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Cicinelli MV, Montesano G, Berni A, Scandale P, Ometto G, Introini U, Battaglia Parodi M, Bandello F, Miserocchi E, Marchese A. Photoreceptor Integrity in MEWDS: Longitudinal Structure-Function Correlations. Invest Ophthalmol Vis Sci 2024; 65:28. [PMID: 38630674 PMCID: PMC11033598 DOI: 10.1167/iovs.65.4.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose The purpose of this study was to investigate structure-function correlations in multiple evanescent white dot syndrome (MEWDS) using microperimetry (MP) and spectral-domain optical coherence tomography (SD-OCT). Methods Single-center prospective observational study including 14 eyes from 13 patients with MEWDS monitored over a median of 49.5 days (interquartile range = 29-92 days). Investigations focused on best-corrected visual acuity (BCVA), foveal granularity, and the Photoreceptor Reflectivity Ratio (PRR) as a measure of photoreceptor integrity. MP assessed average retinal threshold sensitivity (RTS) and bivariate contour ellipse area (BCEA) for fixation stability. A linear mixed model was used to test associations and interactions among RTS, time, and clinical variables. A hierarchical linear mixed model was used to analyze structure-function relationships, addressing both individual and location-specific variations. Results Overall, 2340 MP locations were tested. PRR revealed a transient decrease within 30 days post-presentation, indicative of early photoreceptor disruption, followed by a progressive increase, signaling recovery. Significantly lower foveal sensitivity (RTS = 14.8 ± 7.4 vs. 22.5 ± 4.4 decibel [dB], P = 0.04) and increased fixation spread (63% BCEA = 1.26 ± 0.97 vs. 0.48 ± 0.35 deg2, P = 0.06) were noted in eyes with foveal granularity compared to those without. A significant increase in RTS was demonstrated over time (0.066 dB/day, P < 0.001), with a central-to-peripheral gradient of improvement. The interaction between follow-up time and baseline BCVA (P < 0.001) indicated more rapid improvement in eyes with worse initial vision. There was a robust, nonlinear association between PRR and RTS across all tested locations (P < 0.001), becoming asymptotic for sensitivity losses exceeding 20 dB. Conclusions Photoreceptor reflectivity accurately aligned with visual function in MEWDS on longitudinal examinations. The central-to-peripheral gradient of improvement may suggest specific vulnerabilities underlying the area around the disc.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Montesano
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alessandro Berni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giovanni Ometto
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- London Northwest University Healthcare NHS Trust, London, United Kingdom
| | - Ugo Introini
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Battaglia Parodi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cicinelli MV, Ramtohul P, Marchese A, Bandello F, Bailey Freund K, Miserocchi E, Jampol LM. Latest advances in white spot syndromes: New findings and interpretations. Prog Retin Eye Res 2023; 97:101207. [PMID: 37574123 DOI: 10.1016/j.preteyeres.2023.101207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
White spot syndromes (WSS) pose challenges in the field of ophthalmology, particularly in terms of accurate diagnosis and effective management. However, recent advancements in multimodal imaging (MMI) have significantly contributed to our understanding of WSS, allowing for improved characterization of these inflammatory chorioretinopathies. By employing various imaging modalities, including fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, optical coherence tomography (OCT), ultra-widefield imaging, and OCT angiography, researchers and clinicians have gained valuable insights into the underlying pathophysiological changes and clinical progression of WSS. Furthermore, MMI has unveiled novel and atypical variants within the spectrum of WSS, expanding our knowledge in this field. Notably, the identification of secondary forms of WSS occurring concurrently with unrelated chorioretinal disorders has suggested a potential autoimmune mechanism underlying these conditions. The introduction of MMI has also facilitated a more comprehensive evaluation of previously ill-defined entities, such as acute zonal occult outer retinopathy, leading to improved diagnostic criteria and enhanced recognition of distinct features. This review paper provides a comprehensive overview of the latest advances and interpretations in WSS. By integrating MMI into the diagnosis and management of these conditions, this review aims to enhance patient outcomes and provide valuable insights into the complexities surrounding WSS.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Essilfie J, Bacci T, Abdelhakim AH, Ramtohul P, Turchi F, Freund KB, Yannuzzi LA. ARE THERE TWO FORMS OF MULTIPLE EVANESCENT WHITE DOT SYNDROME? Retina 2022; 42:227-235. [PMID: 34432725 DOI: 10.1097/iae.0000000000003288] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the nature of multiple evanescent white dot syndrome (MEWDS) and differentiate an idiopathic or primary form of MEWDS from a secondary form that is seen in association with other clinical conditions affecting the posterior segment of the eye. METHODS Clinical and multimodal imaging findings including color fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography of patients with secondary MEWDS are presented. RESULTS Twenty consecutive patients with secondary MEWDS were evaluated. Fifteen patients were female. Most were young adults aged between 20 to 40 years with myopia (less than -6 diopters). Pathologic conditions associated with the secondary MEWDS reaction were high myopia (greater than -6 diopters) in two eyes, previous vitreoretinal surgery for rhegmatogenous retinal detachment in 2 eyes, and manifestations of multifocal choroiditis in 18 eyes. In all eyes, the MEWDS lesions followed a course of progression and resolution independent from the underlying condition. CONCLUSION Secondary MEWDS seems to be an epiphenomenon ("EpiMEWDS") that may be seen in association with clinical manifestations disruptive to the choriocapillaris-Bruch membrane-retinal pigment epithelium complex.
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Affiliation(s)
- Juliet Essilfie
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
| | - Aliaa H Abdelhakim
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York
- Irving Medical Center, Columbia University, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York
| | - Prithvi Ramtohul
- Centre Hospitalier, Universitaire de l'Hopital Nord, Marseille, France
- Ophthalmology Department, Universite de Paris, AP-HP, Hopital Larboisiere, Paris, France
| | - Federica Turchi
- Policlinico San Orsola Malpighi, University of Bologna, Bologna, Italy; and
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Irving Medical Center, Columbia University, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Irving Medical Center, Columbia University, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
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Baharani A, Errera MH, Jhingan M, Samanta A, Agarwal A, Singh SR, Reddy P RR, Grewal DS, Chhablani J. Choroidal Imaging in uveitis: an update. Surv Ophthalmol 2022; 67:965-990. [PMID: 35007618 DOI: 10.1016/j.survophthal.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/27/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
An important goal of advancements in ocular imaging algorithms and devices has been to improve the image acquisition and resolution of deeper ocular tissues, namely the choroid and its vasculature that are otherwise inaccessible to direct clinical examination. These advancements have contributed to the understanding of the pathophysiology of a number of ocular inflammatory conditions. We focuse on the imaging characteristics of clinical conditions where imaging the choroid has improved or radically changed the understanding of the disease, has helped in differentiation of phenotypically similar but distinct lesions, and where imaging features have proven vital formonitoring disease activity. The last two decades have seen some major developments in ocular imaging relevant to uveitis. The current review addresses both the imaging characteristics and their interpretation on conventional modalities such as fundus photography, fluorescein angiography, indocyanine green angiography and fundus autofluorescence and the recent additions in the armamentarium including optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography.
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Affiliation(s)
- Abhilasha Baharani
- Uveitis Services, Neoretina Eyecare Institute, Ramchander House, Chapel Road, Nampally, Hyderabad, India. 500001
| | - Marie-Helen Errera
- Department of Ophthalmology, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213
| | - Mahima Jhingan
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | - Raja Rami Reddy P
- Retina Services, Neoretina Eyecare Institute, Ramchander House, Chapel Road, Nampally, Hyderabad, India. 500001
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Rd Durham, NC 27705-4699
| | - Jay Chhablani
- Department of Ophthalmology, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213.
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A Multiple Evanescent White Dot Syndrome–like Reaction to Concurrent Retinal Insults. ACTA ACUST UNITED AC 2021; 5:1017-1026. [DOI: 10.1016/j.oret.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022]
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Bosello F, Westcott M, Casalino G, Agorogiannis G, Micciolo R, Rees A, Pavesio C. Multiple evanescent white dot syndrome: clinical course and factors influencing visual acuity recovery. Br J Ophthalmol 2020; 106:121-127. [DOI: 10.1136/bjophthalmol-2020-317357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 01/13/2023]
Abstract
ObjectiveTo report the demographics and the clinical course of patients with multiple evanescent white dot syndrome (MEWDS) and to investigate for those factors which influence visual acuity (VA) recovery.MethodsThis is a retrospective single-centre observational study. Electronic medical records and retinal imaging of patients with a diagnosis of MEWDS with a minimum follow-up of 3 months were reviewed. Patients were categorised into three groups according to the VA at presentation and at the last visit: group 1 >0.48 logarithm of the minimum angle of resolution (LogMAR), group 2 ≤0.48 and ≥0.18 LogMAR and group 3 <0.18 LogMAR. All patients had non-invasive multimodal imaging including optical coherence tomography, near-infrared reflectance imaging and blue fundus autofluorescence at presentation and during follow-up.ResultsA total of 51 eyes from 51 patients (41 women, mean age 29.8±7.8 years) were included. Significantly more patients presented in the autumn (X2=8.69, p=0.034). The percentage of eyes recovering vision to 0.0 LogMAR or better was 80.3% (41/51). Worse presenting vision and young age at presentation were independent significant predictive variables for poorer final VA (p=0.002 and p=0.02, respectively). No imaging features were significantly predictive of complete versus incomplete recovery, but disc hyperfluorescence on fluorescein angiography was more common in those with incomplete recovery.ConclusionsAlthough the majority of cases have a benign prognosis, the clinical spectrum of MEWDS includes incomplete visual recovery. In our series, poor presenting VA and young age were associated with poor VA outcome. Further study is warranted to confirm these findings.
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Zandi R, Song J, Micevych PS, Fawzi AA. Topographic Relationship between Telangiectasia and Cone Mosaic Disruption in Macular Telangiectasia Type 2. J Clin Med 2020; 9:jcm9103149. [PMID: 33003381 PMCID: PMC7601362 DOI: 10.3390/jcm9103149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/25/2022] Open
Abstract
In this cross-sectional observational study, we investigated the relationship between photoreceptor layer disruption and telangiectasia in patients diagnosed with early stage macular telangiectasia type 2 (MacTel). A total of 31 eyes (17 patients) with MacTel were imaged with adaptive optics scanning laser ophthalmoscopy (AOSLO) and optical coherence tomography angiography (OCTA). Confocal AOSLO was used to visualize dark regions of nonwaveguiding outer segments, which we refer to as “photoreceptor lesions”. En-face OCTA images of the deep capillary plexus (DCP) were used in conjunction with confocal AOSLO to evaluate the topographic relationship between areas of capillary telangiectasias and photoreceptor lesions. Among seven eyes with early stage MacTel (stage 0–2 based on OCT), we identified ten photoreceptor lesions, all of which were located within parafoveal quadrants containing DCP telangiectasia on OCTA. Seven of the lesions corresponded to the intact ellipsoid zone on spectral-domain OCT (SD-OCT), and three of these also corresponded to the intact interdigitation zone. This work demonstrates a topographic relationship between AOSLO photoreceptor lesions and DCP telangiectasias, and it also suggests that these lesions with normal SD-OCT appearance may represent areas of photoreceptors at risk for dysfunction. Thus, confocal AOSLO may have a meaningful role in detecting early photoreceptor abnormalities in eyes with MacTel.
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Vasseur V, Arej N, Alonso AS, Lafolie J, Philibert M, Vignal-Clermont C, Mauget-Faÿsse M. Spectralis High Magnification Module imaging in a case of Multiple Evanescent White Dot Syndrome. Am J Ophthalmol Case Rep 2020; 19:100727. [PMID: 32420514 PMCID: PMC7218256 DOI: 10.1016/j.ajoc.2020.100727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To report the use of Spectralis High Magnification Module (HMM) as part of multimodal imaging in Multiple Evanescent White Dot Syndrome (MEWDS). Observations HMM imaging showed a blurry mosaic pattern corresponding to MEWDS-related photoreceptors’ lesions. These abnormalities remained detectable at later stages of the disease while other imaging modalities were negative. Conclusions and importance HMM can be a useful technique to monitor the structure of the outer retina during the different stages of MEWDS.
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Affiliation(s)
- Vivien Vasseur
- Clinical Research Department, Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France
| | - Nicolas Arej
- Clinical Research Department, Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France.,Department of Ophthalmology (Vitreoretinal Section), Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France
| | - Anne-Sophie Alonso
- Clinical Research Department, Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France
| | - Justine Lafolie
- Clinical Research Department, Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France
| | - Manon Philibert
- Department of Ophthalmology (Neuro-ophthalmology Section), Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France
| | - Catherine Vignal-Clermont
- Department of Ophthalmology (Neuro-ophthalmology Section), Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France
| | - Martine Mauget-Faÿsse
- Clinical Research Department, Rothschild Foundation Hospital, 25-29 Rue Manin, 75019, Paris, France
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Ito Y, Ito M, Ueno S, Kataoka K, Takeuchi J, Kominami T, Takayama K, Terasaki H. Changes in intraocular pressure and aqueous flare in eyes with multiple evanescent white dot syndrome. Jpn J Ophthalmol 2020; 64:378-384. [PMID: 32215769 DOI: 10.1007/s10384-020-00738-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the changes in intraocular pressure (IOP) and aqueous flare in eyes with multiple evanescent white dot syndrome (MEWDS) during the disease course. STUDY DESIGN Retrospective observational study. METHODS Twenty-one patients with unilateral MEWDS were retrospectively evaluated. IOP values were compared between the affected and fellow eyes 2 weeks, 1 month, and 3 months following disease onset in 17 patients, and within 7 days from disease onset in 11 patients. Aqueous flare values measured using a laser flare-cell meter in ten eyes between 1 weeks and 1 month from disease onset were compared between the affected and fellow eyes. RESULTS IOP values were significantly lower in the affected eyes than in the fellow eyes at both 2 weeks (P=0.002) and 1 month from disease onset (P=0.02). However, IOP values of affected eyes did not show significant differences from the fellow eyes within 7 days ((P=0.11) and 3 months of onset (P=0.30). Aqueous flare values were significantly increased in the affected eyes compared to those in the fellow eyes (P=0.010) and significantly correlated with IOP values (r=-0.67, P=0.035). CONCLUSION IOP values mildly decreased in association with aqueous flare values in the acute phase in eyes with MEWDS.
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Affiliation(s)
- Yasuki Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Mari Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinji Ueno
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keiko Kataoka
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun Takeuchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Taro Kominami
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kei Takayama
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
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Russell JF, Pichi F, Scott NL, Hartley MJ, Bell D, Agarwal A, Leong B, Holland GN, Freund KB, Sarraf D. Masqueraders of multiple evanescent white dot syndrome (MEWDS). Int Ophthalmol 2019; 40:627-638. [DOI: 10.1007/s10792-019-01223-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 11/24/2022]
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Zicarelli F, Mantovani A, Preziosa C, Staurenghi G. Multimodal Imaging of Multiple Evanescent White Dot Syndrome: A New Interpretation. Ocul Immunol Inflamm 2019; 28:814-820. [DOI: 10.1080/09273948.2019.1635169] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco,” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Chiara Preziosa
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco,” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco,” Luigi Sacco Hospital, University of Milan, Milan, Italy
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Zhang YS, Onishi AC, Zhou N, Song J, Samra S, Weintraub S, Fawzi AA. Characterization of Inner Retinal Hyperreflective Alterations in Early Cognitive Impairment on Adaptive Optics Scanning Laser Ophthalmoscopy. Invest Ophthalmol Vis Sci 2019; 60:3527-3536. [PMID: 31412112 PMCID: PMC6694736 DOI: 10.1167/iovs.19-27135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/05/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To examine inner retinal hyperreflective features on adaptive optics scanning laser ophthalmoscopy (AOSLO) in individuals with early cognitive impairment. Methods In this prospective, cross-sectional study, we enrolled 12 participants with either amnestic mild cognitive impairment (aMCI, n = 10) or early dementia due to Alzheimer's disease (eAD, n = 2) and 12 age-, sex-, and race-matched cognitively normal controls. All participants completed AOSLO imaging of the inner retina. AOSLO montages of the peripapillary area were graded for hyperreflective features including granular membranes, mottled membranes, and nummular features. Regions of interest on AOSLO were compared qualitatively to corresponding optical coherence tomography (OCT) cross sections. OCT was also used to analyze peripapillary retinal nerve fiber layer (RNFL) thickness. Results Cognitively impaired individuals had a significantly higher number of granular membranes with a larger overall area compared to controls. The proportion of cognitively impaired individuals with two or more granular membranes was 41.7% compared to none in the control group. Granular membrane area was also inversely correlated with cognitive performance on the Montreal Cognitive Assessment. There was no difference between the two groups in terms of other membrane types or RNFL thickness. Conclusions Individuals with early cognitive impairment related to Alzheimer's show hyperreflective granular membranes on high-resolution imaging, which we hypothesize to be manifestations of inner retinal gliosis. The presence of these subtle hyperreflective membranes may obscure underlying RNFL thinning in these eyes on OCT imaging. The distinctive phenotype of granular membranes surrounding the optic nerve on AOSLO may represent a new potential biomarker of early Alzheimer's.
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Affiliation(s)
- Yi Stephanie Zhang
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Alex C. Onishi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Nina Zhou
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Jessica Song
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Sahej Samra
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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