Assessing Photoreceptor Structure Associated With Ellipsoid Zone Disruptions Visualized With Optical Coherence Tomography

Scoles, Drew; Flatter, John; Cooper, Robert F.; Langlo, Christopher S; Robison, Scott; Neitz, Mary Jo; Weinberg, David V.; Pennesi, Mark E.; Han, Dennis P.; Dubra, Alfredo; Carroll, Joseph

doi:10.1097/iae.0000000000000618

Cited by 74 publications

(60 citation statements)

References 48 publications

(50 reference statements)

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“…Using confocal AOSLO, we observed significant disruption of the cone mosaic in areas of an intact EZ, although there was relatively good correspondence between the disruption of the IZ band and disruption of the cone mosaic, consistent with previous results showing that confocal reflectivity corresponds closely to IZ band integrity. 50,65 In addition, we documented remnant cone inner segment structure with split-detector AOSLO beyond the point of EZ termination: in fact, inner segments were observed until the point of ELM collapse. Recent work in patients with macular telangiectasia type 2 has shown that EZ (or IS/OS) layer intensity can spontaneously recover in areas underlying a preserved ELM.…”

Section: Discussionmentioning

confidence: 76%

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Assessing Photoreceptor Structure in Retinitis Pigmentosa and Usher Syndrome

Sun

Johnson

Langlo

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PurposeThe purpose of this study was to examine cone photoreceptor structure in retinitis pigmentosa (RP) and Usher syndrome using confocal and nonconfocal split-detector adaptive optics scanning light ophthalmoscopy (AOSLO).MethodsNineteen subjects (11 RP, 8 Usher syndrome) underwent ophthalmic and genetic testing, spectral-domain optical coherence tomography (SD-OCT), and AOSLO imaging. Split-detector images obtained in 11 subjects (7 RP, 4 Usher syndrome) were used to assess remnant cone structure in areas of altered cone reflectivity on confocal AOSLO.ResultsDespite normal interdigitation zone and ellipsoid zone appearance on OCT, foveal and parafoveal cone densities derived from confocal AOSLO images were significantly lower in Usher syndrome compared with RP. This was due in large part to an increased prevalence of non-waveguiding cones in the Usher syndrome retina. Although significantly correlated to best-corrected visual acuity and foveal sensitivity, cone density can decrease by nearly 38% before visual acuity becomes abnormal. Aberrantly waveguiding cones were noted within the transition zone of all eyes and corresponded to intact inner segment structures. These remnant cones decreased in density and increased in diameter across the transition zone and disappeared with external limiting membrane collapse.ConclusionsFoveal cone density can be decreased in RP and Usher syndrome before visible changes on OCT or a decline in visual function. Thus, AOSLO imaging may allow more sensitive monitoring of disease than current methods. However, confocal AOSLO is limited by dependence on cone waveguiding, whereas split-detector AOSLO offers unambiguous and quantifiable visualization of remnant cone inner segment structure. Confocal and split-detector thus offer complementary insights into retinal pathology.

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Section: Discussionmentioning

confidence: 76%

“…En face scans were generated from the horizontal volumes using previously described custom segmentation software. 50 …”

Section: Methodsmentioning

confidence: 99%

Assessing Photoreceptor Structure in Retinitis Pigmentosa and Usher Syndrome

Sun

Johnson

Langlo

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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“…On AOSLO, photoreceptors appear as bright spots due to their waveguiding properties; light is directed by the inner segment into the outer segment, and then reflected back toward the pupil center [10]. Disruption of the waveguiding properties of photoreceptors on AOSLO has been shown to correspond to disruption of the photoreceptor layers on spectral domain-optical coherence tomography (SD-OCT) [11]. Previous studies using various AO techniques to assess the outer retina in patients with DR have shown decreased perifoveal photoreceptor density [12–14], a higher spread in neighbor distances between cones and a deviation from the normal cone packing arrangement [14].…”

Section: Introductionmentioning

confidence: 99%

Adaptive Optics Reveals Photoreceptor Abnormalities in Diabetic Macular Ischemia

2017

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Diabetic macular ischemia (DMI) is a phenotype of diabetic retinopathy (DR) associated with chronic hypoxia of retinal tissue. The goal of this prospective observational study was to report evidence of photoreceptor abnormalities using adaptive optics scanning laser ophthalmoscopy (AOSLO) in eyes with DR in the setting of deep capillary plexus (DCP) non-perfusion. Eleven eyes from 11 patients (6 women, age 31–68), diagnosed with DR without macular edema, underwent optical coherence tomography angiography (OCTA) and AOSLO imaging. One patient without OCTA imaging underwent fluorescein angiography to characterize the enlargement of the foveal avascular zone. The parameters studied included photoreceptor heterogeneity packing index (HPi) on AOSLO, as well as DCP non-perfusion and vessel density on OCTA. Using AOSLO, OCTA and spectral domain (SD)-OCT, we observed that photoreceptor abnormalities on AOSLO and SD-OCT were found in eyes with non-perfusion of the DCP on OCTA. All eight eyes with DCP non-flow on OCTA showed photoreceptor abnormalities on AOSLO. Six of the eight eyes also had outer retinal abnormalities on SD-OCT. Three eyes with DR and robust capillary perfusion of the DCP had normal photoreceptors on SD-OCT and AOSLO. Compared to eyes with DR without DCP non-flow, the eight eyes with DCP non-flow had significantly lower HPi (P = 0.013) and parafoveal DCP vessel density (P = 0.016). We found a significant correlation between cone HPi and parafoveal DCP vessel density (r = 0.681, P = 0.030). Using a novel approach with AOSLO and OCTA, this study shows an association between capillary non-perfusion of the DCP and abnormalities in the photoreceptor layer in eyes with DR. This observation is important in confirming the significant contribution of the DCP to oxygen requirements of photoreceptors in DMI, while highlighting the ability of AOSLO to detect subtle photoreceptor changes not always visible on SD-OCT.

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“…1 Its superior axial resolution makes it valuable in studying individual retinal layers, and implementation of summed volume projections can provide detailed, layer-specific en face images. 2–5 Despite its use, controversy remains regarding the anatomic origin of the hyperreflective signals corresponding to the photoreceptors and other outer retinal structures on OCT.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Retinal Melanin on Optical Coherence Tomography Images

Wilk

Huckenpahler

Collery

et al. 2017

Trans. Vis. Sci. Tech.

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PurposeWe assessed the effect of melanin on the appearance of hyperreflective outer retinal bands in optical coherence tomography (OCT) images.MethodsA total of 23 normal subjects and 51 patients with albinism were imaged using the Bioptigen high-resolution spectral-domain OCT. In addition, three wild type, three albino (slc45a2b4/b4), and eight tyrosinase mosaic zebrafish were imaged with the hand-held Bioptigen Envisu R2200 OCT. To identify pigmented versus nonpigmented regions in the tyrosinase mosaic zebrafish, en face summed volume projections of the retinal pigment epithelium (RPE) were created from volume scans. Longitudinal reflectivity profiles were generated from B-scans to assess the width and maximum intensity of the RPE band in fish, or the presence of one or two RPE/Bruch's membrane (BrM) bands in humans.ResultsThe foveal RPE/BrM appeared as two bands in 71% of locations in patients with albinism and 45% of locations in normal subjects (P = 0.0003). Pigmented zebrafish retinas had significantly greater RPE reflectance, and pigmented regions of mosaic zebrafish also had significantly broader RPE bands than all other groups.ConclusionsThe hyperreflective outer retinal bands in OCT images are highly variable in appearance. We showed that melanin is a major contributor to the intensity and width of the RPE band on OCT. One should use caution in extrapolating findings from OCT images of one or even a few individuals to define the absolute anatomic correlates of the hyperreflective outer retinal bands in OCT images.Translational RelevanceMelanin affects the appearance of the outer retinal bands in OCT images. Use of animal models may help dissect the anatomic correlates of the complex reflective signals in OCT retinal images.

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Assessing Photoreceptor Structure Associated With Ellipsoid Zone Disruptions Visualized With Optical Coherence Tomography

Cited by 74 publications

References 48 publications

Assessing Photoreceptor Structure in Retinitis Pigmentosa and Usher Syndrome

Assessing Photoreceptor Structure in Retinitis Pigmentosa and Usher Syndrome

Adaptive Optics Reveals Photoreceptor Abnormalities in Diabetic Macular Ischemia

The Effect of Retinal Melanin on Optical Coherence Tomography Images

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