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Ganglion Cell Complex Analysis: Correlations with Retinal Nerve Fiber Layer on Optical Coherence Tomography. Diagnostics (Basel) 2023; 13:diagnostics13020266. [PMID: 36673076 PMCID: PMC9858609 DOI: 10.3390/diagnostics13020266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this review is to analyze the correlations between the changes in the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) on optical coherence tomography in different possible situations, especially in eyes with glaucoma. For glaucoma evaluation, several studies have suggested that in the early stages, GCC analysis, especially the thickness of the infero and that of the inferotemporal GCC layers, is a more sensitive examination than circumpapillary RNFL (pRNFL). In the moderate stages of glaucoma, inferior pRNFL thinning is better correlated with the disease than in advanced cases. Another strategy for glaucoma detection is to find any asymmetry of the ganglion cell-inner plexiform layers (GCIPL) between the two macular hemifields, because this finding is a valuable indicator for preperimetric glaucoma, better than the RNFL thickness or the absolute thickness parameters of GCIPL. In preperimetric and suspected glaucoma, GCC and pRNFL have better specificity and are superior to the visual field. In advanced stages, pRNFL and later, GCC reach the floor effect. Therefore, in this stage, it is more useful to evaluate the visual field for monitoring the progression of glaucoma. In conclusion, GCC and pRNFL are parameters that can be used for glaucoma diagnosis and monitoring of the progression of the disease, with each having a higher accuracy depending on the stage of the disease.
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Kotcharlakota D, Choudhari NS. Role Of Adaptive Optics In Early Diagnosis Of Glaucoma From A Clinician's Perspective. Semin Ophthalmol 2023; 38:44-51. [PMID: 35989652 DOI: 10.1080/08820538.2022.2112701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Glaucoma is one of the leading causes of irreversible blindness across the world. Early detection is important to minimize the loss of visual function. The diagnostic tools, optical coherence tomography (OCT) and standard automated perimetry (SAP) form the keystones of the diagnosis and monitoring of the condition. However, the ability of these tools to diagnose early forms of glaucoma is limited. Adaptive optics (AO) is a technology that could help to overcome this limitation. AO technology can detect slightest changes occurring at the cellular level by compensating for ocular aberrations. METHODS We searched PubMed for publications between 2002 and 2019 on adaptive optics in Ophthalmology. The key words were adaptive optics, lamina cribrosa, retinal nerve fiber layer defects, scanning laser ophthalmoscope and OCT. RESULTS Out of 38 publications, 17 original articles or case series with relevance to glaucoma, and written in English were selected and reviewed. CONCLUSIONS The AO technology, combined with various platforms such as fundus photography, scanning laser ophthalmoscopy and OCT, has been used in glaucoma patients to study the lamina cribrosa, retinal nerve fiber layer (RNFL), retinal photoreceptors as well as ocular circulation in minute detail. Imaging the subtle changes in morphology and reflectivity of RNFL at the preclinical stage may lead to early detection of glaucoma. Longitudinal monitoring of RNFL alterations in glaucoma patients is possible. At present, the technology is expensive with limited availability, and has several limitations.
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Affiliation(s)
- Divya Kotcharlakota
- Glaucoma Fellow, VST Centre for Glaucoma Care, Dr. Kallam Anji Reddy campus, L. V. Prasad Eye Institute, Hyderabad, India
| | - Nikhil S Choudhari
- Faculty, VST Centre for Glaucoma Care, Dr. Kallam Anji Reddy campus, L. V. Prasad Eye Institute, Hyderabad, India
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Morgan JIW, Chui TYP, Grieve K. Twenty-five years of clinical applications using adaptive optics ophthalmoscopy [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:387-428. [PMID: 36698659 PMCID: PMC9841996 DOI: 10.1364/boe.472274] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 05/02/2023]
Abstract
Twenty-five years ago, adaptive optics (AO) was combined with fundus photography, thereby initiating a new era in the field of ophthalmic imaging. Since that time, clinical applications of AO ophthalmoscopy to investigate visual system structure and function in both health and disease abound. To date, AO ophthalmoscopy has enabled visualization of most cell types in the retina, offered insight into retinal and systemic disease pathogenesis, and been integrated into clinical trials. This article reviews clinical applications of AO ophthalmoscopy and addresses remaining challenges for AO ophthalmoscopy to become fully integrated into standard ophthalmic care.
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Affiliation(s)
- Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Contributed equally
| | - Toco Y. P. Chui
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
- Contributed equally
| | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
- Contributed equally
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Sainulabdeen A, Glidai Y, Wu M, Liu M, Alexopoulos P, Ishikawa H, Schuman JS, Wollstein G. 3D Microstructure of the Healthy Non-Human Primate Lamina Cribrosa by Optical Coherence Tomography Imaging. Transl Vis Sci Technol 2022; 11:15. [PMID: 35435922 PMCID: PMC9034718 DOI: 10.1167/tvst.11.4.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose The lamina cribrosa (LC) has an important role in the pathophysiology of ocular diseases. The purpose of this study is to characterize in vivo, noninvasively, and in 3D the structure of the LC in healthy non-human primates (NHPs). Methods Spectral-domain optical coherence tomography (OCT; Leica, Chicago, IL) scans of the optic nerve head (ONH) were obtained from healthy adult rhesus macaques monkeys. Using a previously reported semi-automated segmentation algorithm, microstructure measurements were assessed in central and peripheral regions of an equal area, in quadrants and depth-wise. Linear mixed-effects models were used to compare parameters among regions, adjusting for visibility, age, analyzable depth, graded scan quality, disc area, and the correlation between eyes. Spearmen's rank correlation coefficients were calculated for assessing the association between the lamina's parameters. Results Sixteen eyes of 10 animals (7 males and 3 females; 9 OD, 7 OS) were analyzed with a mean age of 10.5 ± 2.1 years. The mean analyzable depth was 175 ± 37 µm, with average LC visibility of 25.4 ± 13.0% and average disc area of 2.67 ± 0.45mm2. Within this volume, an average of 74.9 ± 39.0 pores per eye were analyzed. The central region showed statistically significantly thicker beams than the periphery. The quadrant-based analysis showed significant differences between the superior and inferior quadrants. The anterior LC had smaller beams and pores than both middle and posterior lamina. Conclusions Our study provides in vivo microstructure details of NHP's LC to be used as the foundation for future studies. We demonstrated mostly small but statistically significant regional variations in LC microstructure that should be considered when comparing LC measurements.
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Affiliation(s)
| | - Yoav Glidai
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Mengfei Wu
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA,Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Langone Health, New York, NY, USA
| | - Mengling Liu
- Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Langone Health, New York, NY, USA
| | | | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA,Center for Neural Science, NYU, New York, NY, USA
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA,Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA,Center for Neural Science, NYU, New York, NY, USA
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Strenk LM, Guo S, Lu K, Werner L, Strenk SA. Force of lifelong crystalline lens growth: chronic traumatic mechanical insult to the choroid. J Cataract Refract Surg 2022; 48:342-348. [PMID: 34321408 PMCID: PMC8752647 DOI: 10.1097/j.jcrs.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/29/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To calculate the forces applied to the uvea and retina as a result of lifelong crystalline lens growth. DESIGN Retrospective study. SETTING MRI Research, Inc., Middleburg Heights, Ohio; Institute of Ophthalmology and Visual Science UMDNJ-New Jersey Medical School, Newark, New Jersey; USC Psychology University of Southern California, Los Angeles. METHODS Magnetic resonance images were acquired from 15 phakic/pseudophakic eye pairs in patients with cataract (ages 46 to 83 years). Choroidal lengths were measured. The forces required to produce differences between phakic/pseudophakic choroidal lengths were calculated. RESULTS The length of the choroid is greater in the phakic eye compared with the corresponding pseudophakic eye (n = 15), and this difference increases with age (P = .00006; power = 0.99). The corresponding choroidal strain also increases with age (P = .00003, power = 0.99) as do the forces required to produce such a change in choroidal length (P = .000008, power = 0.99). CONCLUSIONS The authors theorize that lifelong crystalline lens growth applies a chronic, traumatic, mechanical insult to the uvea and retina. This previously unknown, ever-increasing, force appears to stretch the choroidal tissue and may be an intraocular pressure-independent modifiable risk factor for retinal disease. Implications exist for understanding the pathophysiology of retinal diseases in the aging eye that are often comorbid with cataracts, for example, glaucoma, macular degeneration, and diabetic retinopathy.
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Affiliation(s)
- Lawrence M Strenk
- From the MRI Research, Inc., Middleburg Heights, Ohio (Strenk, Strenk); Institute of Ophthalmology and Visual Science, New Jersey Medical School-Rutgers University, Newark, New Jersey (Guo); Doheny Eye Institute, University of California Los Angeles, Los Angeles, California (Lu); Ophthalmology, University of Utah/Moran Eye Center, Salt Lake City, Utah (Werner)
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Liu Z, Saeedi O, Zhang F, Villanueva R, Asanad S, Agrawal A, Hammer DX. Quantification of Retinal Ganglion Cell Morphology in Human Glaucomatous Eyes. Invest Ophthalmol Vis Sci 2021; 62:34. [PMID: 33760041 PMCID: PMC7995922 DOI: 10.1167/iovs.62.3.34] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To characterize retinal ganglion cell morphological changes in patients with primary open-angle glaucoma associated with hemifield defect (HD) using adaptive optics–optical coherence tomography (AO-OCT). Methods Six patients with early to moderate primary open-angle glaucoma with an average age of 58 years associated with HD and six age-matched healthy controls with an average age of 61 years were included. All participants underwent in vivo retinal ganglion cell (RGC) imaging at six primary locations across the macula with AO-OCT. Ganglion cell layer (GCL) somas were manually counted, and morphological parameters of GCL soma density, size, and symmetry were calculated. RGC cellular characteristics were correlated with functional visual field measurements. Results GCL soma density was 12,799 ± 7747 cells/mm2, 9370 ± 5572 cells/mm2, and 2134 ± 1494 cells/mm2 at 3°, 6°, and 12°, respectively, in glaucoma patients compared with 25,058 ± 4649 cells/mm2, 15,551 ± 2301 cells/mm2, and 3891 ± 1105 cells/mm2 (P < 0.05 for all locations) at the corresponding retinal locations in healthy participants. Mean soma diameter was significantly larger in glaucoma patients (14.20 ± 2.30 µm) compared with the health controls (12.32 ± 1.94 µm, P < 0.05 for all locations); symmetry was 0.36 ± 0.32 and 0.86 ± 0.13 in glaucoma and control cohorts, respectively. Conclusions Glaucoma patients had lower GCL soma density and symmetry, greater soma size, and increased variation of GCL soma reflectance compared with age-matched control subjects. The morphological changes corresponded with HD, and the cellular level structural loss correlated with visual function loss in glaucoma. AO-based morphological parameters could be potential sensitive biomarkers for glaucoma.
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Affiliation(s)
- Zhuolin Liu
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore Maryland, United States
| | - Furu Zhang
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Ricardo Villanueva
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore Maryland, United States
| | - Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore Maryland, United States
| | - Anant Agrawal
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Daniel X Hammer
- Center for Devices and Radiological Health (CDRH), U.S. Food and Drug Administration, Silver Spring, Maryland, United States
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Wynne N, Carroll J, Duncan JL. Promises and pitfalls of evaluating photoreceptor-based retinal disease with adaptive optics scanning light ophthalmoscopy (AOSLO). Prog Retin Eye Res 2020; 83:100920. [PMID: 33161127 DOI: 10.1016/j.preteyeres.2020.100920] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022]
Abstract
Adaptive optics scanning light ophthalmoscopy (AOSLO) allows visualization of the living human retina with exquisite single-cell resolution. This technology has improved our understanding of normal retinal structure and revealed pathophysiological details of a number of retinal diseases. Despite the remarkable capabilities of AOSLO, it has not seen the widespread commercial adoption and mainstream clinical success of other modalities developed in a similar time frame. Nevertheless, continued advancements in AOSLO hardware and software have expanded use to a broader range of patients. Current devices enable imaging of a number of different retinal cell types, with recent improvements in stimulus and detection schemes enabling monitoring of retinal function, microscopic structural changes, and even subcellular activity. This has positioned AOSLO for use in clinical trials, primarily as exploratory outcome measures or biomarkers that can be used to monitor disease progression or therapeutic response. AOSLO metrics could facilitate patient selection for such trials, to refine inclusion criteria or to guide the choice of therapy, depending on the presence, absence, or functional viability of specific cell types. Here we explore the potential of AOSLO retinal imaging by reviewing clinical applications as well as some of the pitfalls and barriers to more widespread clinical adoption.
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Affiliation(s)
- Niamh Wynne
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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Miller DA, Grannonico M, Liu M, Kuranov RV, Netland PA, Liu X, Zhang HF. Visible-Light Optical Coherence Tomography Fibergraphy for Quantitative Imaging of Retinal Ganglion Cell Axon Bundles. Transl Vis Sci Technol 2020; 9:11. [PMID: 33110707 PMCID: PMC7552935 DOI: 10.1167/tvst.9.11.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/18/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose To develop a practical technique for visualizing and quantifying retinal ganglion cell (RGC) axon bundles in vivo. Methods We applied visible-light optical coherence tomography (vis-OCT) to image the RGC axon bundles, referred to as vis-OCT fibergraphy, of healthy wild-type C57BL/6 mice. After vis-OCT imaging, retinas were flat-mounted, immunostained with anti-beta-III tubulin (Tuj1) antibody for RGC axons, and imaged with confocal microscopy. We quantitatively compared the RGC axon bundle networks imaged by in vivo vis-OCT and ex vivo confocal microscopy using semi-log Sholl analysis. Results Side-by-side comparison of ex vivo confocal microscopy and in vivo vis-OCT confirmed that vis-OCT fibergraphy captures true RGC axon bundle networks. The semi-log Sholl regression coefficients extracted from vis-OCT fibergrams (3.7 ± 0.8 mm–1) and confocal microscopy (3.6 ± 0.3 mm–1) images also showed good agreement with each other (n = 6). Conclusions We demonstrated the feasibility of using vis-OCT fibergraphy to visualize RGC axon bundles. Further applying Sholl analysis has the potential to identify biomarkers for non-invasively assessing RGC health. Translational Relevance Our novel technique for visualizing and quantifying RGC axon bundles in vivo provides a potential measurement tool for diagnosing and tracking the progression of optic neuropathies.
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Affiliation(s)
- David A Miller
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Marta Grannonico
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Mingna Liu
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Roman V Kuranov
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Opticent Health, Evanston, IL, USA
| | - Peter A Netland
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Xiaorong Liu
- Department of Biology, University of Virginia, Charlottesville, VA, USA.,Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Hao F Zhang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Department of Ophthalmology, Northwestern University, Evanston, IL, USA
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Beykin G, Norcia AM, Srinivasan VJ, Dubra A, Goldberg JL. Discovery and clinical translation of novel glaucoma biomarkers. Prog Retin Eye Res 2020; 80:100875. [PMID: 32659431 DOI: 10.1016/j.preteyeres.2020.100875] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
Glaucoma and other optic neuropathies are characterized by progressive dysfunction and loss of retinal ganglion cells and their axons. Given the high prevalence of glaucoma-related blindness and the availability of treatment options, improving the diagnosis and precise monitoring of progression in these conditions is paramount. Here we review recent progress in the development of novel biomarkers for glaucoma in the context of disease pathophysiology and we propose future steps for the field, including integration of exploratory biomarker outcomes into prospective therapeutic trials. We anticipate that, when validated, some of the novel glaucoma biomarkers discussed here will prove useful for clinical diagnosis and prediction of progression, as well as monitoring of clinical responses to standard and investigational therapies.
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Affiliation(s)
- Gala Beykin
- Spencer Center for Vision Research at Stanford University, 2370 Watson Ct, Palo Alto, CA, 94303, USA.
| | - Anthony M Norcia
- Department of Psychology, Stanford University, 290 Jane Stanford Way, Stanford, CA, 94305, USA.
| | - Vivek J Srinivasan
- Department of Biomedical Engineering, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA; Department of Ophthalmology and Vision Science, University of California Davis School of Medicine, 4610 X St, Sacramento, CA, 96817, USA.
| | - Alfredo Dubra
- Spencer Center for Vision Research at Stanford University, 2370 Watson Ct, Palo Alto, CA, 94303, USA.
| | - Jeffrey L Goldberg
- Spencer Center for Vision Research at Stanford University, 2370 Watson Ct, Palo Alto, CA, 94303, USA.
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Correction: Within-subject variability in human retinal nerve fiber bundle width. PLoS One 2020; 15:e0229865. [PMID: 32108830 PMCID: PMC7046240 DOI: 10.1371/journal.pone.0229865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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May CA, Rutkowski P. The Horizontal Raphe of the Human Retina and its Watershed Zones. Vision (Basel) 2019; 3:vision3040060. [PMID: 31735861 PMCID: PMC6969909 DOI: 10.3390/vision3040060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/28/2019] [Accepted: 11/06/2019] [Indexed: 12/27/2022] Open
Abstract
The horizontal raphe (HR) as a demarcation line dividing the retina and choroid into separate vascular hemispheres is well established, but its development has never been discussed in the context of new findings of the last decades. Although factors for axon guidance are established (e.g., slit-robo pathway, ephrin-protein-receptor pathway) they do not explain HR formation. Early morphological organization, too, fails to establish a HR. The development of the HR is most likely induced by the long posterior ciliary arteries which form a horizontal line prior to retinal organization. The maintenance might then be supported by several biochemical factors. The circulation separate superior and inferior vascular hemispheres communicates across the HR only through their anastomosing capillary beds resulting in watershed zones on either side of the HR. Visual field changes along the HR could clearly be demonstrated in vascular occlusive diseases affecting the optic nerve head, the retina or the choroid. The watershed zone of the HR is ideally protective for central visual acuity in vascular occlusive diseases but can lead to distinct pathological features.
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