Relationship between visual acuity and spectral domain optical coherence tomography retinal parameters in neovascular age-related macular degeneration.

PURPOSE: Relationship between spectral domain optical coherence tomography (SD-OCT) and visual acuity (VA) in neovascular age-related macular degeneration (NVAMD). PROCEDURES: VA and SD-OCTs of 64 treatment-naive eyes with NVAMD were retrospectively collected at baseline and 1 year (n = 30). Retinal and subretinal spaces were manually analyzed. Volume and thickness measurements were correlated with VA. RESULTS: At baseline, lower VA correlated with increased volume of subretinal hyperreflective material (R = 0.4, p < 0.001) and with decreased volume of the photoreceptor layer (PRL, R = -0.4, p < 0.01). At 1 year, lower VA correlated with decreased volume of the retina (R = -0.7, p < 0.001), outer nuclear layer (R = -0.6, p < 0.05) and PRL (R = -0.7, p < 0.001). Decrease in VA after 1 year correlated with a decrease in PRL (R = 0.4, p < 0.05). CONCLUSIONS: Quantitative analysis of SD-OCT revealed correlations between VA and retinal and subretinal morphological changes in NVAMD. MESSAGE: Atrophy of the outer retina is an important correlate for lower VA in NVAMD.

Different phenotypes of the appearance of the outer plexiform layer on optical coherence tomography.

PURPOSE: To present a selected case series of different phenotypes of the normal outer plexiform layer (OPL) visualized by optical coherence tomography (OCT). METHODS: Five cases were selected to represent the spectrum of appearances of the OPL in this case series. Categorical descriptions of each manifestation were then developed. Additional SD-OCT scans were obtained from a normal volunteer to further support the hypothesis. RESULTS: The inner one-third of the OPL typically appears hyperreflective on OCT, while the outer two-thirds (Henle fiber layer) may have a more varied appearance. Six different phenotypes of Henle fiber layer reflectivity were noted in this series, and classified as: bright, columnar, dentate, delimited, indistinct, and dark. The brightness of the Henle fiber layer appears to depend on the geometric angle between the OCT light beam and the axonal fibers in this portion of the OPL. This angle appears to be a function of the natural orientation of the Henle fiber layer tissue (θN), the existence of subretinal pathology that alters the angle of the neurosensory retina (θ(P)), and the tilt angle of the tissue on the B-scan (θ(T)) due to decentered OCT acquisition. CONCLUSIONS: Since accurate interpretation of the OPL/ONL boundary is of vital importance to study the thickness of ONL, location of cystoid lesions, hyperreflective crescents over drusen, et al., our case series may aid better understanding of the OPL appearance in SD-OCT. In the absence of clear delineation, it may be most correct to refer to indistinct OPL and ONL together as the photoreceptor nuclear axonal complex (PNAC).

Evaluation of the axial location of cystoid spaces in retinal vein occlusion using optical coherence tomography.

PURPOSE: To analyze the axial distribution of intraretinal cystoid changes in patients with retinal vein occlusion (RVO), incorporating a new hypothesis about the optical coherence tomographic boundary between the outer nuclear layer and the outer plexiform layer. METHODS: Data were collected from patients with RVO who underwent spectral domain coherence tomography imaging. For each image set, certified graders evaluated each retinal layer for cystoid macular edema, defined as hyporeflective intraretinal cystoid spaces. Subretinal fluid, if present, was also noted. RESULTS: Forty-eight eyes were evaluated (24 branch RVO, 18 central RVO, 6 hemiretinal vein occlusion). Cystoid macular edema was present in 30.8% of eyes in outer nuclear layer, 77.9 % in outer plexiform layer, 77.9 % in inner nuclear layer, 36.9 % in inner plexiform layer, 48.8 % in ganglion cell layer, and 4.9% in nerve fiber layer. Subretinal fluid was assessed as present in 23.8% of patients. The presence of subretinal fluid correlated most strongly with cystoid changes in the outer nuclear layer (r = 0.514, P = 0.001) but was not significantly correlated with these changes in the superficial retina. CONCLUSION: Use of spectral domain coherence tomography allows precise characterization of the axial location of cystoid spaces in RVO and highlights the frequency of fluid accumulation in the outer plexiform layer and inner nuclear layer. Using updated definitions, cystoid macular edema seems to occur less frequently in the outer nuclear layer, but when it does so, it is often associated with subretinal fluid. Future longitudinal studies, documenting the axial progression of such changes, and their response to treatment, may be of clinical relevance as pharmacotherapeutic options evolve.

Relationship between optical coherence tomography retinal parameters and visual acuity in diabetic macular edema.

PURPOSE: To investigate the relationship between optical coherence tomography (OCT)-derived measurements of retinal morphology and visual acuity in patients with diabetic macular edema. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: A total of 67 consecutive patients (67 eyes) with diabetic macular edema (DME) who underwent Stratus OCT imaging (Carl Zeiss Meditec, Inc., Dublin, CA). METHODS: Best-corrected Snellen visual acuity was recorded for each patient. Raw exported Stratus OCT images for each patient were analyzed using custom software entitled "OCTOR," which allows the precise positioning of prespecified boundaries on individual B-scans. Thickness, volume, and intensity were calculated for neurosensory retina and subretinal fluid. In addition, photoreceptor outer segment (POS) thickness was quantified. MAIN OUTCOME MEASURES: Optical coherence tomography-derived measurements of retinal morphology and visual acuity. RESULTS: The Spearman coefficient values (r) of the correlation between OCTOR-derived measurements of central subfield thickness, intensity, subretinal fluid volume, and POS thickness and the logarithm of the minimum angle of resolution visual acuities were 0.3428 (P = 0.005), -0.2658 (P = 0.03), -0.2683 (P = 0.38), and -0.3703 (P = 0.002), respectively. Multivariate models with stepwise selection revealed a cumulative R(2) of 0.4305 in the total study population, with R(2) of 0.4999 and 0.7628 in the untreated and prior focal laser groups, respectively. CONCLUSIONS: Subanalysis and quantification of OCT features in eyes with DME seem to be of value. In particular, POS thickness seems to be an important predictor of function and visual acuity in patients with DME.

Relationship between angiographic and optical coherence tomographic (OCT) parameters for quantifying choroidal neovascular lesions.

BACKGROUND: To correlate the volume of various spaces on optical coherence tomography (OCT) with fluorescein angiographic (FA) parameters in neovascular age-related macular degeneration (AMD). METHODS: Sixty-five consecutive cases of active subfoveal choroidal neovascularization (CNV) associated with AMD were retrospectively collected. Area and greatest linear dimension of CNV lesion components were calculated on FA. Corresponding StratusOCT image sets were analyzed using custom software (termed OCTOR), which allows manual measurement of the volume of the neurosensory retina, subretinal fluid, subretinal tissue, and pigment epithelial detachment (PED). RESULTS: Area of occult CNV on FA correlated with PED (R = 0.62) and subretinal fluid (R = 0.28) volume and negatively with subretinal tissue volume (R = -0.26) on OCT. Area of classic CNV on FA correlated with subretinal tissue (R = 0.60) and retinal (R = 0.38) volume on OCT. Automated StratusOCT output values showed poorer correlations than manually calculated OCTOR values. CONCLUSIONS: OCT features of CNV lesions as measured by manual quantitative subanalysis correlate better with angiographic parameters than values provided by the automated StratusOCT analysis. These measures may improve our understanding of the morphologic effects of CNV lesions and may facilitate the development of a hybrid FA and OCT-based classification system for future clinical trials, which more fully characterizes CNV lesions.

Effect of ranibizumab retreatment frequency on neurosensory retinal volume in neovascular amd.

PURPOSE: To determine the characteristics of patients with neovascular age-related macular degeneration who show initial anatomic improvements on optical coherence tomography in response to treatment with ranibizumab, but who subsequently regress toward their anatomic baseline. METHODS: Data from 50 consecutive patients, receiving ranibizumab therapy for neovascular age-related macular degeneration, were collected. Raw StratusOCT images were analyzed using custom software ("OCTOR"). Changes in volume of neurosensory retina at months 1, 3, and 6 were calculated. Baseline demographic and morphologic characteristics were compared. RESULTS: Forty-two patients (84%) showed a reduction in total retinal volume 1 month after initial treatment with ranibizumab. Of the patients that initially showed a reduction, 16 (38%) maintained this reduction through month 6, whereas 26 patients (62%) demonstrated a subsequent increase in retinal volume. Patients who maintained a reduction in edema received 3.75 +/- 1.18 injections of ranibizumab versus 2.96 +/- 1.34 injections for patients who did not (P = 0.049). Regression of initial anatomic improvements was associated with worsening of visual acuity (r = 0.599, P = 0.002). CONCLUSION: Patients receiving fewer injections of ranibizumab appeared less likely to maintain anatomic improvements achieved following commencement of ranibizumab therapy; regression of these improvements was associated with deterioration in visual acuity.

Relationship between optical coherence tomography retinal parameters and visual acuity in neovascular age-related macular degeneration.

PURPOSE: To investigate the relationship between optical coherence tomography (OCT)-derived measurements of retinal morphology and visual acuity in patients with neovascular age-related macular degeneration (AMD). DESIGN: Retrospective cross-sectional study. PARTICIPANTS: A total of 216 consecutive patients (216 eyes) newly diagnosed with neovascular AMD who underwent StratusOCT imaging at the time of diagnosis. METHODS: Best-corrected Snellen visual acuity was recorded for each patient. Raw exported StratusOCT images for each patient were analyzed using publicly available custom software entitled "OCTOR," which allows the precise positioning of prespecified boundaries on individual B-scans. Thickness and volume were calculated for morphologic parameters of interest: neurosensory retina, subretinal fluid, subretinal tissue (SRT), and pigment epithelial detachment. MAIN OUTCOME MEASURES: OCT-derived measurements of retinal morphology and visual acuity. RESULTS: An increased total volume of SRT was correlated with decreased visual acuity (r = 0.370, P<0.0001). Decreased visual acuity was also modestly correlated with increased thickness of the neurosensory retina at the foveal center point (r = 0.245, P = 0.0004). No statistically significant association was detected between visual acuity and the total volume of subretinal fluid or pigment epithelial detachment. The association between visual acuity and both the neurosensory retina and the SRT was stronger for lesions classified as minimally classic or occult on fluorescein angiography. For occult lesions, 20% of the variation in visual acuity could be predicted by a multiple regression model that incorporated age and SRT volume, whereas, for minimally classic lesions, 62% of the variation in visual acuity could be predicted by a multiple regression model that incorporated age, total neurosensory retinal volume, and total SRT volume. CONCLUSIONS: The presence of increased SRT thickness and volume on OCT, and to a lesser extent increased neurosensory retinal thickness and volume, is associated with decreased visual acuity in neovascular AMD. However, because of the complex pathophysiology of neovascular AMD and, in part, the limitations of StratusOCT, these factors only account for a small degree of the variation in visual acuity that these patients exhibit. The detection of stronger correlations between retinal anatomy and visual acuity is likely to require the use of more advanced imaging modalities. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Quantitative comparison of optical coherence tomography after pegaptanib or bevacizumab in neovascular age-related macular degeneration.

PURPOSE: To demonstrate the benefit of enhanced quantitative analysis of optical coherence tomography (OCT) images using computer-assisted grading to compare the short-term morphologic effects of pegaptanib and bevacizumab treatment for neovascular age-related macular degeneration (AMD). DESIGN: Retrospective consecutive case series. PARTICIPANTS: Fifty-three cases with neovascular AMD undergoing pegaptanib or bevacizumab therapy. METHODS: Fifty-three consecutive cases of patients who underwent StratusOCT imaging followed by treatment with either intravitreal pegaptanib (n = 18) or bevacizumab (n = 35) for neovascular AMD were retrospectively collected. Raw exported StratusOCT images were analyzed using publicly available custom software (OCTOR) designed to define the boundaries of various spaces manually. Changes in thickness and volume of the retina, subretinal fluid (SRF), subretinal tissue, and pigment epithelial detachments (PEDs) before treatment and at 3 months after treatment were calculated and compared between treatment groups. OCTOR software measurements after manual grading were also compared with the automated StratusOCT output. MAIN OUTCOME MEASURES: Volume and thickness measurements calculated by the automated StratusOCT software and the manual grading software OCTOR. RESULTS: Intravitreal bevacizumab resulted in a statistically significant greater reduction of total retinal volume than pegaptanib (-0.88+/-1.4 mm(3) vs. -0.07+/-0.5 mm(3), P = 0.003). Mean foveal central subfield (FCS) retinal volume decreased from 0.26+/-0.1 mm(3) to 0.21+/-0.1 mm(3) (P = 0.001) in the bevacizumab group and remained constant at 0.22+/-0.1 in the pegaptanib group 3 months after injection. Subanalysis of the SRF, subretinal tissue, and PEDs revealed statistically significant reductions of the total volume of all 3 spaces after bevacizumab injections but no significant change after pegaptanib treatment. Automated StratusOCT output measurements of FCS thickness, foveal center point thickness, and total volume of the retina did not reveal a statistically significant difference between the treatments. CONCLUSIONS: Differences in morphologic response between treatments were less apparent on automated StratusOCT output than on computer-assisted analysis. Although intravitreal bevacizumab was associated with a greater short-term reduction in features of exudation than pegaptanib therapy, the retrospective design of the study limits the significance of this finding. Computer-assisted subanalysis of OCT data, however, may be a useful tool in more precisely defining the anatomic effects of therapies for neovascular AMD.

Quantitative fluorescein angiographic analysis of choroidal neovascular membranes: validation and correlation with visual function.

PURPOSE: To compare computerized analysis with traditional grading methods in the analysis of fluorescein angiograms from patients with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) and to examine the clinical relevance of parameters generated by computerized analysis by testing their relationships with clinical measures of vision. METHODS: Custom quantitative fluorescein analysis (QFA) software was used to analyze 62 angiograms from patients with CNV for whom distance visual acuity (DVA) data were available. On applying QFA, we obtained three mathematical parameters for each lesion component: pixel area (PA), integrated intensity (II), and positive fluorescence (PF). Quotients (Q) were derived for the latter two parameters by correcting against background (b) or optic nerve (o) fluorescence (IIQ(b), IIQ degrees , PFQ(b), and PFQ degrees ). The new metrics were compared with traditional grading parameters of classic CNV and lesion area. The relationships of both sets of angiographic data with measures of vision were explored by regression analyses. RESULTS: Weighted kappa between QFA and traditional grading for lesion subtype assessment was high (kappa = 0.7). Regression analyses with PA, IIQ(b), IIQ degrees , PFQ(b), and PFQ degrees for each lesion descriptor (leakage, classic CNV, occult CNV, total lesion) as independent variables and DVA as the dependent variable showed that in every case PFQ(b) exhibited the most significant relationship with vision (adjusted r(2) = 0.26). Parameter estimates showed that for a change of 30 units on the PFQ(b) for classic CNV, a loss of 20 letters of DVA may be expected. No parameters from traditional grading methods showed statistically significant relationships with DVA. CONCLUSIONS: The markers of dynamic change in area and intensity of fluorescence exhibited stronger relationships with visual function than did area measurements alone.

Error correction and quantitative subanalysis of optical coherence tomography data using computer-assisted grading.

PURPOSE: To demonstrate feature subanalysis and error correction of optical coherence tomography (OCT) data by using computer-assisted grading. METHODS: The raw exported StratusOCT (Carl Zeiss Meditec, Inc., Dublin, CA) scan data from 20 eyes of 20 patients were analyzed using custom software (termed OCTOR) designed to allow the user to define manually the retinal borders on each radial line scan. Measurements calculated by the software, including thickness of the nine standard macular subfields, foveal center point (FCP), and macular volume, were compared between two graders and with the automated Stratus analysis. Mean and range of differences for each parameter were calculated and assessed by Bland-Altman plots and Pearson correlation coefficients. Additional cases with clinically relevant subretinal findings were selected to demonstrate the capabilities of this system for quantitative feature subanalysis. RESULTS: Retinal thickness measurements for the various subfields and the FCP showed a mean difference of 1.7 mum (maximum, 7 microm) between OCTOR graders and a mean difference of 2.3 microm (maximum of 8 microm) between the OCTOR and Stratus analysis methods. Volume measurements between Stratus and OCTOR methods differed by a mean of 0.06 mm(3) (in reference to a mean macular volume of 6.81 mm(3)). The differences were not statistically significant, and the thicknesses correlated highly (R(2) > or = 0.98 for all parameters). CONCLUSIONS: Manual identification of the inner and outer retinal boundaries on OCT scans can produce retinal thickness measurements consistent with those derived from the automated StratusOCT analysis. Computer-assisted OCT grading may be useful for correcting thickness measurements in cases with errors of automated retinal boundary detection and may be useful for quantitative subanalysis of clinically relevant features, such as subretinal fluid volume or pigment epithelial detachment volume.

Reproducibility of quantitative optical coherence tomography subanalysis in neovascular age-related macular degeneration.

PURPOSE: To determine the intergrader reproducibility for computer-assisted grading of optical coherence tomography (OCT) images in eyes with neovascular age-related macular degeneration (AMD), by using a standardized grading procedure. METHODS: Sixty OCT image sets (of six radial lines each) were independently analyzed by two graders using validated custom software (OCTOR) to draw boundaries manually on OCT B-scans. Spaces delineated by these boundaries included retina, subretinal fluid, subretinal tissue, and pigment epithelial detachments (PEDs). Volume measurements for the nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields and the mean foveal center point (FCP) thickness were calculated by the software and compared by using weighted kappa statistics and intraclass correlation coefficients (ICCs). RESULTS: Intergrader comparison of the foveal central subfield (FCS) volume, total volume, and mean FCP thickness showed a high level of agreement and strong correlation between measurements for all spaces (kappa(weighted) = 0.72-0.97; ICC = 0.92-0.99). The best agreement was observed for total volume of the combination of all four graded spaces (kappa(weighted) = 0.97, mean difference = 0.31 mm(3), or 2.51%). The highest ICCs were seen for FCP thickness measurements. The poorest agreement was found for grading of subretinal tissue. Eyes with advanced choroidal neovascularization (CNV) and poor visibility of the retinal pigment epithelium (RPE) band appeared to show the greatest intergrader discrepancies. CONCLUSIONS: Analysis of OCT images by trained graders using computer-assisted grading software allows for highly reproducible quantitative measurements, even in eyes with complex diseases such as neovascular AMD. Quantitative subanalysis may be useful in studying the differential morphologic effect of therapies on various anatomic components.

Factors associated with variability in retinal nerve fiber layer thickness measurements obtained by optical coherence tomography.

OBJECTIVE: To identify factors associated with variability in retinal nerve fiber layer (RNFL) thickness measurements obtained by optical coherence tomography (OCT). DESIGN: Retrospective observational case series. PARTICIPANTS: One hundred fifty consecutive patients with known or suspected glaucomatous optic nerve damage undergoing OCT imaging for RNFL thickness measurement. METHODS: One eye with known or suspected glaucoma from each patient was scanned twice within the same visit using the Stratus OCT's fast nerve fiber layer thickness acquisition protocol. For each scan, the average RNFL thickness, signal strength (a measure of the amount of light reflecting back from the retina), and analysis confidence (AC, a measure of the quality of the data as reported by the OCT software) were recorded. Retinal nerve fiber layer thickness measurements of the initial and repeat scans for each case were compared, and the difference in thickness measurements was correlated with difference in signal strength, AC (either low or normal), and the average RNFL thickness. MAIN OUTCOME MEASURE: Difference in RNFL thickness. RESULTS: The mean difference in RNFL thickness between the initial and repeat scans was 10 microns (12.5%; range, 0.04-86.15 microns). Difference in signal strength between initial and repeat scans positively correlated with the difference in RNFL thickness (Spearman correlation coefficient = 0.44; P<0.001), whereas the average nerve fiber layer thickness negatively correlated with the difference in RNFL thickness (Spearman correlation coefficient = -0.25; P = 0.002). The presence of a scan with low AC was associated with a lower average RNFL thickness and a greater difference in RNFL thickness between the initial and repeat scans. CONCLUSIONS: Signal strength variability, low AC, and low RNFL thickness are associated with variability in RNFL thickness measurements obtained by Stratus OCT. Comparability of RNFL thickness measurements between visits may be improved if scans of similar signal strengths without low AC are obtained. This is especially important for patients with moderate glaucomatous optic nerve damage and for patients from whom good quality scans are not obtainable.

Automated detection of clinically significant macular edema by grid scanning optical coherence tomography.

OBJECTIVE: To compare the detection of clinically significant diabetic macular edema (DME) by an optical coherence tomography (OCT) grid scanning protocol and biomicroscopic examination. DESIGN: Retrospective case series. PARTICIPANTS: Outpatients at the Doheny Eye Institute. METHODS: The clinical and imaging records of a consecutive series of 71 eyes of 40 patients referred for DME who underwent OCT using the both the Macular Grid 5 (MG5) scanning protocol (to allow a more evenly distributed sampling of points in the macula) and the standard Fast Macular Thickness Map (FMTM) pattern were reviewed. An automated algorithm was developed to generate a retinal thickness map using the MG5 data, which was then compared with a normative database to identify presumed areas of retinal edema. Clinically significant macular edema (CSME) was also identified by clinical examination and stereoscopic fundus photographs for comparison with the results of the OCT protocols. MAIN OUTCOME MEASURES: Sensitivity and specificity of scanning protocols. RESULTS: Optical coherence tomograms were inspected visually, and automatically detected retinal boundaries were found to be correct in 69 of 71 MG5 scans and in 65 of 71 FMTM scans. Macular Grid 5 scanning was performed twice in each eye, and the repeatability (pooled standard deviation) of the total area of edema was 0.48 mm2 (coefficient of variation, 6.8%). Sensitivity and specificity of the MG5 for detection of CSME relative to the clinical examination were 89% and 86%, respectively, with kappa being 0.74. Macular Grid 5 and FMTM assessment of foveal CSME also showed good agreement, with kappa being 0.68. CONCLUSIONS: The analysis algorithm for the OCT MG5 grid scan seems to be accurate and repeatable. Automated detection of CSME by the MG5 analysis correlated well with the clinical grading and standard OCT analysis (FMTM). Macular Grid 5 provides more information regarding the perifoveal macula than FMTM and may be of value to clinicians in planning treatment and in future studies of macular edema.

Errors in retinal thickness measurements obtained by optical coherence tomography.

OBJECTIVE: To report the frequency and severity of optical coherence tomography (OCT) retinal thickness measurement errors and to describe parameters that predict these errors. DESIGN: Observational case series. PARTICIPANTS: Two hundred consecutive patients undergoing OCT imaging. METHODS: One eye (primary) from each of 200 consecutive patients undergoing Stratus OCT imaging (Carl Zeiss Meditec, Dublin, CA) with radial lines or fast macular thickness-based acquisition protocols was selected for review by 2 graders. On each of the line scans, graders evaluated the position of the automated retinal boundary lines (inner retinal surface and retinal pigment epithelium band) used by the OCT machine for thickness calculations and graded the positioning on a 6-point subjective, categorical error scale to generate an error score. The presence of thickness errors was correlated with various parameters, including the analysis confidence assessment reported by the OCT software, disease diagnosis, retinal morphologic features, the foveal center thickness standard deviation (FCTSD), and the FCTSD-to-foveal center thickness (FCT) ratio. MAIN OUTCOME MEASURE: Average OCT retinal thickness error score. RESULTS: Errors of retinal boundary detection and thickness measurement were observed in 92% of eyes, but were severe in only 13.5% of eyes. The identification of an error or low analysis confidence by the OCT software was strongly associated with the severity of the retinal thickness errors. A higher FCTSD-to-FCT ratio and presence of subretinal fluid also were associated with more severe errors. Retinal cysts and a diagnosis of retinal vascular disease such as diabetic macular edema were less likely to be associated with significant errors. CONCLUSIONS: Retinal thickness measurement errors occur frequently with current OCT segmentation and analysis algorithms. Severe errors are more frequent in eyes with subretinal pathologic features, but generally are detected by the OCT software. A high FCTSD-to-FCT ratio (>0.1) also may alert the clinician to the possibility of thickness errors. Clinical studies, particularly those pertaining to subretinal diseases, should consider these errors when incorporating OCT imaging in the study design.

Rapid recurrence of geographic atrophy after full macular translocation for nonexudative age-related macular degeneration.

OBJECTIVE: To report the recurrence of geographic atrophy (GA) in a patient with nonexudative age-related macular degeneration (AMD) after full macular translocation. DESIGN: Observational case report. METHODS: Review of the clinical, photographic, and angiographic records of a patient with GA who underwent full macular translocation. MAIN OUTCOME MEASURES: Progression of GA. RESULTS: A 73-year-old man with GA secondary to nonexudative AMD underwent a macular translocation with 360 peripheral retinectomy (MT 360) in his left eye. On postoperative month 4, fundus photography showed subtle alterations of the pigment underneath the translocated foveal region. On postoperative month 9, the visual acuity worsened to preoperative levels and there was frank retinal pigment epithelium atrophy involving the new macular region. CONCLUSIONS: The rapid recurrence and development of GA in the translocated fovea after MT 360 raise new questions regarding the pathogenesis of GA. They also raise concerns regarding the use of MT 360 in the management of nonexudative AMD.

Effect of anti-VEGF treatment on choroidal thickness over time in patients with neovascular age-related macular degeneration.

PURPOSE: To evaluate change in subfoveal choroidal thickness (SCT) as measured by spectral-domain optical coherence tomography (SD-OCT) in patients with neovascular age-related macular degeneration (NVAMD) undergoing anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Patients with a diagnosis of NVAMD were retrospectively reviewed to identify those who had at least 12 months of follow-up. The SCT was manually measured from Bruch membrane to the choroid-sclera junction at baseline and last follow-up. Only cases in which the choroid was fully visible were included in quantitative analyses. The SCT measurements were correlated with other characteristics including number and duration of treatments. RESULTS: Sixty eyes of 47 patients with a follow-up of 23.8 months (SD 7.3) met study inclusion criteria, and 49 eyes of 40 patients received anti-VEGF treatment. Mean age was 83.7 years, and 52% were female. Treated eyes received a mean of 7.8 (SD 7.3) intravitreal anti-VEGF injections. The SCT at baseline was 126.7 µm (SD 50.6) for untreated and 136.2 µm (SD 57.6) for treated eyes. The SCT showed a decrease over time in both groups, with a mean rate of reduction of 6.0 µm (p<0.0002) in treated eyes and 3.6 µm (p = 0.3741) in untreated eyes. However, the change in SCT did not differ between the groups (p = 0.5113), and did not correlate with the number of re-treatments (p = 0.552), visual acuity at baseline (p = 0.618), or change in visual acuity over time (p = 0.429). CONCLUSIONS: Although choroidal thickness decreased over time in eyes with NVAMD, anti-VEGF therapy did not appear to accelerate or otherwise alter this decline.

The retinal disease screening study: retrospective comparison of nonmydriatic fundus photography and three-dimensional optical coherence tomography for detection of retinal irregularities.

PURPOSE: To determine the sensitivity of three-dimensional optical coherence tomography (3D-OCT) versus single field nonmydriatic fundus photography (FP) for detection of a variety of retinal abnormalities. METHODS: Images from consecutive patients in a retina clinic undergoing simultaneous 3D-OCT (512 × 128) and single, foveal nonmydriatic 45° color fundus imaging with 3D-OCT-1000 in a 4 month-period were retrospectively collected. Findings from each modality were graded independently by two graders as present, questionable, or absent. Irregularities were separated into three categories for intermodality comparisons: epiretinal, retinal/subretinal, and RPE/choroidal irregularities. The approximate location of findings in relation to the 3D-OCT field was noted as in field and out of field. Findings from both modalities were combined to form the gold standard for comparison for each modality. RESULTS: Five hundred and one sets of 3D-OCT scans and fundus images of 395 eyes of 223 patients were found in the study period, of which, 474 unique visits were included. Ninety-six percent of the scans had abnormal findings. Twenty-six fundus images (5.5%) were ungradable. 3D-OCT identified some abnormality in 25/26 (96.2%) of the ungradable fundus images. For overall detection of a variety of retinal irregularities or irregularity of each category (epiretinal, intraretinal, or RPE/choroidal irregularity), 3D-OCT was found to be more sensitive than that of nonmydriatic color fundus images. When single specific feature was speculated, 3D-OCT demonstrated various detection abilities: higher than FP for abnormal retinal thickness (or intraretinal hyporeflective features); similar as FP for RPE atrophy; however, lower for pigment migration (or intraretinal hemorrhage). CONCLUSIONS: In this study, sensitivities of 3D-OCT were higher than nonmydriatic fundus images for overall detection of retinal abnormalities or irregularities in each category. 3D-OCT demonstrated good ability to detect most features; however, with limitation to intraretinal hemorrhage and pigment migration. It is likely that OCT will be added to photography screening for chorioretinal diseases in the near future.

Atypical outer retinal fluid accumulation in choroidal neovascularization: a novel OCT finding.

BACKGROUND AND OBJECTIVE: To report a novel optical coherence tomography (OCT) finding in choroidal neovascularization (CNV). PATIENTS AND METHODS: The authors identified seven eyes with CNV demonstrating the atypical pattern of fluid accumulation within the outer retina on OCT. Patient demographics, best corrected visual acuity and spectral-domain OCT (SD-OCT) images were collected for all available follow-up visits. Volume and area of the fluid were measured on SD-OCT. Microperimetry was performed in one case. RESULTS: The outer retinal fluid was located between the external limiting membrane (ELM) and the outer photoreceptor band on SD-OCT. Within this area, the outer segments of the photoreceptors were visualized as a continuous band, which appeared to split from the retina, dropping down toward the retinal pigment epithelium (mean area: 2.53 ± 1.23 mm(2); mean volume: 0.19 ± 0.20 mm(3)). All cases demonstrated the finding only at one time point during follow-up. Recovery of the outer retina and retinal function could be detected. CONCLUSION: Atypical intraretinal fluid accumulation externally to the ELM may be detected on SD-OCT in eyes with CNV. This finding may be transient and may not preclude subsequent improvement in visual function. The frequency of the presumed photoreceptor delamination and its full clinical significance remain to be defined.

The retinal disease screening study: prospective comparison of nonmydriatic fundus photography and optical coherence tomography for detection of retinal irregularities.

PURPOSE: To compare the sensitivity of volume scanning with optical coherence tomography (OCT) to nonmydriatic color fundus photography (FP) for the detection of retinal irregularities in asymptomatic populations. METHODS: Asymptomatic subjects without known ocular disease were recruited over a 6-month period. For each eye, two undilated 45° fundus images and four undilated volume OCT image sets covering the macula and optic nerve were obtained. Color images were evaluated for irregularities both inside and outside the area covered by OCT. OCT image sets were evaluated for internal limiting membrane irregularities, abnormal retinal thickness, hyper/hyporeflective features, and photoreceptor/retinal pigment epithelium (RPE) irregularities. Detection sensitivities were compared and false-negative cases were analyzed. RESULTS: A total of 284 eyes (144 subjects) were included, with a mean age of 38.1 years (range 18-77). Among 253 eyes (135 subjects) with gradable images from both FP and OCTs, the detection sensitivities for OCT were higher (96.2% infield and 85.7% in full field) than for FP (19.9% infield and 43.8% in full field) for all irregularities evaluated in the study (including epiretinal irregularities, abnormal retinal thickness, intraretinal hyperreflective/hyporeflective features, and photoreceptor/RPE irregularities). Overall, the presence of definite irregularities on either fundus imaging or OCT by eye in this asymptomatic population was 42.6% (121/284), with 39.4% (112/284) of eyes having RPE irregularities such as drusen. CONCLUSIONS: For detection of a variety of retinal irregularities evaluated in the current study, volume OCT scanning was more sensitive than nonmydriatic retinal photography in our asymptomatic individuals. OCT detected clinically relevant disease features, such as subretinal fluid, that were missed by FP, and had a lower ungradable image rate. It is likely that OCT will be added to photography screening in the near future for chorioretinal disease.

Juxtapapillary pigment epithelium detachment observed in asymptomatic participants using optical coherence tomography.

PURPOSE: To use three-dimensional optical coherence tomography (3D-OCT) to assess the prevalence of juxtapapillary retinal pigment epithelial detachments (jPED) in an asymptomatic population. METHODS: Asymptomatic participants (i.e., family members of patients) were prospectively recruited over a 6-month period. Each subject completed a questionnaire prior to the acquisition of two undilated 45° fundus images and two undilated raster 3D-OCT scans (512 × 128) covering the macula and optic nerve from each eye using 3D-OCT-1000. Fundus images were graded for the presence of peripapillary atrophy (PPA), peripapillary pigment (PPP), drusen in the macula, and drusen elsewhere, whereas 3D-OCT scans were assessed for the presence of jPED, drusen in the macula, and drusen elsewhere. RESULTS: In all, 276 eyes from 138 participants were evaluated. Mean participant age was 37.6 years (range: 18-74 years; SD: 15.5 years). In all, 87 jPEDs were detected in 26.1% (36/138) of asymptomatic participants (25 bilateral and 11 unilateral) or 17.0% (47/276) of asymptomatic eyes (23 in the right eye and 24 in the left). The maximum height of jPED was 198.3 ± 53.8 (range: 101.8-376.0) µm. The minimum distance of jPED to the border of optic nerve head (OPN) was 2.6 ± 11.1 (range: 0-61.9) µm. The occurrence of jPEDs or drusen elsewhere by subjects increased statistically with increasing age (P < 0.001, respectively). CONCLUSIONS: In this study, definite jPEDs were observed by OCT in asymptomatic participants, which were not seen with fundus photography. jPEDs were seen more commonly with increasing age, although it is not known whether these lesions represent deposition of drusen-like material or aborted choroidal neovascularization adjacent to the natural break in Bruch's membrane at the optic disc.