The options here let you launch Opus or run another command by double-clicking on the Windows desktop. This can provide an extremely quick way to access a Lister when you have no windows currently open - simply find an empty area of the desktop (one with no icons on it) and double-click.
When any of the double-click options are enabled, Opus launches a small helper application called dopusrt.exe that runs continuously in the background. This is added to the registry to run automatically on startup, and means that double-click on the desktop works even when Opus itself isn't running (dopusrt.exe will launch Opus automatically if it's not already running when you double-click).
In order to trap double-clicks on the desktop (which runs in another process to Opus) it's necessary to "inject code" into Explorer - if you have an anti-virus or anti-spyware tool installed you may find it detects this and complains. If you find that double-click on the desktop isn't working check if something is blocking dopusrt.exe from hooking into Explorer or from running on startup.