed. Goldmann’s
200 6 History of the Slit Lamp

A
E
F

Fig. 6.17 Beam path through the first practical con- exponent of 1.52 produces a refraction of −69.4
tact lens (dark shaded) resting on the cornea. Its front dpt (Koeppe 1918, p. 291). A visual axis, F fovea,
is polished flat. Manufactured according to Koeppe’s E apparent position of fovea through microscope
design by Carl Zeiss and Otto Henker. A refractive

Fig. 6.18 (a) Beam path

through a Goldmann contact
lens with a flat anterior
surface. The virtual image
produced is upright and
located close to the posterior
surface of the lens (arrow b
pointing upward). (b) Beam
path through a panfundoscope
after Schlegel illustrated with
a biconvex spherical front lens
section that produces a real
but inverted image within the
biconvex lens (arrow pointing
downward)
6.1 Slit Lamp Construction
remains one of the most widely used contact
lenses in ophthalmology.
Hans Joachim Schlegel from Homburg/Saar
introduced the panfundoscope in 1969 (Schlegel
1969). Very useful, it provides a very large field
of vision (Fig. 6.18b). George Rosenwasser and
James Tiedeman (1986) from Durham demon-
strated how a +90 dpt lens could be attached to a
slit lamp, freeing the clinician’s hand to, for
example, pull back the closed eyelids of a daz-
zled patient (Rosenwasser and Tiedeman 1986).
Fabian Abraham (1988) from Tel Hashomer rec-
ommended a double-aspherical +90 dpt lens of
18 mm diameter placed in the slit lamp’s beam
path for a stereoscopic view of the fundus
(Abraham 1988). The lens is located 11 mm in
front of the patient’s eye. The advantage of hav-
ing the lens affixed is that it frees up the examin-
er’s hands to make any necessary adjustments on
the slit lamp.
6.1.5 Gonioscopy
The iridocorneal angle was first assessed by A.
Trantas in 1907 by pressing his thumb, and later
the diaphanoscope, onto the anterior sclera
(Trantas 1907). A convex lens held in front of the
ophthalmoscope revealed the iridocorneal angle.
In 1900, Trantas was also able to see the ciliary
processes by pressing a finger onto the ciliary
area while using the ophthalmoscope (Trantas
1900; 1928). Mizuo (1914) noted that the lower
part of the iridocorneal angle became visible
when the patient looked downward (through a
conjunctival sac filled with water). In 1942, Peter
Kronfeld et al. (1942) modified the Mizuo
method by applying saline solution into the con-
junctival sac after retracting the lids with a specu-
lum. The Austrian Maximilian Salzmann (1914)
observed the iridocorneal angle in hydrophthal-
mic and myopic eyes by using a concave mirror
(Salzmann 1914). By also employing Eugen
Fick’s contact lens and an ophthalmoscope,
Salzmann could see into the iridocorneal angle of
an emmetropic eye (Salzmann 1915). Fick devel-
oped the first contact “spectacles,” as he called
them, in 1888, testing them on himself and his
201
own patients (Fick 1888). Salzmann had a
“gonioscopic contact lens” made by Carl Zeiss
(Jena); its curvature was greater than that of the
cornea. This led to successful observation of the
iridocorneal angle and accurate assessment of
physiological and pathological anomalies.
Koeppe however argued that Salzmann’s contact
lens created an “astigmatically deformed bundle”
at 10× magnification on the slit lamp, producing
an impaired view (Koeppe 1920). Koeppe used a
cuvette filled with a saline-glycerin mixture as a
kind of contact lens to gain a better perspective of
the iridocorneal angle than was possible with
Salzmann’s (Fig. 6.19).
Koeppe had accounted precisely for the glass’
curvature in his calculations.
To see into the entire iridocorneal angle, the
New Yorker Manuel Troncoso (1925) developed a
gonioscope in 1925; by placing a Koeppe lens
onto the cornea, he could see the iridocorneal
angle thanks to an instrument made by Bausch &
Lomb (consisting of a microscope and periscope).
Troncoso was the first to refer to “gonioscopy.”
Goldmann was the next to introduce in 1938 a
new principle into the iridocorneal angle exami-
nation, namely, the “mirror gonioscope,” which
is now used worldwide (Goldmann 1938). Made
of plastic, it weighs just 5 g. The patient is seated
during the examination (as opposed to previously
with the Salzmann and Koeppe lenses, whereby
the clinician had to walk around the patient in
order to view all sections of the iridocorneal
angle). All regions thereof can be examined
under focal illumination.
An enhancement of the Koeppe lens, the
Koeppe “C,” was produced by Adolph Barkan’s
son Otto in 1952 (Barkan 1952). This was smaller
and lighter than earlier lenses and made of meth-
ylmethacrylic. In 1954, Allen and O’Brien intro-
duced the four-mirror contact prism for easy
observation of all regions of the iridocorneal
angle (Allen et al. 1954).
In 1965, Kenneth T. Richardson and Robert N.
Shaffer were the first to perform gonioscopy in
infants by using a Koeppe-type gonioscopy lens
of small diameter (Richardson and Shaffer 1965).
Successful examination was thus possible with-
out resorting to anesthetics.
202
Fig. 6.19 To examine the nasal iridocorneal angle with
the Koeppe contact lens, one needs a small, round glass
chamber filled with a mixture of saline solution and glyc-
erin (n = 1,336). The half-diameter of the curvature in the
optically visible zone measures 13.5 mm. The silver mir-
ror in the lower part of the illustration is found temporal
beside the microscope. Note that the beam path extends
into the iridocorneal angle (Erggelet 1925, p. 157)
In 1969, Wolfgang Leydhecker was the first to
describe examining the iridocorneal angle using
a lens whose contact surface had been hollowed
out so that it could be placed on the eye without
requiring methyl cellulose or other viscous con-
tact solutions (Leydhecker 1969). The iridocor-
neal angle was illuminated by a plastic rod (with
glass-fiber optics) that was attached to the lens,
thus revealing the goniotomy. Goniophotography
6 History of the Slit Lamp
was also made possible in this manner. Further
“gonio lenses” were developed that had a com-
partment between their inner surface and the cor-
neal surface. The tear fluid, however, completely
filled this compartment and prevented air bub-
bles from entering the space and hampering the
view.
In 1972, Lars Frisén constructed an adjustable
mirror and a mirror fixed onto a contact lens with
a scale for judging position (Frisen 1972). The
iridocorneal angle and fundus were displayed in
an upright image.
A gonio lens without air bubbles was intro-
duced in 1988 by Frederick M. Kapetansky
(1988). This was a Goldmann-type lens less
curved in the center, so that it lies directly on the
cornea. He wrote that a modified Goldmann-type
gonioscopy lens could be successfully applied to
the cornea without requiring methyl cellulose or
other viscous solution between the cornea and
the inner surface of the contact lens. However,
the author is concerned about the risk of corneal
erosion when such lenses are applied without
using viscous solutions.
6.1.6 Slit Lamp Photography
6.1.6.1 Iridocorneal Angle
Photography
The first photographs of the iridocorneal angle
were taken by A Thorburn in 1927 in Stockholm
and illustrated in his dissertation. They did not
however inspire practical application. In 1935,
Ramon Castroviejo from New York photo-
graphed the iridocorneal angle first of cats and
dogs and then of humans (Castroviejo 1835).
David Donaldson constructed in 1950 an instru-
ment consisting of two cameras and an electronic
flash for stereoscopic photography of the anterior
eye segments (Donaldson 1950). Ernst van
Beuningen and Fritz Fischer took stereoscopic
photographs of the iridocorneal angle in color in
1957 using an electronic flash (van Beuningen
and Fischer 1957). Steinvorth and Hötte pub-
lished stereoscopic photographs of the iridocor-
neal angle taken with a Minox camera in 1959
(Steinvorth and Hötte 1959). Hermann Heinzen
6.2 Bibliography 203

and Artur Würth developed in the same year an 6.2 Bibliography

appliance for simultaneous stereoscopic photog-
raphy of the iridocorneal angle – the color photos
they published showed 3.6× magnification
(Heinzen and Würth 1959).
6.1.6.2 Slit Lamp Photography of the
Posterior Eye and Lens
Hugo Wolff was active in Berlin as early as 1903
photographing the posterior eye. He described
the necessary technical details (Wolff 1908).
Rudolf Thiel, also of Berlin, reported about pho-
tos taken with a slit lamp at an exposure of 1/25th
of a second and narrow (0.5 mm) slit, and of
those taken at a 1/50th of a second and wide slit
(1–1.5 mm), which reduced the depth of focus
somewhat (Thiel 1930).
In 1966, Peter Niesel published a list of the
many attempts using the slit lamp to photograph
the lens (Niesel 1966).
Marcus-Matthias Gellrich
6.2.1 The Earliest
German-Language Literature
on the Slit Lamp
The initial success of the slit lamp was due in no
small part to books written by Alfred Vogt (of
Zürich) and Leonhard Koeppe (of Halle) (Table 6.1).
Vogt’s first writings on slit lamp microscopy
appeared in 1921 (Vogt 1921b), which he fol-
lowed by the then most extensive text on the slit
lamp, which was published in three volumes
between 1931 and 1942 (Vol. 1: the cornea, Vol.
2: the lens, and Vol. 3: the iris, vitreous and con-
junctiva). With over 2,000 images, this monu-
mental work demonstrates great diligence and

Table 6.1 Comparison of slit lamp books

Leonhard Marcus-M.
Author Alfred Vogt Koeppe Alois Meesmann Karl Hruby Gellrich
Clinic Klinik Zürich Klinik Halle Klinik Berlin Klinik Wien Praxis
Kellinghusen
Atlas + − + − +
Volumes 3 2 1 1 1 + DVD
Publisher Springer, Julius Springer Urban & Urban & Kaden,
SDVA Schwarzenberg Schwarzenberg Springer
Publishing year (1921) 1920 + 22 1927 1950 2011 (2013)
1930 + 31 + 42
Clinical material 2,396 pictures 58 210 32 2.249 plates, up
on 396 plates to 9 images
1. Eyelids / / / / 151
2. Conjunctiva, sclera 136 5 10 / 107
3. Cornea 622 19 64 / 275
4. Contact lenses / / / / 51
5. Iris 502 13 24 / 146
6. Lens 915 / 89 / 139
7. Vitreous 206 3 15 12 61
8. Retina, choroid 10 7 4 14 318
9. Macula 2 5 / 5 197
10. Optic nerve 3 6 4 1 109
11. Glaucoma / / / / 151
12. Neuro-ophthalmology / / / / 149
13. Orbita, lacrimal disease / / / / 149
14. Strabismus / / / / 246
204
very determined pedagogic enthusiasm (Vogt
1930, 1931, 1942). In addition to the artful slit
lamp images, there are histological samples,
animal experiments, and numerous total body
Fig. 6.20 Alfred Vogt (1879–1943), pioneer of anterior
segment biomicroscopy, with the slit lamp
a D
Fig. 6.21 Optical section of
the cornea and specular
reflection of corneal
endothelium (Table 8 from
c d g
Vol 1 of Vogt’s Atlas (Vogt
1930)) Vogt, Spaltlampenmikroskopie. 2. Aufl.
6 History of the Slit Lamp
photos, especially in the chapter on “twin pathol-
ogies.” Vogt (Fig. 6.20) never fails to make it
clear to the reader when he is taking a personal
approach, i.e., in describing the optical section,
or the technique of specular reflection, especially
of the corneal endothelium (see Fig. 6.21).
Koeppe’s contribution to images in slit lamp
microscopy is rather meager compared to Vogt’s
(Koeppe 1922); nevertheless, a third of his illustra-
tions are devoted to the fundus. These are draw-
ings that display the retina via a method of his
using a silver mirror and contact lens. The tech-
niques involved in slit lamp optics are described
via complex physical formulas. At the end of
Vol. 2 is a chapter entitled “Die Spektroskopie
des lebenden Auges an der Gullstrandschen
Spaltlampe” (Spectroscopy of the living eye
with Gullstrand’s slit lamp), which addresses the
absorption characteristics of various ocular tissues.
Koeppe introduced “oscillating illumination”
as a quick change between different types of illu-
mination to enhance the detection of anomalies.
This is a strong parallel to the flicker test which is
nowadays so important in videography for moni-
toring disease courses.
The preface to Alois Meesmann’s book “Die
Mikroskopie des lebenden Auges an der
Gullstrandschen Spaltlampe mit Atlas typischer
be D’ f
Sp’
43
h 41
6.2 Bibliography
Befunde” (Microscopy of the living eye with
Gullstrand’s slit lamp and atlas of typical find-
ings) (1927) emphasizes in the texts and images
that one should “…concentrate on what is clini-
cally important,” not on “…rare anomalies.” His
material is addressed to the practicing ophthal-
mologist (Meesmann 1927). He also states: “…
while until recently, many ophthalmologists
showed little interest in mastering the slit lamp's
complicated technique” and the “…apparently
difficult examination process, one cannot help
but notice in the relevant literature nowadays how
widespread use of the slit lamp has become.”
In 1950, Karl Hruby dedicated his text – the
first of its kind – exclusively to fundus examina-
tion with a diverging lens, mentioning that
Meesmann had published only eight images of
the posterior eye (of 210 color photos) and that in
Vogt’s extensive work on the slit lamp, examina-
tion of the posterior eye was not addressed at all,
concluding, “…we now face the fact that there
are no published slit-lamp microscopic illustra-
tions of the posterior eye” (Hruby 1950).
All of these slit lamp works and also the follow-
ing are based on classic biomicroscopy which is evi-
dent from the chapters they address (see Table 6.1).
6.2.2 Further Literature on the Slit
Lamp
An early and fundamental text by Fréd Koby was
published in 1924 in French, in 1925 in German,
and in 1930 in English (Koby 1930). Koby, who
was from Basel, wanted to make current informa-
tion on the slit lamp (most of which had only
been published in German until then) available to
French readers. This text, which Koby illustrated
himself in black and white, contains key theoreti-
cal considerations concerning, for example, the
measurement of corneal thickness using the slit
lamp. Fréd Koby dedicated himself to getting the
latest slit lamp terminology in German translated
into other languages.
The US American Milton Lionel Berliner pub-
lished in 1949 a two-volume text on the slit lamp
with very fine drawings which, in its extent, qual-
ity and significance in the slit lamp literature, can
be considered the English-language counterpart
205
to Vogt’s atlas (see Fig. 6.22). Berliner’s book is
still the most recent to contain an extensive atlas
of slit lamp microscopy (Berliner 1949).
Noteworthy is his engaging didactic approach and
how he describes illumination techniques (i.e.,
sclerocorneal scatter). Amazingly, he uses (as did
those before him) only colored drawings to illus-
trate his book, citing the lack of suitable slit lamp
photographs.
Slit lamp photography made its mark on the
book market when the atlases of A.E. Braley
(1970) (Braley et al. 1970) and Ernst-Martin
Meyner (1976) were published. Both books con-
tain substantial technical coverage of stereopho-
tography. The slit lamp photographs taken by the
American eye photographer Csaba Mártonyi are
of especially outstanding quality. His “Slit lamp
– examination and photography” – first published
in 1984 and whose 3rd edition appeared in 2007
– can be considered the modern classic of slit
lamp photography (Mártonyi et al. 2007).
Mártonyi addresses modern fundoscopy with
the slit lamp but no longer does justice to the
clinical importance of and key role this type of
imaging plays nowadays in ophthalmological
practice. Likewise, he describes documentation
of the face, although not with the slit lamp.
Special applications of the slit lamp like goni-
oscopy (Faschinger and Hommer 2012) and bio-
microscopy of the peripheral fundus (Eisner 1973)
are described in great detail in separate books.
In the Russian-language literature, there is the
classic text by the Muscovite ophthalmologist
Nina Borisovna Shulpina published in 1966,
which contains a few colored illustrations and the
fascinating reference to an “infrared” slit lamp
(Shulpina 1966). Russian ophthalmologists do
not have access to later, updated editions of this
text (very difficult to acquire nowadays), as none
have been forthcoming.
6.2.3 Current Trends
The literature market on optics and optometry is
dominated by books on fitting contact lenses. A
good example thereof is Wolfgang Sickenberger’s
book (which has also been translated into English
and Japanese) (Sickenberger 2011).
206 6 History of the Slit Lamp

Fig. 6.22 Pathological

findings of the iris (Plate 53
from Vol 2 of ML Berliner’s
Atlas (Berliner 1949)).
1 Papules in luetic iritis;
2 Atrophic spots resulting from
healed papules; 3 Group of
syphilitic lesions; 4 Papules,
luetic iritis; 5 Verruca-like
growth with internal hemor-
rhage following luetic nodular
iritis; 6 So-called “iris
condyloma” in a woman
appearing six years after initial
infection
Literature
On the ophthalmology book market, we find
the topic “slit lamp” generally embedded in texts
addressing examination methods of the eye. (An
exception is the “Slit lamp primer,” whose cur-
rent edition contains black and white photographs
(Ledford and Sanders 2006).) Examples of the
former are books by P. Kroll (2008) (Kroll et al.
2008) and S. Doshi (2005) (Doshi and Harvey
2005). One notices the tendency in the current
literature, especially in retinology textbooks, to
use the slit lamp in passing, so to speak, when
conducting biomicroscopy of the fundus; they
usually seem to prefer promoting the use of high-
end new technologies (Gellrich 2011b).
With the popularity of e-books and Internet
publications, we now have access to information
on the slit lamp, although the film medium is
often used by individuals with little professional
expertise. The author would like to draw the
readers’ attention to a very readable historic
abridgement published in 2011 on the occasion
of the slit lamp’s 100th anniversary: Eilhard
Koppenhöfer has written a fine history of the slit
lamp’s development (http://de.wikipedia.org/
wiki/Spaltlampe) (Koppenhöfer 2011).
In the same year, the German version of this
book came out focusing on the new perspectives
of video technology, picture processing, and a
much broader application spectrum of the slit
lamp (Gellrich 2011a, c).
Literature
Abraham FA (1988) A device for easy slitlamp fundoscopy
with a +90-diopter lens. Ophthalmologica 196:40–42
Affolter A (1917) Ophthalmoskopische Untersuchungen
in rotfreiem Licht. Graefes Arch Ophthalmol 94:1–27
Allen L, Braley AE, Thorpe HE (1954) An improved gonio-
scopic contact prism. Arch Ophthalmol 51:451–455
Aubert H (1891) Demonstration eines binocularen
Hornhautmikroskops. Tagung der Ophthalmologischen
Gesellschaft Heidelberg, 21. Zusammenkunft. Klin
Monatsbl Augenheilkd 29: 260–261
Axenfeld T (1900) Eine neue Westien’sche binoculare
Handloupe (Brillenloupe) zum Präparieren und für
klinische Zwecke, mit veränderlicher Pupillendistanz
und verstellbarem Kopfhalter. Klin Monatsbl
Augenheilkd 38:20–25
Barkan O (1952) Contact lenses for gonioscopy and oph-
thalmoscopy. Am J Ophthalmol 35:1821
207
Barker FM, Wing JT (1990) Ultra wide field fundus bio-
microscopy with the Volk quadraspheric lens. J Am
Optom Assoc 61:573–575
Berliner ML (1949) Biomicroscopy of the eye. Hoeber,
New York
Birkhäuser R (1921) Eine neue Beleuchtungsvorrichtung
mit Bogenlicht (Bogenlicht-Fokallampe) für die
Untersuchung des vorderen Bulbusabschnittes sowie
für die Ophthalmoskopie mit rotfreiem Licht. Klin
Monatsbl Augenheilkd 66:240–248
Braley AE, Watzke RC, Allen L, Frazier O (1970)
Stereoscopic atlas of slit-lamp biomicroscopy. The CV
Mosby Company, Saint Louis
Castroviejo R (1835) Goniophotography. Photography of
the angle of the anterior chamber in living animals and
human subjects. Am J Ophthalmol 18:524–527
Coccius A (1853) Über die Anwendung des Augenspiegels
nebst Angabe eines neuen Instrumentes. Müller,
Leipzig
Comberg W (1933) Über eine neue Spaltlampe. Klin
Monatsbl Augenheilkd 91:577–583
Czapski S (1899) Binoculares Cornealmikroskop. Graefes
Arch Ophthalmol 48:229–235
Donaldson D (1950) A camera for stereoscopic photog-
raphy of the anterior segment. Arch Ophthalmol 43:
1083–1087
Doshi S, Harvey W (2005) Assessment and investiga-
tive techniques, Eye essentials. Elsevier/Butterworth
Heinemann, Edinburgh
Draeger J (1973) Technischer Fortschritt bei der
Kontaktglas-Untersuchung des Augenhintergrundes.
Ber Dtsch Ophthalmol Ges 73:297–301. Bergmann,
München
Duke-Elder S, David A (1970) System of ophthalmology,
vol 5. Kimpton, London, pp 94–95
Eisner G (1973) Biomicroscopy of the peripheral fun-
dus - An atlas and textbook. Springer, New York,
Heidelberg, Berlin, pp 1–191
El Bayadi G (1953) New method of slit-lamp microscopy.
Br J Ophthalmol 37:625–628
El Bayadi G (1965) Textbook of ophthalmology. Hani
Printing Office, Cairo
Erggelet H (1925) Das Spaltlampengerät. Die
Gullstrand’sche Spaltlampe und die Beobachtungsmittel
zur Untersuchung in fokaler Beleuchtung. In:
Handbuch der gesamten Augenheilkunde (begr. Graefe
A, Saemisch Th) Die Untersuchungsmethoden, 3.
Band, S. Springer, Berlin, pp 119–183
Evans JN (1932) Reflecting prism-lens for slit-lamp
microscopy of the retina. Arch Ophthalmol 8:274–277
Faschinger C, Hommer A (2012) Gonioscopy. Springer,
New York, Heidelberg, Berlin, pp 1–84
Fick EA (1888) Eine Contactbrille. Arch Augenheilkd
18:279–289
Frisen L (1972) An adjustable biomicroscopy contact glass
with erect imagery. Arch Ophthalmol 87:202–205
Funder W, Rotter H (1951) Ein neues Zusatzgerät zur
Untersuchung im optischen Horizontalschnitt an der
Spaltlampe von Haag-Streit. Graefes Arch Ophthalmol
151:765–771
208
Gellrich M-M (2011a) Spaltlampenvideografie ermög-
licht umfassenden Ophthalmologie-Bildatlas (Slit
lamp videography makes a comprehensive oph-
thalmological atlas possible). Z prakt Augenheilkd
32:567–573
Gellrich M-M (2011b) Centenary of the slit lamp (1911–
2011) Video presented at the conference of DOG in
Berlin and at the conference of cataract and refractive
surgery in Moscow 2011
Gellrich M-M (2011c) Die Spaltlampe – 1. Mitteilung Die Theorie, Apparatur und
Konstruktionsgeschichte, Untersuchungsmethoden,
Videografie. Kaden, Heidelberg, pp 1–194
Goldmann H (1933) Eine neue Spaltlampe. Klin Monatsbl
Augenheilkd 91:494–502
GoldmannH(1938)ZurTechnikderSpaltlampenmikroskopie.
Ophthalmologica 96:90–97
Goldmann H (1949) Einige Ergebnisse der Spaltlam-
penuntersuchungen des Kammerwinkels und des
Augenhintergrunds. Ophthalmologica 117:253–258
Goldmann H (1970) Fokale Beleuchtung. In: Die ophthal-
mologischen Untersuchungsmethoden (Hrsg: Straub
W). Enke, Stuttgart, pp 104–230
Gullstrand A (1907) Zur Maculafrage. Graefes Arch
Ophthalmol 66:141–188
Gullstrand A (1911) Demonstration der Nernst-Spaltlampe.
37. Versammlung der Ophthalmologischen Gesellschaft
Heidelberg. S. 374–376. Bergmann, Wiesbaden
Gullstrand A (1912) Die Nernstspaltlampe in der oph-
thalmologischen Praxis. IV. Jahresversammlung des
schwedischen augenärztlichen Vereins, Stockholm 1911
(translated by Fritz Ask) Klin Monatsbl Augenheilkd
50:483–484
Gullstrand A (1918) Die Macula centralis im rotfreien
Lichte. Klin Monatsbl Augenheilkd 60:289–324
Heinzen H, Würth A (1959) Die Photographie des
Kammerwinkels. Ophthalmologica 138:214–220
Hembold R (1910) Die Verwendung von Spektrallicht zur
Augenuntersuchung. Med Klin 6:1649–1650
Henker O (1916) Ein Träger für die Gullstrandsche
Nernst-Spaltlampe. Z ophthalmol Opt 4:75–85
Henker O (1920) Das vereinfachte große Gullstrand’sche
Ophthalmoskop. Z ophthalmol Opt 8:108–117
Heydenreich A (1959) Untersuchungsmethoden. In: Der
Augenarzt, Band 2 (Hrsg: Velhagen K) S. Thieme,
Stuttgart, pp 1–146
Holland G (2004) Von der seitlich fokalen Beleuchtung
zur modernen Spaltlampe. Mitteilungen der
Julius Hirschberg Gesellschaft zur Geschichte der
Augenheilkunde 6:53–84
Hruby K (1941) Über eine wesentliche Vereinfachung der
Untersuchungstechnik des hinteren Augenabschnittes
im Lichtbüschel der Spaltlampe. Graefes Arch
Ophthalmol 143:224–228
Hruby K (1942) Spaltlampenmikroskopie des hinteren
Augenabschnittes ohne Kontaktglas. Klin Monatsbl
Augenheilkd 108:195–200
Hruby K (1950) Spaltlampenmikroskopie des hinteren
Augenabschnittes. Untersuchungstechnik, Ergebnisse
und praktische Bedeutung. Urban & Schwarzenberg,
Wien
6 History of the Slit Lamp
Kapetansky FM (1988) A bubble-free goniolens.
Ophthalmic Surg 19:414–416
Kleefeld G (1937) La photographie des opacités annulai-
res du vitré. Bull Soc Belge Ophtalmol 75:116–118
Koby FE (1930) Slit lamp microscopy of the living eye.
Churchill, London
Koeppe L (1918) Die Mikroskopie des lebenden
Augenhintergrundes mit starker Vergrößerung im
fokalen Lichte der Gullstrand’schen Nernstspaltlampe.
Anwendungstechnik der Spaltlampenuntersuchung
des Augenhintergrundes im fokalen Licht. Graefes
Arch Ophthalmol 95:282–306
Koeppe L (1920) Die Mikroskopie des lebenden
Kammerwinkels im fokalen Lichte der Gullstrandschen
Nernstlampe. Graefes Arch Ophthalmol 101:48–66
Koeppe L (1922) Die Mikroskopie des lebenden Auges.
Springer, Berlin
Koppenhöfer E (2011) Von der seitlichen Beleuchtung
zur Spaltlampe. Ein kurzer medizinhistorischer Abriss
(From Lateral Illumination to Slit Lamp — A Brief
Outline of Medical History). http://de.wikipedia.org/
wiki/Spaltlampe
Kroll P, Küchle M, Küchle HJ (2008) Augenärztliche
Untersuchungsmethoden. Thieme, Stuttgart
Kronfeld PC, McGarry HI, Smith HE (1942) Gonioscopic
studies on the canal of Schlemm. Am J Ophthalmol
25:1163–1173
Laqueur L (1887) Über Beobachtungen mittelst der
Zehender-Westien’schen binocularen Cornealloupe.
Klin Monatsbl Augenheilkd 25:463–478
Ledford JK, Sanders V (2006) The slit lamp primer.
SLACK Incorporated, Thorofare
Lee NB (1990) Biomicroscopic examination of the ocu-
lar fundus with a +150 dioptre lens. Br J Ophthalmol
74:294–296
Lemoine V (1923) Ophtalmoscopie microscopique du
fond d’oeil vivant (sans verre de contact). Bull Mem
Soc Fr Ophtalmol 36:366–373
Leydhecker W (1969) Zwei Instrumente zur Goniotomie
und Angulozision. Klin Monatsbl Augenheilkd
154:111–112
Littmann H (1950a) Die Theorie der stereoskopischen
Fundusmikroskopie mit dem Spaltlampengerät.
Graefes Arch Ophthalmol 150:539–554
Littmann H (1950b) A new slit lamp apparatus. Am J
Ophthalmol 33:1863–1870
Lopez Enriquez EM (1936) Weitere Neuerungen
zur Untersuchung des Augenhintergrundes mit-
tels Spaltlampe. Klin Monatsbl Augenheilkd
96:181–182
Lopez Enriquez M (1935) Neue Zusatzeinrichtung für
die Mikroskopie des lebenden Auges. Klin Monatsbl
Augenheilk 95:77–79
Lundberg C (1985) Biomicroscopic examination of
the ocular fundus with a +60-Diopter lens. Am J
Ophthalmol 99:490–491
Mártonyi CL, Bahn CF, Meyer RF (2007) Slit lamp:
examination and photography. Revised and expanded
third edition. Time One Ink, Sedona
Literature
Meesmann A (1927) Die Mikroskopie des lebenden
Auges an der Gullstrandschen Spaltlampe mit Atlas
typischer Befunde. Urban & Schwarzenberg, Berlin
Meyner E-M (1976) Atlas der Spaltlampenphotographie –
a Atlas of slit lamp photography. Ferdinand Enke,
Stuttgart, pp 1–142
Michel J (1890) Lehrbuch der Augenheilkunde.
Bergmann, Wiesbaden
Mizuo (1914) Ein Verfahren zur Besichtigung der
Kammerbucht. (Abstract) Japan. Augenärztetagung
in Tokio (1913). “Nippon Gankakai Zashi”. Klin
Monatsbl Augenheilkd 52:561
Niesel P (1966) Probleme der Spaltlampenphotographie
der menschlichen Linse. Doc Ophthalmol 20:131–140
Richardson KT, Shaffer RN (1965) Infant ophthalmos-
copy and gonioscopy without general anesthesia. Arch
Ophthalmol 73:55–57
Rosenwasser G, Tiedeman JS (1986) A stable slit lamp
mounting device for 90 D lens use in non-contact oph-
thalmoscopy. Ophthalmic Surg 17:525
Rotter H (1955) Zur Theorie der Spaltlampenmikroskopie
des Augenhintergrundes. Über die Verwendung
einer Sammellinse als Vorsatzglas. Graefes Arch
Ophthalmol 156:503–518
Salzmann M (1914) Die Ophthalmoskopie der
Kammerbucht. Z Augenheilkd 31:1–19
Salzmann M (1915) Die Ophthalmoskopie der
Kammerbucht. Z Augenheilkd 34:26–69
Schanz F (1895) Ein Hornhautmikroskop und ein
Netzhautfernrohr mit conaxialer Beleuchtung. Arch
Augenheilkd 31:265–272
Schanz F (1898) Demonstration eines stereoskopischen
Hornhaut-Mikroskops. Tagung der Ophthalmol
Gesellsch Heidelberg 27:336–338. Bergmann,
München
Schlegel HJ (1969) Eine einfache Weitwinkeloptik
zur spaltlampenmikroskopischen Untersuchung
des Augenhintergrundes (Panfunduskop). Doc
Ophthalmol 26:300–308
Schmidt TAF (1975) On slit-lamp microscopy. Doc
Ophthalmol 39:117–153
Schmidt D (2001) Carl Wilhelm von Zehender (1819–
1916), “Vater der Mikrochirurgie”, erster Herausgeber
der Klinischen Monatsblätter für Augenheilkunde und
Mitbegründer der Ophthalmologischen Gesellschaft
Heidelberg. In: Mitteilungen der Julius-Hirschberg-
Gesellschaft zur Geschichte der Augenheilkunde
(Hrsg: Krogmann F). Königshausen & Neumann,
Würzburg, pp 79–166
Schnyder WF (1921) Eine einfache Bogenspaltlampe
und theoretische Ausführungen über das neue
Beleuchtungsprinzip der Spaltlampe und dessen
Bedeutung. Z Augenheilkd 46:328–345
Shulpina NB (1966) Биомикроскопия глаза
(Biomicroscopy of the eye). Medicina, Moscow
Sickenberger W (2011) Klassifikation von
Spaltlampenbefunden, DOZ
Stähli J (1915) Die Azo-Projektionslampe (Halbwatt-
Lampe) der deutschen Auergesellschaft, ein Ersatz für
Nernstlicht. Klin Monatsbl Augenheilkd 54:685–688
209
Steinvorth E, Hötte E (1959) Kammerwinkelphotographie
mit der Minox-Kamera. Klin Monatsbl Augenheilkd
135:112–113
Streuli H (1920) Beleuchtungstechnik der Spaltlampe.
Klin Monatsbl Augenheilkd 65:769–782
Streuli H (1921) Beleuchtungstechnik der Spaltlampe.
Mitteilung über ein einfaches und praktisches
Modell einer Bogenspaltlampe nebst Vorrichtung zur
Ophthalmoskopie im rotfreien Licht. Klin Monatsbl
Augenheilkd 66:512–524
Thiel R (1930) Photographierte Spaltlampenbilder.
Tagung der Dtsch Ophthalmol Ges 48:355–357.
Bergmann, München
Trantas A (1900) Moyens d’explorer par l’ophtalmoskope
– et par translucidité – la partie antérieure du fond ocu-
laire, le cercle ciliaire y compris. (Abstract) Cbl prakt
Augenheilkd 24:277–278
Trantas A (1907) Ophtalmoscopie de la région ciliaire et
rétrociliaire. Arch Ophtalmol (Paris) 27:581–606
Trantas A (1928) Sur la gonioscopie (Ophtalmoscopie
de l’angle irido-cornéen). Arch Ophtalmol (Paris)
45:617–635
Troncoso MU (1925) Gonioscopy and its clinical applica-
tions. Am J Ophthalmol 8:433–449
van Beuningen EGA, Fischer FW (1957) Über eine
Methode zur Photographie farbiger, stereoskopischer
Kammerwinkelbilder. Ber Dtsch Ophthalmol
Gesellsch 60. Zusammenkunft S. 291–296. Bergmann,
München
Vogt A (1913a) Herstellung eines gelbblauen
Lichtfiltrates, in welchem die Macula in vivo in gelber
Färbung erscheint, die Nervenfasern der Netzhaut und
andere feine Einzelheiten derselben sichtbar werden,
und der Grad der Gelbfärbung der Linse ophthalmos-
kopisch nachweisbar ist. Graefes Arch Ophthalmol
84:293–311
Vogt A (1913b) Demonstration eines von Rot bef-
reiten Ophthalmoskopierlichtes. Tagung der
Ophthalmologischen Gesellschaft Heidelberg 39:416–
417. Ritter, Wiesbaden
Vogt A (1920) Die Tiefenlokalisation in der
Spaltlampenmikroskopie. Z Augenheilkd 43:393–402
Vogt A (1921a) Vergleichende Messungen der spezifischen
Helligkeit von Nernst-Nitra- und Bogenspaltlampe
bei alter und neuer Abbildungsweise. Z Augenheilkd
46:1–7
Vogt A (1921b) Atlas der Spaltlampenmikroskopie.
Springer, Berlin
Vogt A (1921c) Die Reflexion der Netzhautvorderfläche
im rotfreien Licht. Präretinale (superfizielle reti-
nale) Fältchenbildung. Klin Monatsbl Augenheilkd
66:838–859
Vogt A (1925) Die Ophthalmoskopie im rotfreien Licht.
In: Handbuch der gesamten Augenheilkunde (begr.
Graefe A, Saemisch Th). Die Untersuchungsmethoden
3. Band. Springer, Berlin, pp 1–118
VogtA(1930)LehrbuchundAtlasderSpaltlampenmikroskopie
des lebenden Auges mit Anleitung zur Technik und
Methodik der Untersuchung. Zugleich zweite Auflage
des “Atlas der Spaltlampenmikroskopie”. Erster Teil:
210 6 History of the Slit Lamp

Technik und Methodik, Hornhaut und Vorderkammer. Volk D United States patent No. 4,721,378, 26 Jan 1988
Springer, Berlin (zit bei Snead et al. 1992)
Vogt A (1931) Lehrbuch und Atlas der von Zehender CW, Westien H (1887) Beschreibung der
Spaltlampenmikroskopie des lebenden Auges binocularen Cornealoupe. Klin Monatsbl Augenheilkd
mit Anleitung zur Technik und Methodik der 25:496–499
Untersuchung. Zugleich zweite Auflage des “Atlas der Wegner W (1929) Demonstrationspolyophthalmoskop.
Spaltlampenmikroskopie”. Zweiter Teil: Linse und Klin Monatsbl Augenheilkd 83:544–548
Zonula. Springer, Berlin Wolff H (1908) Zur Photographie des menschlichen
Vogt A (1942) Lehrbuch und Atlas der Augenhintergrunds. Arch Augenheilkd 59:115–142
Spaltlampenmikroskopie des lebenden Auges Zamenhof A (1930) Ein neuer Weg zur Untersuchung des
mit Anleitung zur Technik und Methodik der Augenhintergrundes im fokalen Licht. Graefes Arch
Untersuchung. Zugleich zweite, stark erweiterte Ophthalmol 124:87–102
Auflage des “Atlas der Spaltlampenmikroskopie”. Zamenhof A (1933) Die Ophthalmoskopie im fokalen
Dritter Teil: Iris, Glaskörper, Bindehaut. Schweizer und indirekten Licht. Graefes Arch Ophthalmol
Druck- und Verlagsanstalt, Zürich 129:149–190