Coronal plane OCT imaging and vision in macular pucker

Abstract

Matoba et al. [1] performed a retrospective chart review to examine coronal plane (“en face”) images in 64 cases of premacular membrane (PMM, a term preferrable to “ERM”) formation following rhegmatogenous retinal detachment repair. Unfortunately, they failed to utilize the full potential of coronal plane imaging in patients with macular pucker. Previous studies [2] employing coronal plane OCT-SLO imaging revealed that half of patients with macular pucker have more than one center of retinal contraction (Fig. 1). Multifocal retinal contraction is important, since cases with 3 or 4 centers of retinal contraction had greater macular thickening and more frequent intraretinal cysts than cases with only 1 or 2 foci. This impacts vision and could thus explain why Matoba et al. found no difference in visual acuity between patients who developed PMM and macular pucker and those who did not; i.e., they did not identify a subgroup of individuals with multifocal retinal contraction who probably have worse vision. Another explanation could be that visual acuity is not the best way to evaluate the impact of macular pucker on vision. Studies have demonstrated that quantifying distortions and measuring contrast sensitivity function (CSF) are far better ways to evaluate patients with macular pucker than visual acuity [3]. Indeed, these measures of vision determined that following vitrectomy with membrane peeling, CSF improved by 54%, and distortions decreased by 92% [3]. Lastly, although Matoba et al. also used B-scan OCT imaging to stage disease severity, they failed to seek the