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Amarasekera S, Williams AM, Freund KB, Rossi EA, Dansingani KK. MULTIMODAL IMAGING OF MULTIFOCAL CHOROIDITIS WITH ADAPTIVE OPTICS OPHTHALMOSCOPY. Retin Cases Brief Rep 2022; 16:747-753. [PMID: 36288621 PMCID: PMC9606444 DOI: 10.1097/icb.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe longitudinal, anatomical, and functional alterations caused by inflammatory and neovascular lesions of idiopathic multifocal choroiditis/punctate inner choroidopathy using adaptive optics imaging and microperimetry. METHODS Longitudinal case study using multiple imaging modalities, including spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, optical coherence tomography angiography, flood illumination adaptive optics, and microperimetry. RESULTS A 21-year-old myopic Asian man presented with blurred vision in the right eye. Clinical examination was notable for an isolated hypopigmented, perifoveal lesion in each eye. Multimodal imaging showed inflammatory lesions in the outer retina, retina pigment epithelium, and inner choroid lesions of both eyes. The right eye additionally exhibited active Type-2 macular neovascularization with loss of cone mosaic regularity that was associated with reduced sensitivity on microperimetry. The clinical picture was consistent with multifocal choroiditis/punctate inner choroidopathy. The patient was treated with oral steroids and three injections of intravitreal bevacizumab in the right eye. After therapy, imaging showed reestablishment of the cone mosaic on flood illumination adaptive optics and improvement in sensitivity on microperimetry. CONCLUSION Adaptive optics imaging and microperimetry may detect biomarkers that help to characterize the nature and activity of multifocal choroiditis lesions and to help monitor response to therapy. With timely intervention, structural abnormalities in the outer retina and choroid can be treated, and anatomical improvements precede improvements in visual function.
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Affiliation(s)
- Sohani Amarasekera
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew M. Williams
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - K. Bailey Freund
- Vitreous Retina Macular Consultants of New York, New York, New York
- LuEsther T. Merz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Ethan A. Rossi
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kunal K. Dansingani
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Domdei N, Reiniger JL, Holz FG, Harmening WM. The Relationship Between Visual Sensitivity and Eccentricity, Cone Density and Outer Segment Length in the Human Foveola. Invest Ophthalmol Vis Sci 2021; 62:31. [PMID: 34289495 PMCID: PMC8300048 DOI: 10.1167/iovs.62.9.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose The cellular topography of the human foveola, the central 1° diameter of the fovea, is strikingly non-uniform, with a steep increase of cone photoreceptor density and outer segment (OS) length toward its center. Here, we assessed to what extent the specific cellular organization of the foveola of an individual is reflected in visual sensitivity and if sensitivity peaks at the preferred retinal locus of fixation (PRL). Methods Increment sensitivity to small-spot, cone-targeted visual stimuli (1 × 1 arcmin, 543-nm light) was recorded psychophysically in four human participants at 17 locations concentric within a 0.2° diameter on and around the PRL with adaptive optics scanning laser ophthalmoscopy-based microstimulation. Sensitivity test spots were aligned with cell-resolved maps of cone density and cone OS length. Results Peak sensitivity was at neither the PRL nor the topographical center of the cone mosaic. Within the central 0.1° diameter, a plateau-like sensitivity profile was observed. Cone density and maximal OS length differed significantly across participants, correlating with their peak sensitivity. Based on these results, biophysical simulation allowed to develop a model of visual sensitivity in the foveola, with distance from the PRL (eccentricity), cone density, and OS length as parameters. Conclusions Small-spot sensitivity thresholds in healthy retinas will help to establish the range of normal foveolar function in cell-targeted vision testing. Because of the high reproducibility in replicate testing, threshold variability not explained by our model is assumed to be caused by individual cone and bipolar cell weighting at the specific target locations.
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Affiliation(s)
- Niklas Domdei
- Department of Ophthalmology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Jenny L Reiniger
- Department of Ophthalmology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Wolf M Harmening
- Department of Ophthalmology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Li C, Xu F, Zhou L, Zhao H, Yu M, Zhou S, Jin C. Quantitative evaluation of photoreceptor density in chronic central serous chorioretinopathy using the Spectralis High Magnification Module. Photodiagnosis Photodyn Ther 2021; 35:102410. [PMID: 34147696 DOI: 10.1016/j.pdpdt.2021.102410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantitatively evaluate the photoreceptor density in patients with chronic central serous chorioretinopathy (cCSC) using the Spectralis High Magnification Module (HMM). METHODS Twenty-four eyes of 24 patients with resolved cCSC, 24 fellow eyes from 24 other patients with unilateral cCSC, and 24 normal eyes of 24 healthy clients were enrolled in this observational case study. Photoreceptor densities of the retina in the nasal, temporal, superior, and inferior areas 500 μm from the central fovea were counted manually through the High Magnification Module (HMM) images using ImageJ software, and the average values were taken for further analysis. RESULTS The mean photoreceptor density 500 μm from the central fovea in the normal eyes (17,217 ± 1144 cells/mm2) was significantly higher than that of both affected eyes (9721 ± 1699 cells/mm2) and fellow eyes (15,667 ± 1909 cells/mm2) (P < 0.001; P = 0.002, respectively). The mean photoreceptor density was significantly correlated with logMAR visual acuity (r = -0.432, P = 0.035), duration of symptoms (r = -0.537, P = 0.007), retinal sensitivity and fixation stability P2 in eyes with resolved cCSC (r = 0.430, P = 0.036; r = 0.420, P = 0.041, respectively). CONCLUSIONS The HMM images revealed significant photoreceptor loss in patients with cCSC. The findings suggest that early intervention of the affected eyes, with short duration and good visual function, might be beneficial in preserving photoreceptor cells. As a novel imaging modality producing fast, high-resolution images, HMM shows great potential to detect microstructural impairments in retinal diseases.
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Affiliation(s)
- Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Hongkun Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China
| | - Minzhong Yu
- Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Shaobo Zhou
- Department of Ophthalmology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, China.
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Akyol E, Hagag AM, Sivaprasad S, Lotery AJ. Adaptive optics: principles and applications in ophthalmology. Eye (Lond) 2021; 35:244-264. [PMID: 33257798 PMCID: PMC7852593 DOI: 10.1038/s41433-020-01286-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/19/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022] Open
Abstract
This is a comprehensive review of the principles and applications of adaptive optics (AO) in ophthalmology. It has been combined with flood illumination ophthalmoscopy, scanning laser ophthalmoscopy, as well as optical coherence tomography to image photoreceptors, retinal pigment epithelium (RPE), retinal ganglion cells, lamina cribrosa and the retinal vasculature. In this review, we highlight the clinical studies that have utilised AO to understand disease mechanisms. However, there are some limitations to using AO in a clinical setting including the cost of running an AO imaging service, the time needed to scan patients, the lack of normative databases and the very small size of area imaged. However, it is undoubtedly an exceptional research tool that enables visualisation of the retina at a cellular level.
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Affiliation(s)
- Engin Akyol
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ahmed M Hagag
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
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Subtype-differentiated impacts of subretinal drusenoid deposits on photoreceptors revealed by adaptive optics scanning laser ophthalmoscopy. Graefes Arch Clin Exp Ophthalmol 2020; 258:1931-1940. [PMID: 32488329 DOI: 10.1007/s00417-020-04774-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/17/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To examine the structure of photoreceptors surrounding two subtypes of subretinal drusenoid deposits (SDD), namely, dot and ribbon SDD, using multimodal imaging including adaptive optics scanning laser ophthalmoscopy (AOSLO) and spectral-domain optical coherence tomography (SD-OCT). METHODS Twenty-six eyes of 13 patients with age-related macular degeneration (AMD) and SDD and 16 eyes of 8 subjects in normal chorioretinal health were studied. SDD presence, stage, and subtype were determined using color fundus photographs, infrared reflectance, autofluorescence imaging, and SD-OCT. SDD and surrounding photoreceptors were imaged using AOSLO. The structure of cone photoreceptors and SDD was examined at the baseline and at 2-year follow-up studies in 6 patients. RESULTS Dot SDD were identified in 18 eyes of 9 patients and coexisting dot and ribbon SDD were observed in 8 eyes of 4 patients. While a characteristic photoreceptor mosaic was clearly revealed by AOSLO in the area unaffected by lesions in those eyes with dot-only SDD, in unaffected areas adjacent to retinal regions with predominantly ribbon SDD, photoreceptors could no longer be visualized. CONCLUSION The invisibility of the photoreceptor mosaic in unaffected areas adjacent to retinal regions with predominantly ribbon SDD suggests degeneration in the outer segment and the interdigitation zone, which impairs the waveguiding ability of the photoreceptors. Our study implies possible differentiation of disease outcome and functional impact in different types of SDD.
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Yap TE, Donna P, Almonte MT, Cordeiro MF. Real-Time Imaging of Retinal Ganglion Cell Apoptosis. Cells 2018; 7:E60. [PMID: 29914056 PMCID: PMC6025611 DOI: 10.3390/cells7060060] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023] Open
Abstract
Monitoring real-time apoptosis in-vivo is an unmet need of neurodegeneration science, both in clinical and research settings. For patients, earlier diagnosis before the onset of symptoms provides a window of time in which to instigate treatment. For researchers, being able to objectively monitor the rates of underlying degenerative processes at a cellular level provides a biomarker with which to test novel therapeutics. The DARC (Detection of Apoptosing Retinal Cells) project has developed a minimally invasive method using fluorescent annexin A5 to detect rates of apoptosis in retinal ganglion cells, the key pathological process in glaucoma. Numerous animal studies have used DARC to show efficacy of novel, pressure-independent treatment strategies in models of glaucoma and other conditions where retinal apoptosis is reported, including Alzheimer’s disease. This may forge exciting new links in the clinical science of treating both cognitive and visual decline. Human trials are now underway, successfully demonstrating the safety and efficacy of the technique to differentiate patients with progressive neurodegeneration from healthy individuals. We review the current perspectives on retinal ganglion cell apoptosis, the way in which this can be imaged, and the exciting advantages that these future methods hold in store.
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Affiliation(s)
- Timothy E Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK.
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK.
| | - Piero Donna
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK.
| | - Melanie T Almonte
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK.
| | - Maria Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London NW1 5QH, UK.
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London NW1 5QH, UK.
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London EC1V 9EL, UK.
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Recent Advances in Ocular Imaging in Management of Uveitis and Related Intraocular Inflammations. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.yaoo.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Agarwal A, Afridi R, Agrawal R, Do DV, Gupta V, Nguyen QD. Multimodal Imaging in Retinal Vasculitis. Ocul Immunol Inflamm 2017; 25:424-433. [DOI: 10.1080/09273948.2017.1319494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rupesh Agrawal
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- School of Material Science and Engineering, Nanyang Technological University, Singapore
| | - Diana V. Do
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Quan Dong Nguyen
- Department of Ophthalmology, Imaging Research and Reading Center (OIRRC), Menlo Park, California, USA
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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Khanna S, Nesper PL, Koreishi AF, Goldstein DA, Fawzi AA. Visualization of Photoreceptors in Birdshot Chorioretinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy: A Pilot Study. Ocul Immunol Inflamm 2017; 25:610-620. [PMID: 28362542 DOI: 10.1080/09273948.2017.1298819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Adaptive optics scanning laser ophthalmoscopy (AOSLO) allows en face visualization of specific layers of the retina. This pilot study evaluated the ability of AOSLO to visualize photoreceptor integrity in patients with birdshot chorioretinopathy (BCR). METHOD A total of 16 consecutive patients with HLA-A29+ BCR were imaged using the prototype Apaeros retinal imaging system. Images of high quality were aligned with infrared reflectance photos and correlated with spectral domain optical coherence tomography (SD-OCT). RESULTS Images of four eyes of three patients were of sufficient quality to allow posterior pole montage and point-to-point correlation with SD-OCT. Areas of photoreceptor disruption on SD-OCT were seen as patchy areas of loss on AOSLO, whereas areas of intact interdigitation zone and inner segment/outer segment junction correlated with normal appearing photoreceptors on AOSLO. CONCLUSIONS Using AOSLO, we found one instance of subclinical photoreceptor disruption not seen on SD-OCT. Ultimately, there are unique challenges associated with imaging BCR patients using AOSLO.
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Affiliation(s)
- Sheena Khanna
- a Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Peter L Nesper
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Anjum F Koreishi
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Debra A Goldstein
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
| | - Amani A Fawzi
- b Department of Ophthalmology , Feinberg School of Medicine, Northwestern University , Chicago , Illinois , USA
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Parafoveal cone abnormalities and recovery on adaptive optics in posterior uveitis. Am J Ophthalmol Case Rep 2016; 1:16-22. [PMID: 29503883 PMCID: PMC5757342 DOI: 10.1016/j.ajoc.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/18/2016] [Accepted: 03/08/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To determine if adaptive optics (AO) flood illumination imaging can detect subclinical changes in 4 cases of posterior uveitis affecting the outer retina. Observations In all 4 cases, the affected eye showed altered areas in the photoreceptor mosaic on AO that corresponded to changes on other imaging modalities. Abnormalities not apparent on other imaging modalities were also noted. In one case of multifocal choroiditis with acute outer retinal atrophy, AO revealed decreased visualization of photoreceptors in the unaffected eye that was not noted on spectral domain-optical coherence tomography. In the patient with multiple evanescent white dot syndrome, focal photoreceptor abnormalities were more apparent on AO compared to other imaging modalities, and these areas normalized on AO during follow-up. Five weeks after initiation of high dose prednisone and azathioprine in a patient with serpiginous choroidopathy, AO images showed recovery in apparent parafoveal cone density. Conclusions and importance AO detects subclinical changes in the photoreceptor layer in posterior uveitis that can recover over time. AO may be useful in following outer retinal inflammatory conditions.
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