[Impact of mydriatic eyedrops on distance visual acuity in patients with exudative age-related macular degeneration]

PURPOSE

To demonstrate a decrease in distance visual acuity (VA) following instillation of mydriatic eyedrops in eyes with exudative age-related macular degeneration (AMD).

MATERIALS AND METHODS

A prospective assessment in clinical practice was conducted in our ophthalmology department at the University Hospital of Tours from 7/19/2018 to 8/29/2018. Distance (ETDRS) and near (Parinaud) VA were assessed before and after instilling one drop each of tropicamide 0.5% and phenylephrine 10% in the 40 included eyes with exudative AMD.

RESULTS

The mean difference in distance VA before and after pupillary dilation (PD) was 0.06 LogMAR (SD=0.14) (P<0.01), i.e. -3.05 letters read (SD=7.52) on the ETDRS chart (P=0.01). For near VA, the mean difference was 0.16 LogMAR (SD=0.16) (P<0.001), i.e. -1.58 paragraphs read (SD=1.63) on the Parinaud chart (P<0.001).

DISCUSSION

The absence of a clinically significant loss in post-dilation distance VA for exudative AMD could be explained by negligible glare coming from the ETDRS chart, milder photophobia, low pre-dilation VA's and a balance between higher order optical aberrations and diffraction. The opposite result for near VA could essentially be explained by greater glare induced by the light illuminating the Parinaud chart.

CONCLUSION

Our primary goal was not achieved. A study presuming the absence of a clinically significant decrease in post-dilation distance VA would be necessary to consider directly measuring post-dilation VA in eyes with exudative AMD in our daily practice.

Comparison of Choroidal Thickness Measurements Using Spectral Domain Optical Coherence Tomography in Six Different Settings and With Customized Automated Segmentation Software

Purpose

We investigate which spectral domain-optical coherence tomography (SD-OCT) setting is superior when measuring subfoveal choroidal thickness (CT) and compared results to an automated segmentation software.

Methods

Thirty patients underwent enhanced depth imaging (EDI)-OCT. B-scans were extracted in six different settings (W+N = white background/normal contrast 9; W+H = white background/maximum contrast 16; B+N = black background/normal contrast 12; B+H = black background/maximum contrast 16; C+N = Color-encoded image on black background at predefined contrast of 9, and C+H = Color-encoded image on black background at high/maximal contrast of 16), resulting in 180 images. Subfoveal CT was manually measured by nine graders and by automated segmentation software. Intraclass correlation (ICC) was assessed.

Results

ICC was higher in normal than in high contrast images, and better for achromatic black than for white background images. Achromatic images were better than color images. Highest ICC was achieved in B+N (ICC = 0.64), followed by B+H (ICC = 0.54), W+N, and W+H (ICC = 0.5 each). Weakest ICC was obtained with Spectral-color (ICC = 0.47). Mean manual CT versus mean computer estimated CT showed a correlation of r = 0.6 (P = 0.001).

Conclusion

Black background with white image at normal contrast (B+N) seems the best setting to manually assess subfoveal CT. Automated assessment of CT seems to be a reliable tool for CT assessment.

Translational Relevance

To define optimized OCT analysis settings to improve the evaluation of in vivo imaging.

Visualization of the conventional outflow pathway in the living human eye

PURPOSE

We sought to visualize the aqueous outflow system in 3 dimensions (3D) in living human eyes, and to investigate the use of commercially available spectral-domain optical coherence tomographic (SD-OCT) systems for this purpose.

DESIGN

Prospective, observational study.

PARTICIPANTS

One randomly determined eye in each of 6 normal healthy subjects was included.

TESTING

We performed 3D SD-OCT imaging of the aqueous humor outflow structures with 2 devices: The Cirrus HD-OCT and the Bioptigen SDOIS.

MAIN OUTCOME MEASURES

We created 3D virtual castings of Schlemm's canal (SC) and more distal outflow structures from scan data from each device.

RESULTS

Virtual casting of the SC provided visualization of more aqueous vessels branching from SC than could be located by interrogating the 2-dimensional (2D) image stack. Similarly, virtual casting of distal structures allowed visualization of large and small aqueous outflow channel networks that could not be appreciated with conventional 2D visualization.

CONCLUSIONS

The outflow pathways from SC to the superficial vasculature can be identified and tracked in living human eyes using commercially available SD-OCT.

Demographic features of idiopathic macular telangiectasia in Japanese patients

PURPOSE

Idiopathic macular telangiectasia (MacTel) is classified into aneurysmal telangiectasia (type 1), perifoveal telangiectasia (type 2) and occlusive telangiectasia (type 3). Most instances of telangiectasia in Western countries are type 2. This study reports clinical and demographic features of MacTel in Japanese patients.

METHODS

Newly diagnosed patients with MacTel were examined retrospectively. All patients underwent fluorescein angiography and optical coherence tomography.

RESULTS

Thirty-four eyes of 27 patients with MacTel were included. Twenty eyes of 20 patients (74.1%) had type 1, ten eyes of five patients (18.5%) had type 2, and four eyes of two patients (7.4%) had type 3. Foveal capillary dilatation and microaneurysms were observed in all except for one eye of early stage type 2 MacTel. Optical coherence tomography revealed cystoid macular edema in type 1, temporal foveal thinning and a loss of boundary between the inner and outer segments of photoreceptors in type 2, and thinning of all retinal layers around the fovea in type 3.

CONCLUSION

The most frequent among our patients was aneurysmal MacTel, whereas perifoveal MacTel was not common. Although the clinical characteristics were similar, the most common type was different from that in Western countries.

Subretinal dot-like precipitates and yellow material in central serous chorioretinopathy

PURPOSE

Multiple, dot-like, yellow precipitates and subretinal yellow material are sometimes deposited within the area of a serous retinal detachment in central serous chorioretinopathy. We report the incidence and clinical features of these depositions in central serous chorioretinopathy.

METHODS

Eighty eyes of 75 patients (average age, 50.2 years) with central serous chorioretinopathy were studied retrospectively. Fundus autofluorescence and optical coherence tomography findings were evaluated. Precipitates were defined as those ≤ 63 μm in diameter and subretinal yellow material >63 μm.

RESULTS

The mean follow-up period was 17.6 months. Forty-five eyes (56.3%) had dot-like precipitates, and 40 eyes (50.0%) had subretinal yellow material. Fifty-two of 80 eyes (65.0%) had both or at least one of them; of these 52 eyes, 50 eyes (96.2%) had hyperautofluorescence and 42 eyes (80.8%) had high reflectivity on optical coherence tomography. The depositions in 23 eyes were not hyperautofluorescent at the initial examination, but the hyperautofluorescence developed during the follow-up period.

CONCLUSION

Dot-like precipitates and subretinal yellow material were seen in 65% of cases with central serous chorioretinopathy that also showed high reflectivity on optical coherence tomography and hyperautofluorescence during follow-up. These findings may indicate that these formations are associated with shedding of the photoreceptor outer segments and metabolism by phagocytes.

Structural and functional correlates in color vision deficiency

PURPOSE

The aim of this study is to assess the photoreceptor integrity, using spectral domain optical coherence tomography (SD-OCT), and to measure the retinal sensitivity of patients with congenital red-green color vision deficiency (CVD).

METHODS

In all, 14 eyes from 7 patients with congenital red-green CVD (diagnosed by Farnsworth Munsell 100 hue test), and 14 eyes from 7 control subjects were examined by SD-OCT and microperimetry. Radial scans (7-mm) were taken of the macula. The center of the fovea was defined. The thickness of different retinal layers, at the foveal center, and at multiple defined points along all six radial scans, was measured. The median readings were compared between the two groups using Mann-Whitney U-test.

RESULTS

SD-OCT demonstrated normal total retinal thickness, normal thickness of the photoreceptor layer, normal thickness of the outer nuclear layer, normal vertical thickness of the outer segments (OSs), and normal vertical thickness of the inner segments. OS horizontal diameter was less in left eye in cases with CVD when compared with controls. The mean retinal and foveal sensitivity was similar between cases and controls.

CONCLUSIONS

In subjects with congenital red-green CVD, there are no discernible anatomical abnormalities seen on SD-OCT in various retinal layers, except for a narrower foveal pit. However, further studies with larger sample size are required.

Changes of fundus autofluorescence, photoreceptor inner and outer segment junction line, and visual function in patients with retinitis pigmentosa

BACKGROUND

To determine whether a significant correlation exists among the changes in the size of the abnormal parafoveal autofluorescence ring, the length of the photoreceptor inner and outer segment (IS/OS) junction, and the visual function in patients with retinitis pigmentosa.

METHODS

Retrospective observational case series. A total of 50 eyes of 26 patients with typical retinitis pigmentosa and an autofluorescence ring were examined by optical coherence tomography and microperimetry. During the follow-up period of >2 years, the changes in the diameter and area of the autofluorescence ring, the length of the IS/OS line, the best-corrected visual acuity and mean retinal sensitivity in the central 10 degrees were determined.

RESULTS

The diameter and area of the autofluorescence ring, and the length of the IS/OS line decreased significantly during the follow-up period (all, P < 0.0001). The decrease in autofluorescence ring diameter was significantly correlated with the decrease in retinal sensitivity, visual acuity and IS/OS length (P = 0.0105, P = 0.0252 and P < 0.0001, respectively). The decrease in autofluorescence ring area was significantly correlated with the decrease in retinal sensitivity, visual acuity and IS/OS length (P < 0.0001, P = 0.0026 and P = 0.0011, respectively).

CONCLUSION

During the progression of retinitis pigmentosa, the progressive constriction of the autofluorescence ring reflects the morphological changes of the photoreceptors, and is associated with a worsening of visual function.

The optical coherence tomography-ophthalmoscope for examination of central serous chorioretinopathy with precipitates

PURPOSE

To report the exact location of multiple yellowish dot-like precipitates in central serous chorioretinopathy (CSC) with the Optical Coherence Tomography (OCT)-Ophthalmoscope (Nidek-OTI, Gamagori, Japan).

DESIGN

Retrospective, observational study.

METHODS

Twenty eyes of 18 patients (average age, 53 years) with CSC were examined by the OCT-Ophthalmoscope. Multiple yellowish dot-like precipitates were seen in all eyes by biomicroscopic examination.

RESULTS

Multiple highly reflective dots (bright dots) were seen by the OCT-Ophthalmoscope in all 20 eyes. The bright dots were observed on the posterior surface of the detached neurosensory retina by cross-sectional B-scan OCT in all eyes and in the detached neurosensory retina in 14 eyes. The bright dots were preferentially located in the outer retinal layer. Transverse C-scan OCT confirmed that the location of the bright dots coincided with that of the precipitates.

CONCLUSIONS

Both cross-sectional B-scan and transverse C-scan images obtained with the OCT-Ophthalmoscope showed subretinal and intraretinal bright dots in eyes with CSC, which may indicate that the yellowish dot-like precipitates are not only on the posterior surface of the detached retina but also in the detached neurosensory retina. Intraretinal precipitates in eyes with CSC may result from the accumulation of proteins or macrophages with the phagocytized photoreceptor outer segments.

Clinical application of rapid serial fourier-domain optical coherence tomography for macular imaging

PURPOSE

To introduce and examine the utility of a retinal imaging technique using high-speed optical coherence tomography (OCT) for creating a more complete retinal structural map to aid in the evaluation of patients with macular pathology.

DESIGN

Prospective observational case series.

PARTICIPANTS

Five patients with a variety of macular pathologies.

METHODS

Patients were imaged with a Fourier-domain high-speed high-resolution OCT system built at our institution. A sweeping serial OCT B-scan of the macula was acquired to create a detailed retinal structural map. The data were then used to make individual clinical observations.

RESULTS

Rapid serial OCT B-scans produced detailed macular maps for all 5 patients. Diagnoses of imaged patients included macular hole, lamellar macular hole, regressed macular hole or macular microhole, choroidal neovascular membrane (CNV) from age-related macular degeneration, and CNV from presumed ocular histoplasmosis syndrome. Reconstructed B-scans and C-scans are shown for selected patients to illustrate the additional perspectives gained by obtaining a detailed retinal map.

CONCLUSIONS

Rapid serial Fourier-domain OCT B-scanning can be used to create a detailed retinal structural map. This technique provides additional information that can be missed on single OCT images and provides an accurate way to image large or complex lesions, and allows B-scan and C-scan reconstructions to be made that provide additional perspectives into retinal structures that may be missed using traditional imaging methods.

Ultrahigh-resolution full-field optical coherence tomography

We have developed a white-light interference microscope for ultrahigh-resolution full-field optical coherence tomography of biological media. The experimental setup is based on a Linnik-type interferometer illuminated by a tungsten halogen lamp. En face tomographic images are calculated by a combination of interferometric images recorded by a high-speed CCD camera. Spatial resolution of 1.8 microm x 0.9 microm (transverse x axial) is achieved owing to the extremely short coherence length of the source, the compensation of dispersion mismatch in the interferometer arms, and the use of relatively high-numerical-aperture microscope objectives. A shot-noise-limited detection sensitivity of 90 dB is obtained in an acquisition time per image of 4 s. Subcellular-level images of plant, animal, and human tissues are presented.