Structural dissociation of optic disc margin components with optic disc tilting: a spectral domain optical coherence tomography study.

PURPOSE: To investigate the dissociation of the Bruch's membrane opening (BMO) from the scleral canal opening (SO) of the optic disc. METHODS: In this prospective, cross-sectional, observational study, 101 eyes from 101 patients or suspected subjects of primary open angle glaucoma were included. Enhanced depth imaging spectral domain optical coherence tomography images along the long axis of the optic disc were used to visualize better the deep structures around the optic disc on both the temporal and nasal sides. The distances between the BMO and SO were measured at the temporal and nasal sides of the optic disc, and their correlations with age, axial length, intraocular pressure, disc size, disc ovality index, disc torsion degree, and visual field mean deviation were investigated. RESULTS: The temporal and nasal distances of BMO from SO correlated significantly with each other (R = 0.632, P < 0.0001). By multiple linear regression analysis, significant correlations were found for disc ovality index (temporal: ß = -0.691, P < 0.0001; nasal: ß = -0.420, P < 0.0001) and axial length (temporal: ß = 0.224, P = 0.002; nasal: ß = 0.310, P = 0.001). The other factors did not show any significant correlation. CONCLUSION: Locations of the SO at not only the temporal, but also the nasal side of the optic disc are nasally shifted from the BMO with optic disc tilting and axial length elongation in glaucomatous eyes, and are significantly correlated to each other. The nasal shift of the deep structures of the optic disc should be considered especially when assessing myopic eyes with optic disc tilt.

Sensitivity and specificity for detecting early glaucoma in eyes with high myopia from normative database of macular ganglion cell complex thickness obtained from normal non-myopic or highly myopic Asian eyes.

PURPOSE: We aimed to determine the sensitivity and specificity of the normative database of non-myopic and highly myopic eyes of the macular ganglion cell complex (mGCC) thickness embedded in the NIDEK RS-3000 spectral-domain optical coherence tomography (SD-OCT) for detecting early glaucoma in highly myopic eyes. METHODS: Forty-seven highly myopic eyes (axial length ≥26.0 mm) of 47 subjects were studied. The SD-OCT images were used to determine the mGCC thickness within a 9-mm diameter circle centered on the fovea. The sensitivity and specificity of the non-myopic database were compared to that of the highly myopic database for distinguishing the early glaucomatous eyes from the non-glaucomatous eyes. The mGCC scans were classified as abnormal if at least one of the eight sectors of the significance map was < 1 % of the normative thickness. RESULTS: Twenty-one eyes were diagnosed to be non-glaucomatous and 26 eyes to have early glaucoma. . The average mGCC thickness was significantly thinner (80.9 ± 8.5 µm) in the early glaucoma group than in the non-glaucomatous group (91.2 ± 7.5 µm; p <1 × 10(-4)). The sensitivity was 96.2 % and specificity was 47.6 % when the non-myopic database was used, and the sensitivity was 92.3 % and the specificity was 90.5 % when the highly myopic database was used. The difference in the specificity was significant (p < 0.01). CONCLUSIONS: The significantly higher specificity of the myopic normative database for detecting early glaucoma in highly myopic eyes will lead to fewer false positive diagnoses. The database obtained from highly myopic eyes should be used when evaluating the mGCC thickness of highly myopic eyes.

EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON LONG-TERM VISUAL OUTCOMES FOR DIABETIC MACULAR EDEMA.

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling on the long-term visual outcomes in eyes with diffuse, nontractional diabetic macular edema. METHODS: One hundred and sixteen eyes of 58 patients with the same degree of diabetic macular edema in both eyes underwent pars plana vitrectomy with the creation of a posterior vitreous detachment in both eyes. Internal limiting membrane peeling was performed in one randomly selected eye (ILM-off group), and ILM peeling was not performed (ILM-on group) in the fellow eye. The postoperative follow-up period ranged from 12 months to 161 months (average, 80.4 months). RESULTS: In the ILM-off group, the mean best-corrected visual acuity in logMAR units (Snellen equivalent) increased from 0.55 ± 0.31 (20/71) before surgery to 0.35 ± 0.35 (20/45) at 1 year (P < 0.0001) and 0.46 ± 0.43 (20/59) at the final visit (P = 0.058). In the ILM-on group, the mean best-corrected visual acuity increased from 0.55 ± 0.41 (20/71) before surgery to 0.43 ± 0.38 (20/54) at 1 year (P = 0.010) and 0.44 ± 0.45 (20/56) at the final visit (P = 0.043). The differences in the best-corrected visual acuity between the two groups were not significant at any time point. CONCLUSION: Pars plana vitrectomy with or without ILM peeling improves the long-term visual acuity of nontractional diabetic macular edema. Internal limiting membrane peeling does not affect the postoperative best-corrected visual acuity significantly.

Measurement of macular ganglion cell layer and circumpapillary retinal nerve fiber layer to detect paracentral scotoma in early glaucoma.

BACKGROUND: Glaucoma patients with paracentral scotoma are at higher risk of losing central vision than those without glaucoma. The purpose of this study was to determine whether macular inner retinal layer (MIRL) measurements with spectral-domain optical coherence tomography (SD-OCT) outperform circumpapillary retinal nerve fiber layer (cpRNFL) measurements in discriminating between eyes with and without paracentral scotoma. METHODS: This retrospective study included 63 early glaucomatous eyes of 63 patients with (PSI group) or without (PSF group) paracentral visual field (VF) defects. MIRL thicknesses, including macular ganglion cell complex (mGCC), macular ganglion cell layer + inner plexiform layer (mGCL+), macular RNFL (mRNFL), and cpRNFL thickness were measured using a SD-OCT instrument (3D OCT-2000). The MIRL and cpRNFL were divided into 50 grid cells and 36 sectors, respectively, which were numbered from center/temporal to periphery/nasal. Discriminating ability of the methods for number of cells/sectors with abnormal thickness (<5% of normal) and average thickness in the hemisphere corresponding to the VF defects (termed hemi-thickness) was compared by area under the receiver operating characteristics curves (AROCs). RESULTS: The number of abnormal nearest sectors of cpRNFL and all MIRL parameters were significantly smaller in the PSI group than in the PSF group (P ≤ 0.001-0.047), whereas no significant differences were found for average or hemi-cpRNFL thickness. The AROCs of the number of abnormal nearest cells for mGCC and mGCL+ and average hemi-thickness for mGCC, mGCL+, and mRNFL were comparable and significantly higher than those of the number of abnormal nearest sectors/cells for cpRNFL (P = 0.0002-0.0063) and mRNFL (P = 0.0003-0.0267) parameters. CONCLUSIONS: Regional assessment of MIRL thickness as measured by SD-OCT may potentially be an effective method for predicting central involvement of VF defects in early glaucoma.

Frequency-doubling technology and retinal measurements with spectral-domain optical coherence tomography in preperimetric glaucoma.

BACKGROUND: To determine the relationship between visual fields and retinal structures measured with spectral-domain optical coherence tomography in preperimetric glaucoma (PPG). METHODS: Twenty-six eyes of 26 patients with PPG and 20 healthy eyes of 20 volunteers were included. All patients underwent Heidelberg retina tomography-2 (HRT2), standard automated perimetry (SAP), frequency-doubling technology (FDT) perimetry, and RTVue-100. SAP and FDT indices, HRT parameters, and circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (mGCC) thicknesses were correlated using Pearson's test. Areas under the receiver operating characteristic curves (AUROCs) and sensitivity/specificity based on each parameter's definition of abnormalities were compared between parameters. RESULTS: Significant differences were found in FDT-MD, FDT-PSD, SAP-PSD, cpRNFL, and mGCC parameters (p < 0.001-0.015), but not in SAP-MD or HRT parameters, between PPG and control groups. Significant correlations were not found between visual field indices and structural parameters, except between FDT-MD and HRT rim area (r = 0.450, p = 0.021) and between FDT-PSD and temporal cpRNFL thickness (r = 0.402, p = 0.021). AUROCs for cpRNFL (p = 0.0047-0.033) and mGCC (p = 0.0082-0.049) parameters were significantly better than those of HRT parameters, whereas significant differences were not found between FDT indices and cpRNFL or mGCC parameters or between cpRNFL and mGCC parameters. Adding average cpRNFL or mGCC thickness to FDT-MD significantly increased sensitivity compared to single parameters (p = 0.016-0.031). CONCLUSIONS: Structural and functional parameters were poorly correlated but complementary for glaucoma detection in PPG. Combining these parameters may improve PPG diagnosis.

Photoreceptor outer segment abnormalities and retinal sensitivity in acute zonal occult outer retinopathy.

PURPOSE: To investigate the relationship between retinal function and photoreceptor abnormalities in eyes with acute zonal occult outer retinopathy. METHODS: Five patients with acute zonal occult outer retinopathy underwent complete ophthalmologic examination, including spectral-domain optical coherence tomography. Spectral-domain optical coherence tomography findings were compared with retinal sensitivity measured by microperimetry. RESULTS: Spectral-domain optical coherence tomography images revealed disruptions in the inner segment/outer segment junction line in four of five eyes and disruptions in the outer segment (OS) tip lines in all eyes. Mean retinal sensitivity was 15.1 ± 3.6 dB in the intact OS tip regions and 6.0 ± 6.3 dB in disrupted regions (P < 0.001). In all eyes, disruption of the OS tip lines was also seen in regions of reduced retinal sensitivity, although the inner segment/outer segment was intact. Within the intact inner segment/outer segment regions, mean retinal sensitivity was 7.5 ± 6.7 dB at locations of OS tip disruption and 15.1 ± 3.6 dB at intact OS tip locations (P < 0.001). CONCLUSION: Structural abnormalities in the photoreceptors were correlated with visual function in eyes with acute zonal occult outer retinopathy. Loss of photoreceptor OS, as indicated by disruptions of the OS tip lines on spectral-domain optical coherence tomography, may represent the primary lesion in acute zonal occult outer retinopathy.

Local biometric features and visual prognosis after surgery for treatment of myopic foveoschisis.

PURPOSE: To identify the local biometric factors associated with postoperative best-corrected visual acuity (BCVA) after surgical treatment of myopic foveoschisis by using spectral-domain optical coherence tomography. METHODS: Eleven eyes of 10 patients that underwent vitrectomy combined with internal limiting membrane peeling for treatment of myopic foveoschisis were investigated. We measured the height and lateral width of the foveal detachment, subfoveal choroidal thickness, and height of the posterior staphyloma using spectral-domain optical coherence tomography. RESULTS: Foveal detachments found in 8 eyes were not significantly related to postoperative BCVA. Intraclass correlation coefficients of spectral-domain optical coherence tomography measurements were substantial to nearly perfect (0.786-0.951). The postoperative BCVA 12 months after surgery was significantly correlated with age (r(s) = 0.616, P = 0.044), preoperative BCVA (r(s) = 0.833, P = 0.001), preoperative subfoveal choroidal thickness (r(s) = -0.661, P = 0.027), and posterior staphyloma height (r(s) = 0.642, P = 0.033). Neither postoperative BCVA nor changes in BCVA showed significant correlations with the axial length or height or lateral width of the foveal detachment. CONCLUSION: These results at least raise the possibility that a thin choroid and likely severe posterior staphyloma before surgery can predict postoperative BCVA after vitrectomy for the treatment of myopic foveoschisis.

Assessment of macular choroidal thickness by optical coherence tomography and angiographic changes in central serous chorioretinopathy.

OBJECTIVE: To investigate the relationship between macular choroidal thickness measured by high-penetrating swept-source optical coherence tomography (SS-OCT) and angiographic findings in central serous chorioretinopathy (CSC). DESIGN: Prospective cross-sectional case series. PARTICIPANTS AND CONTROLS: Thirty-four patients with CSC (44 eyes) and 17 volunteer subjects (17 normal eyes). METHODS: All subjects underwent a comprehensive ophthalmologic and SS-OCT prototype examination. All patients with CSC also underwent simultaneous fluorescein angiography (FA) and indocyanine green angiography (IA). Mean regional choroidal thickness measurements on the Early Treatment Diabetic Retinopathy Study (ETDRS) layout and squared sector grids were obtained by 3-dimensional raster scanning using SS-OCT. MAIN OUTCOME MEASURES: Macular choroidal thickness and angiographic abnormalities. RESULTS: Mean whole macular choroidal thickness in eyes with CSC (total, 329.3±83.0 µm; classic CSC, 326.9±83.1 µm; chronic CSC, 325.4±93.3 µm; and multifocal posterior pigment epitheliopathy, 359.0±15.5 µm) was greater than that in normal eyes (233.0±67.0 µm) (P < 0.001). In unilateral cases, mean whole macular choroidal thickness was greater in eyes with unilateral CSC than in unaffected fellow eyes (P=0.021). There was no significant difference in choroidal thickness between active eyes and resolved eyes in any of the ETDRS sectors. Mean choroidal thickness was greater in areas with leakage on FA than in areas without leakage (P=0.001). Mean choroidal thickness was greater in areas with choroidal vascular hyperpermeability and in areas with punctate hyperfluorescent spots on IA than in unaffected areas (P<0.001 for both). CONCLUSIONS: Increased choroidal thickness was observed in the whole macular area of eyes with any of the CSC subtypes. Choroidal thickness was related to leakage from the retinal pigment epithelium, choroidal vascular hyperpermeability, and punctate hyperfluorescent lesions. These findings provide evidence that CSC may be caused by focally increased hydrostatic pressure in the choroid.

Vitreoretinal interface and foveal deformation in asymptomatic fellow eyes of patients with unilateral macular holes.

PURPOSE: To compare the vitreoretinal interface of the asymptomatic fellow eyes of patients with unilateral macular holes (MHs) with that of the asymptomatic fellow eyes of patients with other retinal diseases and with that of healthy eyes. DESIGN: Retrospective, observational cross-sectional study. PARTICIPANTS: This study included 137 healthy volunteers and 929 eyes of 929 patients with various unilateral retinal diseases. METHODS: We reviewed medical charts, fundus photographs, and spectral-domain optical coherence tomographic (SD OCT) images. The incidence of the features of the vitreoretinal interface and foveal structures in the SD OCT images were compared among the asymptomatic fellow eyes of patients with unilateral MHs (n = 242), age-related macular degeneration (n = 129), epiretinal membrane (n = 185), macular pseudohole (n = 48), rhegmatogenous retinal detachment (n = 68), retinal vein occlusion (n = 257), and 1 of the eyes of healthy individuals (n = 137). MAIN OUTCOME MEASURES: Findings of slit-lamp biomicroscopy and SD OCT B-scan images. RESULTS: The SD OCT B-scan images showed different types of foveal deformations associated with vitreofoveal adhesions in eyes without a posterior vitreous detachment (PVD) in the macular area. The incidence of the foveal deformations associated with vitreofoveal adhesions was significantly higher (P<0.0001) in the fellow eyes of the unilateral MH group (17%) than that in the other groups (0%-2%), except for the macular pseudohole group (8%). The SD OCT B-scan images also showed residual foveal deformations in eyes with a macular PVD. The incidence of a residual foveal deformation in eyes with a macular PVD was significantly higher (P<0.0001) in the MH group (32%) than that in any other group (0%-9%). CONCLUSIONS: The higher incidence of foveal deformations in the fellow eyes of patients with unilateral MHs with and without vitreofoveal adhesions suggests that patients in whom MHs develop have abnormally strong vitreofoveal adhesions sufficient to cause foveal deformation. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Macular ganglion cell layer imaging in preperimetric glaucoma with speckle noise-reduced spectral domain optical coherence tomography.

OBJECTIVE: To visualize the macular ganglion cell layer (GCL) and measure its thickness in normal eyes and eyes with preperimetric glaucoma, using speckle noise-reduced spectral domain optical coherence tomography (SD-OCT). DESIGN: Retrospective consecutive case series. PARTICIPANTS: Thirty-seven eyes of 37 patients with preperimetric glaucoma and 39 normal eyes of 39 volunteers. METHODS: Vertical and horizontal SD-OCT B-scan images were acquired with minimal speckle noise by using eye-tracking to obtain and average 50 B-scans at each identical location of interest. B-scan images were manually analyzed for GCL, retinal nerve fiber layer (RNFL), and inner plexiform layer shapes and thicknesses in the macula. MAIN OUTCOME MEASURES: Macular GCL images and thickness in normal eyes and in eyes with preperimetric glaucoma. RESULTS: The macular GCL was clearly seen on speckle noise-reduced SD-OCT images in normal eyes and eyes with preperimetric glaucoma. In each eye with preperimetric glaucoma, thinning of the macular GCL was visually apparent, particularly on vertical scans. The mean regional macular GCL was most severely thinned in the inferior perifoveal region, where its thickness was <70% of its normal thickness in 30 (81.1%) of the 37 eyes and <50% of its normal thickness in 13 (35.1%) of the 37 eyes. When the sensitivity and specificity for detecting abnormal thinning (outside the lower limit of 99% confidence interval [CI] for the means in the 39 normal eyes) in at least one 0.5-mm segment or sector were compared, the macular GCL on vertical B-scans exhibited higher sensitivity (81.1%) than the other layers on vertical B-scans (99% CI, 5.4%-59.5%; P = 0.00075-0.02100), the macular GCL (99% CI, 40.5%; P = 0.00027) on horizontal B-scans, the other layers (99% CI, 5.4%-48.6%; P<0.00048-0.00400) on horizontal B-scans, and circumpapillary RNFL automatically measured on SD-OCT (54.1%; P = 0.021), and scanning laser polarimetry with variable corneal compensation (24.3%; P = 0.00095). All the macular layers on both the vertical and horizontal B-scans and circumpapillary RNFL thickness exhibited comparable specificity (91.4-100.0%, statistically not different). CONCLUSIONS: Speckle noise-reduced SD-OCT imaging allowed clear visualization and measurement of the macular GCL, which was severely thinned in eyes with preperimetric glaucoma. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

High-resolution imaging of the photoreceptor layer in epiretinal membrane using adaptive optics scanning laser ophthalmoscopy.

OBJECTIVE: To compare, in eyes with an idiopathic epiretinal membrane (ERM), photoreceptor cell structural abnormalities identified on high-resolution images obtained by adaptive optics scanning laser ophthalmoscopy (AO-SLO) with the severity of metamorphopsia and anatomic findings on spectral-domain optical coherence tomography (SD-OCT). DESIGN: Observational case series. PARTICIPANTS: Twenty-five eyes of 24 patients with idiopathic ERM and 20 normal eyes of 20 volunteer subjects. METHODS: All participants underwent a full ophthalmologic examination, SD-OCT, and imaging with an original prototype AO-SLO system that incorporated liquid crystal-on-silicon technology. In eyes with ERM, M-CHARTS results were used to quantify metamorphopsia. MAIN OUTCOME MEASURES: Cone mosaic patterns on AO-SLO images and metamorphopsia severity. RESULTS: In normal eyes, AO-SLO images showed a regular photoreceptor mosaic pattern. In 24 (96%) of 25 eyes with ERM, "microfolds" (multiple thin, straight, hyporeflective lines in the photoreceptor layer) were identified on AO-SLO images; microfolds were not seen in normal eyes. Individual microfolds were approximately 5 to 20 µm wide, which is narrower than retinal folds seen in fundus photographs (>50 µm). Amsler charts revealed metamorphopsia around the fixation point in 12 of 13 eyes with microfolds in the fovea on AO-SLO but in none of 5 eyes without microfolds in the fovea (P < 0.001). Compared with eyes without foveal microfolds, eyes with foveal microfolds had more severe metamorphopsia (M-CHARTS distortion) in both horizontal and vertical lines (P < 0.001 for both) and greater average foveal thickness detected by SD-OCT (P=0.010). Voronoi analysis revealed that smaller numbers of cones in eyes with ERM had 6 neighbors, compared with normal eyes (P < 0.001). In eyes with ERM, average foveal thickness measured by SD-OCT correlated with visual acuity (P=0.001) and metamorphopsia scores, both horizontal (P=0.002) and vertical (P < 0.001), but visual acuity, metamorphopsia scores, and average foveal thickness were not related to SD-OCT findings of disruption in the photoreceptor inner and outer segment junction. CONCLUSIONS: Adaptive optics scanning laser ophthalmoscopy images in eyes with ERM showed abnormal cone mosaic patterns, described as microfolds in the foveal photoreceptor layer. The presence of microfolds was associated with metamorphopsia, suggesting that microfolds may be involved in the formation of metamorphopsia.

Detection of localized retinal nerve fiber layer defects in glaucoma using enhanced spectral-domain optical coherence tomography.

OBJECTIVE: To compare retinal nerve fiber layer (RNFL) defects on fundus photographs with circumpapillary RNFL (cpRNFL) thinning or disruption on images obtained by speckle-noise-reduced spectral-domain optical coherence tomography (enhanced SD OCT), single-scan SD OCT, and single-scan time-domain OCT (TD OCT). DESIGN: Retrospective, comparative case series. PARTICIPANTS: Forty-four eyes of 44 patients with open-angle glaucoma with localized, wedge-shaped RNFL defects on red-free photographs and 35 normal eyes of 35 volunteers. METHODS: Cross-sectional images of the cpRNFL and cpRNFL thinning, compared with the confidence interval limit of the normative database where the RNFL defect was photographically identified, were compared between the 3 types of OCT instruments: enhanced SD OCT (SD OCT with eye tracking and averaging of 16 images at the same location to reduce speckle noise; Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany), single-scan SD OCT (RTVue-100; Optovue, Fremont, CA), and single-scan TD OCT (Stratus; Carl Zeiss-Meditec, Dublin, CA). MAIN OUTCOME MEASURES: Cross-sectional images of localized RNFL defects on red-free fundus photographs, sensitivity for detecting the photographic RNFL defect, and sensitivity and specificity for detecting glaucoma as having at least 1 abnormally thinned sector on the cpRNFL thickness map on OCT. RESULTS: Among the 44 eyes with glaucoma, 65 RNFL defects were identified on red-free fundus photographs. The cpRNFL boundaries were clearer on enhanced SD OCT images than on single-scan SD OCT or TD OCT images, particularly in regions corresponding to the RNFL defects. Enhanced SD OCT revealed various degrees of cpRNFL thinning, and disruption of cpRNFL reflectivity was seen in the same location as the photographic RNFL defect for 23 (35.4%) of the 65 RNFL defects. The RNFL defects were significantly less likely to be detected by single-scan TD OCT or SD OCT (P = 0.002 and P = 0.006, respectively) when the RNFL was not disrupted. Enhanced SD OCT was more sensitive in detecting the RNFL defects that were not disrupted compared with single-scan TD OCT (P<0.0001) or SD OCT (P<0.0001). Enhanced SD OCT had better sensitivity and specificity for detecting glaucoma compared with single-scan TD OCT or SD OCT (sensitivity, P = 0.006 and P = 0.001; specificity, P = 0.001 and P = 0.004, respectively). CONCLUSIONS: These results suggest that speckle-noise reduction can improve the detection of photographic RNFL defects in which cpRNFL reflectivity on OCT images is not disrupted. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

High-resolution imaging of resolved central serous chorioretinopathy using adaptive optics scanning laser ophthalmoscopy.

OBJECTIVE: To compare pathologic changes in photoreceptors in eyes with resolved central serous chorioretinopathy (CSC) seen on high-resolution images obtained by adaptive optics scanning laser ophthalmoscopy (AO SLO) with visual acuity (VA) and findings on spectral-domain optical coherence tomography (SD OCT). DESIGN: Observational case series. PARTICIPANTS: Forty-five eyes of 38 patients with resolved CSC and 20 normal eyes of 20 volunteer subjects. METHODS: All patients underwent a full ophthalmologic examination, SD OCT, and imaging with an original prototype AO SLO system fabricated using liquid crystal-on-silicon technology. MAIN OUTCOME MEASURES: Cone mosaic patterns and cone density on AO SLO images and VA in eyes with CSC. RESULTS: In normal eyes, AO SLO images showed a regular photoreceptor mosaic pattern and average cone densities 0.2, 0.5, and 1.0 mm from the central fovea of 67,900, 33,320, and 14,450 cones/mm(2). In eyes with CSC, cone densities were significantly lower at each distance from the central fovea (P = 0.009 at 0.2 mm, P = 0.007 at 0.5 mm, and P = 0.004 at 1.0 mm), and 2 distinct cone mosaic patterns were seen. Group 1 CSC eyes had regular cone mosaic patterns with small dark regions. Group 2 CSC eyes had irregular mosaic patterns with large dark regions. Compared with group 1, group 2 had significantly lower average cone density and worse average logarithm of the minimum angle of resolution (logMAR) VA (P<0.001). Mean cone density in eyes with disruptions in the photoreceptor inner and outer segment (IS/OS) junction or in the intermediate line on SD OCT images was significantly lower than that in eyes with an intact IS/OS junction or intermediate line (P<0.001 for both). Cone density 0.2 mm from the central fovea correlated with logMAR VA and mean foveal thickness (1-mm diameter area) measured on SD OCT images (P<0.001 for both). CONCLUSIONS: Adaptive optics SLO images showed abnormal cone mosaic patterns and reduced cone densities in eyes with resolved CSC, and these abnormalities were associated with VA loss, suggesting that AO SLO is a useful means to detect and measure cone abnormalities associated with VA loss in these eyes.

Automated layer segmentation of macular OCT images using dual-scale gradient information.

A novel automated boundary segmentation algorithm is proposed for fast and reliable quantification of nine intra-retinal boundaries in optical coherence tomography (OCT) images. The algorithm employs a two-step segmentation schema based on gradient information in dual scales, utilizing local and complementary global gradient information simultaneously. A shortest path search is applied to optimize the edge selection. The segmentation algorithm was validated with independent manual segmentation and a reproducibility study. It demonstrates high accuracy and reproducibility in segmenting normal 3D OCT volumes. The execution time is about 16 seconds per volume (480x512x128 voxels). The algorithm shows potential for quantifying images from diseased retinas as well.

Early trabeculectomy bleb walls on anterior-segment optical coherence tomography.

BACKGROUND: To correlate the cross-sectional features of filtering blebs on anterior-segment optical coherence tomography (AS-OCT) 2 weeks after trabeculectomy with bleb function at 6 months. METHODS: Forty-eight eyes followed for 6 months or more after trabeculectomy with mitomycin C were included. Bleb wall reflectivity of developing blebs on AS-OCT 2 weeks postoperatively was correlated with mature bleb function at 6-month postoperative visit. RESULTS: Developing bleb walls at 2 weeks were classified as uniform in 10/48 eyes (20.8%) and multiform in 38/48 eyes (79.2%). Blebs with uniform reflectivity were significantly more likely to have worse function at 6 months (P < 0.001). Multiform bleb walls had hyporeflective areas seeming to represent loosely-arranged connective tissue (multiple-layer structures), subconjunctival separation, and microcysts. Blebs with multiple-layer structures at 2 weeks were associated with better bleb function at 6 months (P = 0.025). Intraocular pressure (IOP) of developing blebs at 2 weeks did not correlate with bleb function at 6 months (P = 0.471). CONCLUSIONS: Bleb wall reflectivity on AS-OCT 2 weeks after surgery may predict bleb function at 6 months, whereas IOP of developing blebs may not.

Correlation between thickening of the inner and outer retina and visual acuity in patients with epiretinal membrane.

PURPOSE: The purpose of this study was to examine the relationship between thickening of the inner and outer retinal layers and visual acuity in patients with idiopathic epiretinal membrane. METHODS: We examined 30 eyes of 30 patients and 25 eyes of 25 healthy volunteers as age-matched normal control subjects. The inner (between the vitreoretinal interface and the outer border of inner plexiform layer), outer, and full retinal thickness at the fovea, parafovea, and perifovea were measured using spectral-domain optical coherence tomography. RESULTS: Thickening ratios of both the inner and outer retina were greater in the fovea than in the other macular regions (P < 0.0001). Inner foveal retinal thickening was significantly greater than outer foveal retinal thickening (P < 0.0001). However, outer retinal thickening in the fovea (r = 0.644, P < 0.001), parafovea (r = 0.616, P < 0.001), and perifovea (r = 0.410, P = 0.025) was significantly correlated with visual acuity; inner retinal thickening was not. Visual acuity tended to be worse, although not significantly so, in eyes with photoreceptor disruption. CONCLUSION: Epiretinal membrane-induced retinal damage associated with visual acuity seems to be located within the outer retina external to the inner plexiform layer.

Spatial and Temporal Relationship between Structural Progression and Disc Hemorrhage in Glaucoma in a 3-Year Prospective Study.

PURPOSE: To investigate the spatial and temporal relationship between disc hemorrhage (DH) and structural progression in patients with primary open-angle glaucoma (POAG) in a 3-year prospective study. DESIGN: Prospective cohort study. PARTICIPANTS: Patients with POAG and intraocular pressure of ≤18 mmHg on monotherapy with prostaglandin analogs. METHODS: Fundus photographs were taken at baseline and every 3 months for 3 years. Disc hemorrhage and structural progression were detected independently by flicker chronoscopy. If present, clock-hour disc locations in the right eye format and colocalization were determined. Statistical comparisons were based on mixed-effects models accounting for the correlation between different disc sites within the same eye and between fellow eyes in the same patient. MAIN OUTCOME MEASURES: Relationship between DH and structural progression at the same site. RESULTS: Among 195 eyes of 115 patients, DH appeared in 85 sites in 65 eyes (33.3%) and was most frequently at the 7 o'clock disc location (29.4%, P < 0.0001). Structural progression occurred at 63 sites of 52 eyes (26.7%) comparably in both superior and inferior hemidiscs, which was mostly detected as widening of the retinal nerve fiber layer defects (RNFLDs). Temporal RNFLD widening was common, whereas nasal widening occurred exclusively in the vertical quadrants (P = 0.035). Of 41 progression sites in eyes with DH, 28 sites (68.2%) had both DH and progression. Progression sites with DH were less common in the superior quadrant than in the inferior and temporal quadrants (P = 0.011). Eyes with DH had a significantly higher risk of progression than eyes without DH (hazard ratio, 3.72; P < 0.0001). For 63 progression sites, DH recurrence and more visits with DH at the progression site were significantly associated with shorter time to progression from baseline (P = 0.021, P = 0.017, respectively), whereas colocalization of DH and progression were not. CONCLUSIONS: In a 3-year prospective study with a Japanese POAG cohort, the relationship between DH and RNFLD and the pattern of RNFLD progression differed by disc location. The association between more frequent DH at the progression site and shorter time to progression indicates that DH may reflect vulnerability to same-site structural deterioration.

Acute Vogt-Koyanagi-Harada disease in enhanced spectral-domain optical coherence tomography.

OBJECTIVE: To demonstrate unique membranous structures seen on enhanced spectral domain optical coherence tomography (SD-OCT) images of eyes with acute Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective, observational case series. PARTICIPANTS: Twenty eyes of 10 consecutive patients diagnosed with acute VKH disease. METHODS: We reviewed fundus photographs, conventional OCT images, fluorescein angiograms (FA), and enhanced SD-OCT images, including serial sections through the macula, obtained at the initial visit and periodically after steroid treatment until complete resolution of serous retinal detachment. MAIN OUTCOME MEASURES: Findings on enhanced SD-OCT imaging and FA in eyes with VKH disease. RESULTS: All 20 eyes had multifocal serous retinal detachment in the posterior fundus that appeared as multilobular dye pooling on late-phase FA. In 17 of the 20 eyes (85%), some areas of dye pooling corresponded to cystoid spaces on enhanced SD-OCT images and in 14 of the 20 (70%) eyes, there were areas of dye pooling and cystoid spaces in the fovea. The floors of the cystoid spaces consisted of a membranous structure of uniform thickness (mean thickness in the fovea of 14 eyes, 62.5+/-3.3 microm). The membranous structure, on SD-OCT, seemed to include a highly reflective line, which was continuous with the line representing the junction of the photoreceptor inner and outer segments (IS/OS) in attached areas of the retina. Intraretinal split was seen to overlie the abnormal IS/OS line in the vicinity of cystoid spaces involving the fovea in 9 of the 20 eyes (45%). During the course of steroid therapy, the membranous structure changed to a granular structure. CONCLUSIONS: The membranous structure that can be seen in eyes with acute VKH disease seems to represent a portion of the outer segment layer that has become separated from the inner segment layer by cystoid spaces. We hypothesize that the membranous form of the outer segment is bound with the action of inflammatory products, such as fibrin, and this membranous structure changes to a granular structure as steroid therapy "dissolves" the fibrin holding the outer segments together. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Three-dimensional high-speed optical coherence tomography imaging of lamina cribrosa in glaucoma.

OBJECTIVE: To evaluate the appearance of the optic nerve head and lamina cribrosa in patients with glaucoma using spectral/Fourier-domain optical coherence tomography (SD-OCT) and to test for a correlation between lamina cribrosa thickness measured on SD-OCT images and visual field loss. DESIGN: Observational case series. PARTICIPANTS: We evaluated 52 eyes of 30 patients with glaucoma or ocular hypertension. METHODS: The high-speed SD-OCT equipment used was a prototype system developed for 3-dimensional (3D) imaging. It had a sensitivity of 98 decibels (dB), a tissue axial resolution of 4.3 mum, and an acquisition rate of approximately 18,700 axial scans per second. For 3D analyses, a raster scan protocol of 256 x 256 axial scans covering a 2.8 x 2.8 mm disc area was used. Lamina cribrosa thickness was measured on 3D images using 3D image processing software. Correlation between lamina cribrosa thickness and mean deviation (MD) values obtained using static automatic perimetry were tested for statistical significance. MAIN OUTCOME MEASURES: Clarity of lamina cribrosa features, lamina cribrosa thickness, and MD values on static automatic perimetry. RESULTS: On 3D images, the lamina cribrosa appeared clearly as a highly reflective plate that was bowed posteriorly and contained many circular areas of low reflectivity. The dots of low reflectivity visible just beneath the anterior surface of the lamina cribrosa in en face cross-sections corresponded with dots representing lamina pores in color fundus photographs. The mean (+/-1 standard deviation) thickness of the lamina cribrosa was 190.5+/-52.7 mum (range, 80.5-329.0). Spearman rank testing and linear regression analysis showed that lamina cribrosa thickness correlated significantly with MD (Spearman sigma = 0.744; P<0.001; r(2) = 0.493; P<0.001). Different observers performed measurements of the lamina cribrosa thickness in SD-OCT cross-sectional images with high reproducibility (intraclass correlation coefficient = 0.784). CONCLUSIONS: These 3D SD-OCT imaging clearly demonstrated the 3D structure of the lamina cribrosa and allowed measurement of its thickness, which correlated significantly with visual field loss, in living patients with glaucoma. This noninvasive imaging technique should facilitate investigations of structural changes in the optic nerve head lamina cribrosa in eyes with optic nerve damage due to glaucoma. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Ultrahigh-resolution versus speckle noise-reduction in spectral-domain optical coherence tomography.

Ultrahigh-resolution (UHR) spectral-domain optical coherence tomography (SD-OCT) and speckle noise-reduced SD-OCT instruments were compared with regard to their ability to visualize retinal microstructures and detect micropathologies in the same series of eyes in this hospital-based study. Both the instruments identically visualized normal retinal structures, except for the retinal ganglion cell layer, which was better delineated by the speckle noise-reduced SD-OCT instrument. Retinal pigment epithelium (RPE) and Bruch's membrane were better delineated by UHR SD-OCT. Retinal and sub-RPE pathologies were also identically visualized by both the instruments. Layer differentiation for locating each pathology was better visualized by speckle noise-reduced SD-OCT.