Fundus autofluorescence findings in central serous chorioretinopathy using two different confocal scanning laser ophthalmoscopes: correlation with functional and structural status

Fundus autofluorescence abnormalities can predict fluorescein angiography abnormalities in patients with chronic central serous chorioretinopathy

PURPOSE

This study is to assess the possible correlation between findings on fundus autofluorescence (FAF) and fluorescein angiography (FA) in patients with chronic central serous chorioretinopathy (cCSC).

METHODS

This multicentre retrospective cohort study included 71 cCSC patients (92 eyes) with at least 6 months of follow-up, who had a FAF-FA imaging discrepancy larger than 0.5 optic disc diameters in size in the corresponding areas of hyperfluorescent abnormalities. A comparison was performed between progression in size of areas of hyperautofluorescent retinal pigment epithelium (RPE) abnormalities on FAF (HF-FAF) and the hyperfluorescent areas on FA (HF-FA) at first visit and last visit. The possible correlations were estimated between FAF-FA discrepancy and disease characteristics.

RESULTS

The median area of HF-FAF at first visit was 7.48 mm2 (1.41-27.9). The median area of HF-FA at first visit and last visit was 2.40 mm2 (0.02-17.27) and 5.22 mm2 (0.53-25.62), respectively. FAF-FA discrepancy was associated with follow-up duration and the area of HF-FAF at first visit. A mathematical algorithm for grading FAF-FA discrepancy in time was suggested, which predicted the enlargement of hyperfluorescent RPE abnormalities on FA in 82.6% of cases.

CONCLUSION

There is a statistically significant relationship between the areas of HF-FAF and HF-FA in cCSC patients with FAF-FA imaging discrepancy at first presentation. Long-term changes in RPE alterations in cCSC on FA can be predicted based on baseline HF-FAF and follow-up duration.

FUNDUS AUTOFLUORESCENCE PATTERNS IN CENTRAL SEROUS CHORIORETINOPATHY

The fundus autofluorescence pattern of central serous chorioretinopathy is related to the disease chronicity, visual acuity, and optical coherence tomography findings. Classification of fundus autofluorescence patterns in central serous chorioretinopathy is helpful when predicting the disease status and considering the timing of treatment.

Purpose:

To investigate the patterns of fundus autofluorescence (FAF) abnormalities in patients with central serous chorioretinopathy (CSC).

Methods:

This cross-sectional observational study included 126 eyes of 118 patients who were diagnosed with central serous chorioretinopathy from December 2006 to April 2012 at Kyung Hee University Hospital, Seoul, Korea. Fundus autofluorescence patterns were analyzed with spectral domain optical coherence tomography and visual acuity.

Results:

Fundus autofluorescence patterns were grouped as blocked (38.9%), mottled (8.7%), hyper (31.0%), hyper/hypo (13.5%), or descending tract (8.0%). The duration of symptoms was 7.8 (±20.4), 28.3 (±31.8), 42.5 (±69.1), 163.8 (±183.5), and 174.5 (±162.3) days in the blocked, mottled, hyper, descending tract, and hyper/hypo groups, respectively (P < 0.001). The blocked FAF group had the best visual acuity (P = 0.011). The intact ellipsoid zone on the spectral domain optical coherence tomography was mostly found in the blocked FAF group (P < 0.001), and the disrupted ellipsoid zone was commonly exhibited in the hyper/hypo and descending tract groups. Disrupted external limiting membrane line on the spectral domain optical coherence tomography was seen in two patients of the descending tract group only.

Conclusion:

The FAF abnormalities in central serous chorioretinopathy show multiple patterns and are related with the chronicity and visual acuity. Fundus autofluorescence patterns in central serous chorioretinopathy are helpful when considering the timing of treatment and predicting the disease status.

Multimodal Imaging Features of Optic Disc Drusen

PURPOSE

To identify key en face multimodal imaging features of optic disc drusen (ODD).

DESIGN

Retrospective cross-sectional study.

METHODS

Setting: a single academic center. Patient orStudyPopulation: 786 patients (10-82 years of age) with diagnostic codes for optic disc drusen (ODD) in clinical notes extracted using natural language processing. Intervention orObservationProcedures: color fundus imaging, green-light and blue-light fundus autofluorescence (FAF), near-infrared reflectance (NIR), and enhanced-depth imaging optical coherence tomography (EDI-OCT). MainOutcomeMeasurements: Ophthalmic imaging characteristics and sensitivity of en face imaging compared with EDI-OCT.

RESULTS

A total of 38 patients (61 eyes) had high-quality EDI-OCT scans and en face multimodal imaging. Green-light FAF imaging had the highest diagnostic sensitivity (96.8%) for ODD and showed homogeneous hyperautofluorescence, whereas blue-light FAF imaging had heterogeneous brightness, which helped differentiate superficial from deep ODD. Blue-light FAF (93.5%) and NIR (91.8%) imaging were also sensitive tests and revealed papillary and peripapillary features that were not well seen on green-light FAF, including the size and depth of ODD, morphology of the optic disc, and common ODD-associated structures such as horizontal hyper-reflective lines and peripapillary hyper-reflective ovoid mass-like structures (PHOMS). Color fundus imaging had the lowest sensitivity (82%). There was good inter-rater reliability for all en face imaging modalities (P < .0001 for all).

CONCLUSIONS

In en face imaging, green-light FAF had the highest sensitivity for the diagnosis of ODD, whereas blue-light FAF and NIR images provided more information regarding the severity, location, depth, and size of ODD. In eyes that are negative on green-light FAF, EDI-OCT should be performed and provides the highest-resolution characterization of the entire optic disc to assess or rule out ODD.

Clinical application of ultra-widefield fundus autofluorescence

PURPOSE

To review the basic principles of ultra-widefield fundus autofluorescence (UWF-FAF) and discuss its clinical application for a variety of retinal and choroidal disorders.

METHODS

A systematic review of the PubMed database was performed using the search terms "ultra-widefield," "autofluorescence," "retinal disease" and "choroidal disease."

RESULTS

UWF-FAF imaging is a recently developed noninvasive retinal imaging modality with a wide imaging range that can locate peripheral fundus lesions that traditional fundus autofluorescence cannot. Multiple commercially available ultra-widefield imaging systems, including Heidelberg Spectralis and Optomap Ultra-Widefield systems, are available to the clinician. Imaging by UWF-FAF is more comprehensive; it can reflect the content and distribution of the predominant ocular fluorophore in retinal pigment epithelial cells and evaluate the metabolic status of RPE of various retinal and choroidal disorders.

CONCLUSION

UWF-FAF can detect abnormalities that traditional fundus autofluorescence cannot; therefore, it can be used to better elucidate disease pathogenesis, analyze genotype-phenotype correlations, diagnose and monitor disease.

Fundus autofluorescence imaging: systematic review of test accuracy for the diagnosis and monitoring of retinal conditions

We conducted a systematic review of the accuracy of fundus autofluorescence (FAF) imaging for diagnosing and monitoring retinal conditions. Searches in November 2014 identified English language references. Sources included MEDLINE, EMBASE, the Cochrane Library, Web of Science, and MEDION databases; reference lists of retrieved studies; and internet pages of relevant organisations, meetings, and trial registries. For inclusion, studies had to report FAF imaging accuracy quantitatively. Studies were critically appraised using QUADAS risk of bias criteria. Two reviewers conducted all review steps. From 2240 unique references identified, eight primary research studies met the inclusion criteria. These investigated diagnostic accuracy of FAF imaging for choroidal neovascularisation (one study), reticular pseudodrusen (three studies), cystoid macular oedema (two studies), and diabetic macular oedema (two studies). Diagnostic sensitivity of FAF imaging ranged from 32 to 100% and specificity from 34 to 100%. However, owing to methodological limitations, including high and/or unclear risks of bias, none of these studies provides conclusive evidence of the diagnostic accuracy of FAF imaging. Study heterogeneity precluded meta-analysis. In most studies, the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported whether FAF images were interpreted consistently. No studies of monitoring accuracy were identified. An update in October 2016, based on MEDLINE and internet searches, identified four new studies but did not alter our conclusions. Robust quantitative evidence on the accuracy of FAF imaging and how FAF images are interpreted is lacking. We provide recommendations to address this.

Is the unaffected eye really unaffected? Color Doppler ultrasound findings in unilaterally active central serous chorioretinopathy

PURPOSE

To evaluate ocular hemodynamic changes using color Doppler ultrasonography imaging (CDI) with an emphasis on unaffected eyes of patients with central serous chorioretinopathy (CSC).

METHODS

Twenty-seven patients with active CSC and 25 controls were analyzed using spectral domain-optical coherence tomography (SD-OCT) and CDI for choroidal imaging and evaluation of retrobulbar vessels, respectively.

RESULTS

Resistive index (RI), pulsatility index (PI), and peak systolic velocity (PSV) of the ophthalmic artery (OA) and PSV, end-diastolic velocity (EDV), and mean velocity (Vmean) of the central retinal artery (CRA) in the patient group were less than those in the control group. RI and PI of the CRA were greater in the patient group compared to the control group. RI, PI, PSV, and Vmean of the OA and PSV, EDV, and Vmean of the CRA in the patients' unaffected eyes were less than those in the control group. OCT measurements of central choroidal thickness (CCT) of the affected eyes in the patient group were significantly greater than those of the unaffected eyes in the patient and control groups; that of the unaffected eyes was greater than that in the control group.

CONCLUSIONS

Hemodynamic changes in OA reflect choroidal hyperperfusion. Hemodynamic and OCT changes in the unaffected eyes of the patient group suggest CSC as a bilateral disorder and the systemic nature of the disease. Further investigations may aid in the evaluation of treatment response and the follow-up of disease, providing a new insight into management strategies.

Clinical applications of fundus autofluorescence in retinal disease

Fundus autofluorescence (FAF) is a non-invasive retinal imaging modality used in clinical practice to provide a density map of lipofuscin, the predominant ocular fluorophore, in the retinal pigment epithelium. Multiple commercially available imaging systems, including the fundus camera, the confocal scanning laser ophthalmoscope, and the ultra-widefield imaging device, are available to the clinician. Each offers unique advantages for evaluating various retinal diseases. The clinical applications of FAF continue to expand. It is now an essential tool for evaluating age related macular degeneration, macular dystrophies, retinitis pigmentosa, white dot syndromes, retinal drug toxicities, and various other retinal disorders. FAF may detect abnormalities beyond those detected on funduscopic exam, fluorescein angiography, or optical coherence tomography, and can be used to elucidate disease pathogenesis, form genotype-phenotype correlations, diagnose and monitor disease, and evaluate novel therapies. Given its ease of use, non-invasive nature, and value in characterizing retinal disease, FAF enjoys increasing clinical relevance. This review summarizes common ocular fluorophores, imaging modalities, and FAF findings for a wide spectrum of retinal disorders.