Exploring Photoreceptor Reflectivity Through Multimodal Imaging of Outer Retinal Tubulation in Advanced Age-Related Macular Degeneration

Litts, Katie M.; Wang, Xiaolin; Clark, Mark E.; Owsley, Cynthia; Freund, K. Bailey; Curcio, Christine A.; Zhang, Yuhua

doi:10.1097/iae.0000000000001265

Cited by 18 publications

(20 citation statements)

References 58 publications

(89 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Zweifel et al[13] first reported these characteristic structures in OCT images acquired from subjects with age-related macular degeneration,[13] while recent work by Litts et al revealed that the branching, interconnected structure of ORTs is composed of degenerating cones and infolded ELM. [14] Consistent with recent results published by Litts et al .,[27] ORTs did not display IZ/EZ bands on SD-OCT or recognizable cone reflectivity on confocal imaging. However, we did observe remnant cone inner segments in these structures using split-detector imaging.…”

Section: Discussionsupporting

confidence: 88%

“…[12, 17–26] Indeed, confocal AOSLO has recently been used to document lack of cone reflectivity in the ORTS found in age-related macular degeneration. [27] In choroideremia, AOSLO imaging has uncovered novel pathologic features including bubble-like lesions that appear to co-localize to structures in the choroid visualized by SD-OCT[26] and yielded results suggesting a primary RPE degeneration with subsequent loss of photoreceptors and choroid. [12, 26] Recent work by Morgan et al showed an abrupt decline in confocal AOSLO photoreceptor reflectivity in areas of RPE degeneration[26], while SD-OCT imaging revealed interdigitation zone (IZ, thought to represent the junction of photoreceptors and RPE) dropout and RPE thinning prior to disruptions in the overlying EZ.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Multimodal Imaging of Photoreceptor Structure in Choroideremia

et al. 2016

View full text Add to dashboard Cite

PurposeChoroideremia is a progressive X-linked recessive dystrophy, characterized by degeneration of the retinal pigment epithelium (RPE), choroid, choriocapillaris, and photoreceptors. We examined photoreceptor structure in a series of subjects with choroideremia with particular attention to areas bordering atrophic lesions.MethodsTwelve males with clinically-diagnosed choroideremia and confirmed hemizygous mutations in the CHM gene were examined. High-resolution images of the retina were obtained using spectral domain optical coherence tomography (SD-OCT) and both confocal and non-confocal split-detector adaptive optics scanning light ophthalmoscope (AOSLO) techniques.ResultsEleven CHM gene mutations (3 novel) were identified; three subjects had the same mutation and one subject had two mutations. SD-OCT findings included interdigitation zone (IZ) attenuation or loss in 10/12 subjects, often in areas with intact ellipsoid zones; RPE thinning in all subjects; interlaminar bridges in the imaged areas of 10/12 subjects; and outer retinal tubulations (ORTs) in 10/12 subjects. Only split-detector AOSLO could reliably resolve cones near lesion borders, and such cones were abnormally heterogeneous in morphology, diameter and density. On split-detector imaging, the cone mosaic terminated sharply at lesion borders in 5/5 cases examined. Split-detector imaging detected remnant cone inner segments within ORTs, which were generally contiguous with a central patch of preserved retina.ConclusionsEarly IZ dropout and RPE thinning on SD-OCT are consistent with previously published results. Evidence of remnant cone inner segments within ORTs and the continuity of the ORTs with preserved retina suggests that these may represent an intermediate state of retinal degeneration prior to complete atrophy. Taken together, these results supports a model of choroideremia in which the RPE degenerates before photoreceptors.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Multimodal Imaging of Photoreceptor Structure in Choroideremia

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The presence of ORTs shows that cones may survive for a relatively long duration in atrophic areas. Fundus camera and scanning AOO can both detect the outlines of ORTs (figure 13) 55 . It has been shown that scanning AOO can detect cone structure within ORTs 56 .…”

Section: Outer Retinal Tubulationsmentioning

confidence: 99%

Adaptive optics ophthalmoscopy: Application to age-related macular degeneration and vascular diseases

Pâques

Meimon

Rossant

et al. 2018

Progress in Retinal and Eye Research

View full text Add to dashboard Cite

Adaptive optics (AO)-enhanced en face retinal imaging, termed here AO ophthalmoscopy (AOO) has reached a level of robustness which fuels its increasing use in research and clinical centers. Here we will review the contribution of clinical AOO to the understanding and monitoring of 1) age-related macular degeneration and 2) vascular diseases. The main contributions of AOO to the phenotyping of AMD are a better identification of drusen, a better delineation of the limits of atrophy, and the identification of novel features such as punctate hyperreflectivity and mobile melanin-containing clumps. Characterization of progression of atrophy is facilitated by time-lapse imaging. In vessels, AOO enables the observation and measurement of parietal structures and the observation of microscopic pathological features such as small hemorrhages and inflammatory cell accumulations.

show abstract

“…79,[102][103][104][105][106] ORTs appear on OCT B-scans as circular or ovoid structures in the outer nuclear layer, which may show a branching morphology with en face OCT reconstruction. The hyporeflective lumen of ORTs is delimited by a hyperreflective band representing the ELM.…”

Section: Outer Retinal Tubulationsmentioning

confidence: 99%