For clinical examinations and gene therapy trials the optical imaging of the retina is essential in order to identify the earliest stages or changes of a disease. Due to the fact that pathogenesis of retinal neurodegenerations begins at the level of individual cells, medical devices with a resolution up to a few µm are needed. With the adaptive optics (AO) fundus imaging a resolution up to parafoveal cone size is given. Therefore the AO-imaging is a potential novel possibility to examine the subtle changes in the photoreceptor mosaic, the wall-to-lumen ratio in retinal neurodegenerations and also retinal inflammatory and immune reaction (e.g. giant pigmented cells) in a non-invasive way. Subtle changes in the photoreceptor structure are of high interest in developing new therapies and also for the safety and efficacy of therapy. Furthermore by visualizing of immune cells in the subretinal space, their behavior with associated changes in the tissue and the investigation of vessel changes new insight into the detection and dynamics of retinal immune reactions are possible. In this study patients with hereditary retinal degenerations caused by mutations in genes which are in consideration for preparation for or in running gene therapy trials, patients with a juvenile macular degeneration and patients with inflammatory diseases of the retina are observed.