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Hernández RF, Rodriguez JEM, Trecu MSG, Tariq Bhatti M. Not everything is ischemic optic neuropathy. Surv Ophthalmol 2024:S0039-6257(24)00054-7. [PMID: 38796109 DOI: 10.1016/j.survophthal.2024.05.005] [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: 01/03/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
A 71-year-old woman developed sudden, painful, decreased vision in the left eye accompanied by progressive instability. Initial examination revealed left optic disc edema, and macular optical coherence tomography confirmed the presence of intraretinal and subretinal fluid, as well as hyperreflective material under the retinal pigment epithelium. Subsequent investigations, including brain magnetic resonance imaging and a comprehensive serological analysis, ruled out infectious and autoimmune causes, further complicating the diagnostic picture. The patient's vision in both eyes continued to deteriorate, prompting empirical corticosteroid treatment. While the vision improved, the case took an unexpected turn with worsening neurological symptoms. Ultimately a brain biopsy was consistent with diffuse large B-cell lymphoma.
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Affiliation(s)
| | | | | | - M Tariq Bhatti
- The Permanente Medical Group. Department of Ophthalmology, Kaiser Permanente-Northern California, Roseville, CA, USA
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Cheng W, Liu J, Jiang T, Li M. The application of functional imaging in visual field defects: a brief review. Front Neurol 2024; 15:1333021. [PMID: 38410197 PMCID: PMC10895022 DOI: 10.3389/fneur.2024.1333021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/31/2024] [Indexed: 02/28/2024] Open
Abstract
Visual field defects (VFDs) represent a prevalent complication stemming from neurological and ophthalmic conditions. A range of factors, including tumors, brain surgery, glaucoma, and other disorders, can induce varying degrees of VFDs, significantly impacting patients' quality of life. Over recent decades, functional imaging has emerged as a pivotal field, employing imaging technology to illustrate functional changes within tissues and organs. As functional imaging continues to advance, its integration into various clinical aspects of VFDs has substantially enhanced the diagnostic, therapeutic, and management capabilities of healthcare professionals. Notably, prominent imaging techniques such as DTI, OCT, and MRI have garnered widespread adoption, yet they possess unique applications and considerations. This comprehensive review aims to meticulously examine the application and evolution of functional imaging in the context of VFDs. Our objective is to furnish neurologists and ophthalmologists with a systematic and comprehensive comprehension of this critical subject matter.
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Affiliation(s)
- Wangxinjun Cheng
- Department of Rehabilitation, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Queen Mary College, Nanchang University, Nanchang, China
| | - Jingshuang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Queen Mary College, Nanchang University, Nanchang, China
| | - Tianqi Jiang
- The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Moyi Li
- Department of Rehabilitation, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Bouthour W, Biousse V, Newman NJ. Diagnosis of Optic Disc Oedema: Fundus Features, Ocular Imaging Findings, and Artificial Intelligence. Neuroophthalmology 2023; 47:177-192. [PMID: 37434667 PMCID: PMC10332214 DOI: 10.1080/01658107.2023.2176522] [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: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023] Open
Abstract
Optic disc swelling is a manifestation of a broad range of processes affecting the optic nerve head and/or the anterior segment of the optic nerve. Accurately diagnosing optic disc oedema, grading its severity, and recognising its cause, is crucial in order to treat patients in a timely manner and limit vision loss. Some ocular fundus features, in light of a patient's history and visual symptoms, may suggest a specific mechanism or aetiology of the visible disc oedema, but current criteria can at most enable an educated guess as to the most likely cause. In many cases only the clinical evolution and ancillary testing can inform the exact diagnosis. The development of ocular fundus imaging, including colour fundus photography, fluorescein angiography, optical coherence tomography, and multimodal imaging, has provided assistance in quantifying swelling, distinguishing true optic disc oedema from pseudo-optic disc oedema, and differentiating among the numerous causes of acute optic disc oedema. However, the diagnosis of disc oedema is often delayed or not made in busy emergency departments and outpatient neurology clinics. Indeed, most non-eye care providers are not able to accurately perform ocular fundus examination, increasing the risk of diagnostic errors in acute neurological settings. The implementation of non-mydriatic fundus photography and artificial intelligence technology in the diagnostic process addresses these important gaps in clinical practice.
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Affiliation(s)
- Walid Bouthour
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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4
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Ledesma-Gil G, Querques G, Souied EH, Smith RT, Otero-Marquez O, Mainster MA. Correspondence. Retina 2022; 42:e48-e49. [PMID: 36129271 DOI: 10.1097/iae.0000000000003565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/26/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Gerardo Ledesma-Gil
- Institute of Ophhtalmology Fundacion Conde de Valenciana, Mexico City, Mexico
| | - Giuseppe Querques
- Ophthalmology Department, University Vita-Salute, Via Olgettina, Milan, Italy
| | - Eric H Souied
- Department of Ophthalmology, Hôpital Intercommunal de Créteil Université, Créteil, France
| | - R Theodore Smith
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Oscar Otero-Marquez
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Martin A Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas
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Zhu R, Xiao S, Zhang W, Li J, Yang M, Zhang Y, Gu X, Yang L. Comparison of hyperreflective foci in macular edema secondary to multiple etiologies with spectral-domain optical coherence tomography: An observational study. BMC Ophthalmol 2022; 22:352. [PMID: 36038824 PMCID: PMC9426241 DOI: 10.1186/s12886-022-02575-9] [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] [Received: 04/16/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background Hyperreflective foci (HRF) features in macular edema associated with different etiologies may indicate the disease pathogenesis and help to choose proper treatment. The goal of this study is to investigate the retinal microstructural features of macular edema (ME) secondary to multiple etiologies with spectral-domain optical coherence tomography (SD-OCT) and analyze the origin of HRF in ME. Methods This was a retrospective study. SD-OCT images were reviewed to investigate macular microstructural features such as the number and distribution of HRF and hard exudates and the internal reflectivity of the cysts. The differences in microstructural features between groups and the correlations between the number of HRF and other parameters were analyzed. Results A total of 101 eyes with ME from 86 diabetic (diabetic macular edema, DME) patients, 51 eyes from 51 patients with ME secondary to branch retinal vein occlusion (branch retinal vein occlusion-macular edema, BRVO-ME), 59 eyes from 58 central retinal vein occlusion (central retinal vein occlusion-macular edema, CRVO-ME) patients, and 26 eyes from 22 uveitis (uveitic macular edema, UME) patients were included in this study. The number of HRF, the frequency of hard exudates and the enhanced internal reflectivity of the cysts were significantly different among the groups. The number of HRF in the DME group was significantly higher than that in the other groups (all P < 0.05). The frequency of hard exudates and enhanced internal reflectivity of the cysts in the DME group were significantly higher than ME secondary to other etiologies (all P < 0.001). Within the DME group, the number of HRF in the patients with hard exudates was significantly higher than that in the patients without hard exudates (P < 0.001). Conclusion HRF detected with SD-OCT were more frequent in DME patients than in BRVO-ME, CRVO-ME, or UME patients. The occurrence of HRF was correlated with the frequency of hard exudates. HRF may result from the deposition of macromolecular exudates in the retina, which is speculated to be a precursor of hard exudates.
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Affiliation(s)
- Ruilin Zhu
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Shiyu Xiao
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Wenbo Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Jun Li
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Menglu Yang
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
| | - Yadi Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Xiaopeng Gu
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China.
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Di Marino M, Di Marco E, Lombardo M, Mancino R, Nucci C, Cesareo M. Drusen-like deposits in a patient heterozygous for phenylketonuria. J Fr Ophtalmol 2022; 45:e393-e396. [DOI: 10.1016/j.jfo.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/25/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
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Acquired night blindness due to rod dysfunction after long-term hemodialysis. Jpn J Ophthalmol 2021; 66:1-7. [PMID: 34741231 DOI: 10.1007/s10384-021-00883-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: 04/20/2021] [Accepted: 09/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the clinical findings in 6 patients who developed night blindness after long-term hemodialysis. STUDY DESIGN Retrospective case series. PATIENTS AND METHODS The medical charts of the 6 patients were examined. The fundus photographs, spectral-domain optical coherence tomographic (SD-OCT) images, full-field ERGs, and blood chemistry panels were analyzed. RESULTS The mean age of the 6 patients (4 men) at the time of diagnosis was 69.1 ± 5.9 years. The mean duration of the hemodialysis was 21.8 ± 13.4 years (7-41 years). The visual acuity of the patients was preserved at 20/30 or better except in 1 eye. Ophthalmoscopy showed white flecks that were scattered over the midperipheral retina in all the eyes. SD-OCT showed mild macular degeneration in 5 eyes. The scotopic ERGs elicited by dim flashes were absent, and those elicited by bright flashes had negative waveforms. The photopic ERGs were relatively well preserved. These data indicated a rod-specific dysfunction that may account for the night blindness. The plasma concentration of vitamin A was within the normal range in 4 of the patients and slightly lower than the normal limit in 1 of the patients. Administration of vitamin A was performed for 1 patient, and the symptom of night blindness and scotopic ERGs were improved 3 months later. DISCUSSION Long-term hemodialysis can be associated with the night blindness that may be caused by vitamin A deficiency, even though the plasma concentration of vitamin A in these patients was within the normal range.
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Tsunoda K, Fujinami K, Yoshitake K, Iwata T. Late-onset night blindness with peripheral flecks accompanied by progressive trickle-like macular degeneration. Doc Ophthalmol 2019; 139:171-184. [PMID: 31286363 DOI: 10.1007/s10633-019-09705-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To report the clinical and genetic characteristics of 6 cases with late-onset night blindness with peripheral flecks accompanied by progressive trickle-like macular degeneration. METHODS Clinical and genetic data were collected from 6 independent patients who complained of night blindness in their fifth to eighth decade of life. The ophthalmological examinations included ophthalmoscopy, fundus autofluorescence (FAF), and full-field electroretinography (ERG). Whole exome sequencing with target gene analysis was performed to determine the causative genes and variants. RESULTS All of the patients first complained of night blindness at the ages of 40-71 years. Funduscopic examinations demonstrated white or atrophic flecks scattered in the posterior pole and peripheral retina bilaterally. FAF showed patchy hypo-autofluorescence spots in the posterior pole similar to that of the trickling type of age-related macular degeneration (AMD). The region of abnormal FAF rapidly expanded with age, and one eye developed a choroidal neovascularization. The full-field scotopic ERGs with 20 min of dark adaptation were severely reduced or extinguished in all cases. There was partial recovery of the ERGs after 180 min of dark adaptation. The cone ERGs were reduced in all cases. Whole exome sequencing revealed no pathogenic variants of 301 retinal disease-associated genes. CONCLUSIONS The six cases had some common features with the flecked retina syndrome, familial drusen, and late-onset retinal degeneration although none had pathogenic variants causative for these disorders. These cases may represent a subset of severe trickling AMD or a new clinical entity of acquired pan-retinal visual cycle deficiency of unknown etiology.
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Affiliation(s)
- Kazushige Tsunoda
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Kaoru Fujinami
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Kazutoshi Yoshitake
- Division of Molecular and Cellular Biology, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Takeshi Iwata
- Division of Molecular and Cellular Biology, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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Nam KY, Kim BJ, Kim JH, Kang TS, Cho HK, Chung IY, Park JM, Han YS. Fundus Albipunctatus Diagnosed in a 9-year-old Female. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.10.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ki Yup Nam
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Bum Jun Kim
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Ji Hye Kim
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Tae Seen Kang
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyun Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jong Moon Park
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Vogel RN, Langlo CS, Scoles D, Carroll J, Weinberg DV, Kim JE. High-Resolution Imaging of Intraretinal Structures in Active and Resolved Central Serous Chorioretinopathy. Invest Ophthalmol Vis Sci 2017; 58:42-49. [PMID: 28055101 PMCID: PMC5225998 DOI: 10.1167/iovs.16-20351] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose To improve our understanding of central serous chorioretinopathy (CSC), we performed an analysis of noninvasive, high-resolution retinal imaging in patients with active and resolved CSC. Methods Adaptive optics scanning light ophthalmoscopy (AOSLO) and spectral-domain optical coherence tomography (SD-OCT) were performed on five subjects with CSC. A custom AOSLO system was used to simultaneously collect confocal and split-detector images. Spectral domain–OCT volume scans were used to create en face views of various retinal layers, which then were compared to montaged AOSLO images after coregistration. Results Three distinct types of intraretinal hyperreflective clusters were seen with AOSLO. These clusters had a well-demarcated, round, and granular appearance. Clusters in active CSC over areas of serous retinal detachment were termed type-1. They were found primarily in the outer nuclear layer (ONL) and were associated with large defects in the photoreceptor mosaic and ellipsoid zone. Clusters in areas where the retina had reattached were termed type-2. They also were located primarily in the ONL but showed stability in location over a period of at least 8 months. Smaller clusters in the inner retina along retinal capillaries were termed type-3. Conclusions Retinal imaging in CSC using en face OCT and AOSLO allows precise localization of intraretinal structures and detection of features that cannot be seen with SD-OCT alone. These findings may provide greater insight into the pathophysiology of the active and resolved phases of the disease, and support the hypothesis that intraretinal hyperreflective foci on OCT in CSC are cellular in nature.
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Affiliation(s)
- Ryan N Vogel
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Christopher S Langlo
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Drew Scoles
- University of Rochester Medical Center, Rochester, New York, United States
| | - Joseph Carroll
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States 2Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - David V Weinberg
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Judy E Kim
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY IMAGE CONTRAST AND BACKGROUND COLOR SETTINGS INFLUENCE IDENTIFICATION OF RETINAL STRUCTURES. Retina 2017; 36:1888-96. [PMID: 27219667 DOI: 10.1097/iae.0000000000001060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate image contrast and color setting on assessment of retinal structures and morphology in spectral-domain optical coherence tomography. METHODS Two hundred and forty-eight Spectralis spectral-domain optical coherence tomography B-scans of 62 patients were analyzed by 4 readers. B-scans were extracted in 4 settings: W + N = white background with black image at normal contrast 9; W + H = white background with black image at maximum contrast 16; B + N = black background with white image at normal contrast 12; B + H = black background with white image at maximum contrast 16. Readers analyzed the images to identify morphologic features. Interreader correlation was calculated. Differences between Fleiss-kappa correlation coefficients were examined using bootstrap method. Any setting with significantly higher correlation coefficient was deemed superior for evaluating specific features. RESULTS Correlation coefficients differed among settings. No single setting was superior for all respective spectral-domain optical coherence tomography parameters (P = 0.3773). Some variables showed no differences among settings. Hard exudates and subretinal fluid were best seen with B + H (κ = 0.46, P = 0.0237 and κ = 0.78, P = 0.002). Microaneurysms were best seen with W + N (κ = 0.56, P = 0.025). Vitreomacular interface, enhanced transmission signal, and epiretinal membrane were best identified using all color/contrast settings together (κ = 0.44, P = 0.042, κ = 0.57, P = 0.01, and κ = 0.62, P ≤ 0.0001). CONCLUSION Contrast and background affect the evaluation of retinal structures on spectral-domain optical coherence tomography images. No single setting was superior for all features, though certain changes were best seen with specific settings.
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Adhi M, Jusufbegovic D, Schaal S. Sequential Chorioretinal Changes in Presumed Ocular Histoplasmosis Syndrome Analyzed Using Spectral Domain Optical Coherence Tomography. Ocul Immunol Inflamm 2016; 25:545-553. [DOI: 10.3109/09273948.2016.1158841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mehreen Adhi
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Denis Jusufbegovic
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Shlomit Schaal
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Optical coherence tomography findings in a patient with myelinated retinal nerve fiber layer. J Ophthalmic Vis Res 2013; 8:280-1. [PMID: 24349674 PMCID: PMC3853790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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