Suman Pilli

Fourier-domain optical coherence tomography of eyes with idiopathic epiretinal membrane: correlation between macular morphology and visual function.

PurposeThe purpose of this study is to evaluate the macular morphological changes associated with idiopathic epiretinal membrane (iERM) using high-resolution Fourier-domain optical coherence tomography (FD-OCT), as they correlate with visual acuity and microperimetry (MP-1).MethodsIn all, 24 eyes (19 subjects) with iERM were imaged prospectively using FD-OCT with axial resolution of 4.5 μm and transverse resolution of 10 to 15 μm. MP-1 and Stratus OCT were carried out in a subset of eyes.ResultsThe mean log of the minimum angle of resolution best-corrected visual acuity (BCVA) was 0.18±0.16 (range: −0.08 to 0.48, Snellen equivalent 20/15−1 to 20/60). ERM was visualized in all 24 eyes with FD-OCT and in 17 eyes (85%) of 20 eyes imaged with Stratus OCT. Although BCVA correlated with macular thickening in the central 1 mm sub-field of the Stratus ETDRS (P=0.0005) and macular volume (central 3 mm area) on FD-OCT (P<0.0001), macular thickening on thickness map and volume correlated poorly with decrease in macular sensitivity on MP-1 (P=0.16). On FD-OCT, foveal morphological changes correlated best with decrease in BCVA, the strongest being central foveal thickness (P<0.0001). Other significant changes included blurring of the foveal inner segment–outer segment (IS–OS) junction and/or Verhoeffs membrane, vitreal displacement of foveal outer nuclear layer and foveal detachment (P<0.05). Foveal IS–OS junction disruption was seen in 25% of eyes on Stratus OCT but in none of the eyes on FD-OCT.ConclusionFD-OCT allowed improved visualization of ERM and associated foveal morphological changes that correlated best with BCVA. Macular thickening correlated weakly with decreased macular function as assessed by MP-1.

Visual outcome correlates with inner macular volume in eyes with surgically closed macular hole.

Purpose: To determine the macular morphologic features that correlate best with visual outcome in eyes with surgically closed idiopathic macular hole. Methods: Transversal observational case series of 24 eyes (22 subjects) imaged postoperatively using high-resolution Fourier domain optical coherence tomography (FD-OCT). Total and inner macular volume for central 3 mm area, central foveal thickness, and size of foveal inner segment–outer segment junction abnormality were correlated with best-corrected visual acuity. Microperimetry (MP-1) test was performed in a subset of 18 eyes. Results: Mean postoperative best-corrected visual acuity was 20/36 (range, 20/25–20/70). Postoperative follow-up mean was 32.97 ± 24.68 months (range, 5–96 months). Eighteen eyes underwent internal limiting membrane (ILM) peeling. Among FD-OCT parameters, logarithm of the minimum angle of resolution best-corrected visual acuity and mean total microperimetry-1 sensitivity correlated best with inner macular volume in all eyes and ILM-peeled eyes (P < 0.05). Macular surface irregularities were noted in 12 eyes (66.7%) with ILM peeling but in none of the non–ILM-peeled eyes (P = 0.02). No significant correlation was found between microperimetry-1 sensitivity and other FD-OCT parameters. Conclusion: Because inner macular volume strongly correlated with visual outcome in eyes with surgically closed macular hole, the possible effect of ILM peeling on visual outcome needs to be further investigated.

Staging of Macular Telangiectasia: Power-Doppler Optical Coherence Tomography and Macular Pigment Optical Density

PURPOSE Two methods were used to study the stages of macular telangiectasia (MACTEL): Power-Doppler optical coherence tomography (PD-OCT), which allows imaging of the retinal circulation in three dimensions, and macular pigment optical density (MPOD), which quantifies the distribution of macular carotenoids. METHODS Among 49 patients with MacTel identified, 12 eyes (6 patients) with MacTel and 7 age-matched control eyes (7 patients) were imaged with a custom-built Fourier-domain OCT instrument to acquire PD-OCT images. MPOD was measured using heterochromatic flicker photometry in 10 eyes (5 patients) with MacTel and compared with 44 age-matched control eyes (44 patients). Clinical staging of MacTel was based on best-corrected visual acuity, fundus biomicroscopy, fluorescein angiography, and OCT. RESULTS Stage 1 eyes (n = 2) had subtle punctate vascular signal confined to the inner portion of the outer plexiform layer (OPL) on PD-OCT. Stage 2 (n = 2) showed larger oblique vascular signal extending into deeper OPL. Stage 3 (n = 5) had disruption of outer retinal layers with abnormal vasculature extending into the outer nuclear layer. Stage 4 (n = 3) showed diffuse blurring of the retinal layers with vascular channels extending the full thickness of the retina. MPOD values in four eyes with stage 1 or 2 MacTel correlated well with age-matched controls. Six eyes with stage 3 or 4 MacTel had loss of MPOD especially at the fovea. CONCLUSIONS PD-OCT shows penetration of the retinal capillaries into the deeper retinal layers in early stages of MacTel, with full thickness vascular proliferation in advanced disease. MPOD is commonly depleted but may appear normal in early stage MacTel.

Survey of patients with age-related macular degeneration: knowledge and adherence to recommendations

OBJECTIVE To evaluate the patients understanding of the importance and adherence to the various lifestyle and Age-Related Eye Disease Study (AREDS) supplement recommendations for age-related macular degeneration (AMD). DESIGN Cross-sectional study. PARTICIPANTS Patients with AMD treated at the vitreoretinal service clinic. METHODS Telephone questionnaire survey was administered to assess knowledge and adherence to various recommendations made to patients with AMD about lifestyle and AREDS supplements in this single-institution study. RESULTS Among 92 patients with AMD contacted, dietary modification, exercise and weight reduction, smoking cessation, and AREDS supplementation recommendations were recalled by 47 (51%), 21 (23%), 5 (5%), and 90 (98%) patients, respectively. The necessity of making these interventions was believed by 29 (62%), 16 (76%), 4 (80%), and 67 (74%) patients, respectively. Patient adherence to dietary modification was 81%, to exercise and weight reduction was 76%, to smoking cessation was 0%, and to AREDS supplementation was 88% (71% on correct dose). Financially, 29% of the patients noted a mean increase of

Five-year Follow-up Of Macular Morphologic Changes After Rhegmatogenous Retinal Detachment Repair: Fourier Domain Oct Findings

88 per month in expenditure because of making dietary modifications, but most reported such as justified; 61% noted a mean increase of

High-Resolution Fourier-Domain Optical Coherence Tomography Findings in Vitelliform Detachment Associated with Basal Laminar Drusen

25 per month in expenditure from consumption of AREDS supplements, and most (96%) believed this was justified. CONCLUSIONS Patients with AMD recalled recommendations for AREDS supplementation more often than other lifestyle changes but generally felt recommendations were necessary and affordable. Adherence to smoking cessation recommendation was poor (0%), but to other recommendations was good.

The dose-dependent macular thickness changes assessed by fd-oct in patients with retinitis pigmentosa treated with ciliary neurotrophic factor.

Purpose: To evaluate serially long-term macular morphologic changes after successful macula-involving rhegmatogenous retinal detachment repair and correlate changes with macular function. Methods: Repeat Fourier domain optical coherence tomography (FD OCT) imaging and microperimetry (MP-1) testing of 8 of the initial cohort of 17 eyes studied 5 years earlier. Results: The mean follow-up after rhegmatogenous retinal detachment repair was 3.4 months (range, 1–8.5 months) for the first FD OCT and 5 years (range, 3.75–5.75 years) for the follow-up FD OCT. The final postoperative best-corrected visual acuity mean was 20/201 (range, 20/20 to counting fingers). Six eyes with final best-corrected visual acuity >20/40 had an intact external limiting membrane and progressive resolution of photoreceptor inner segment–outer segment junction disruption and/or subretinal fluid on serial FD OCT, which correlated with improvement in macular function on MP-1. Two eyes with poor or worsening best-corrected visual acuity on follow-up had persistent or worsening inner segment–outer segment disruption on serial FD OCT. External limiting membrane was intact in one eye and persistently disrupted in the other. Conclusion: Macular function may progressively improve or worsen long-term after successful rhegmatogenous retinal detachment repair. Progressive resolution of subretinal fluid and/or inner segment–outer segment disruption on FD OCT correlated with improvement in macular function, whereas worsening or persistent inner segment–outer segment disruption correlates with worsening or persistently poor visual outcome.

Retinal Imaging with a Combined Adaptive Optics: Optical Coherence Tomography and Adaptive Optics: Scanning Laser Ophthalmoscopy System

We illustrate the morphologic features of a 70-year-old white male with basal laminar drusen in both eyes and vitelliform detachment in the left eye (OS), visual acuity of 20/40 OS (Figure 1). The patient was imaged using a research-grade high-resolution Fourier-domain optical coherence tomography system developed at the University of California, Davis, with an axial resolution of 4.5 μm and a broadband light of 852 nm central wavelength and 78-nm bandwidth1 and a commercial Fourier-domain optical coherence tomography system (Cirrus; Zeiss Meditec, Inc, Dublin, CA). Fig. 1 Fundus photographs and FA images of the left eye of the patient with vitelliform detachment associated with BLD. A. Color fundus photograph showing BLD seen as yellow subretinal lesions scattered over the macula and a foveal detachment. B. Red-free fundus ... Fourier-domain optical coherence tomography B-scans showed multiple, small, nodular to sawtooth elevations of the retinal pigment epithelial/Bruch membrane (BM) layer (Figures 2 and ​and3),3), corresponding to the basal laminar drusen seen on fluorescein angiography (Figure 1, C and D).2,3 The left central macula showed a dome-shaped elevation with an intact photoreceptor inner segment–outer segment junction and thickened photoreceptor outer segment layer in the area of the detachment (Figures 2 and ​and3).3). A B-scan through the upper part of the detachment showed homogeneous hyporeflective material suggestive of subretinal fluid and the retinal pigment epithelial layer appeared irregular and elevated, suggestive of basal laminar drusen within the vitelliform detachment (Figure 3). A B-scan through the fovea showed a heterogeneous moderate-to-highly reflective subretinal material contiguous with the retinal pigment epithelial/BM layer but with a discernible separation from the overlying photoreceptor outer segment layer (Figures 2 and ​and3B).3B). The Bruch membrane appeared intact throughout the macula, although some variations in reflectivity were noted (Figures 2 and ​and3).3). A vertical B-scan through the lesion clearly demonstrates the presence of 2 distinct types of subretinal material with a sharp demarcation, the hyporeflective material filling the upper portion of vitelliform detachment and the hyperreflective material fluid filling the lower portion (Figure 3B). Fig. 2 Averaged research-grade high-resolution FD-OCT B-scan of the fovea OS. An averaged B-scan was obtained by taking multiple B-scans (40 B-scans) over the same retinal location and coregistering and averaging the images to remove speckle noise and improve ... Fig. 3 Research-grade high-resolution and Cirrus FD-OCT B-scan images of vitelliform detachment associated with BLD. A. B-scan image obtained using research-grade FD-OCT system.1 The location of the B-scan is indicated by the white line passing through a superior ... On Fourier-domain optical coherence tomography, the hyperreflective subretinal material appears contiguous with retinal pigment epithelium/BM, and the BM layer appeared intact within the vitelliform detachment (Figures 2 and ​and3).3). This intact BM may explain why these lesions are rarely associated with choroidal neovascularization or severe vision loss. The late hyperfluorescence seen on fluorescein angiography likely represents slow late staining of the subretinal material rather than the window defect from underlying choroidal circulation as previously speculated (Figure 1D).4 In conclusion, these high-resolution Fourier-domain optical coherence tomography images provide new morphologic insights into the pathogenesis of this rather uncommon condition.

Macular pigment and macular volume in eyes of patients with cystic fibrosis

Purpose: To evaluate the effect of intravitreal ciliary neurotrophic factor (CNTF) implant on mean macular thickness (MMT) in eyes with retinitis pigmentosa using high-resolution Fourier domain optical coherence tomography imaging. Methods: A cohort of 8 patients (CNTF-3: n = 5; CNTF-4: n = 3) enrolled in Neurotech sponsored Phase 2 clinical trial underwent Fourier domain optical coherence tomography imaging. A ≥3% change in MMT from baseline or fellow eye was considered as a measurable change. Results: Two patients enrolled in the CNTF-3 study received low-dose implant. At 18 months, a change in MMT from −4.47 &mgr;m to 6 &mgr;m from baseline was noted. Six patients received high-dose implant (CNTF-3: n = 3; CNTF-4: n = 3). In CNTF-3 group, 1 eye showed an increase in MMT by 19.25 &mgr;m (+7.6%) from baseline at 18 months. In CNTF-4 group, 1 eye had an increase in MMT of 27.08 &mgr;m (+11%) from baseline at 30 months; second eye had increase in MMT of 31.36 &mgr;m (+12%) from contralateral eye. Amongst these 3 responsive high-dose implant eyes, overall thickening of the retina could not be attributed to any specific retinal layer. Conclusion: A heterogeneous dose-dependent response on MMT was noted in eyes treated using intravitreal CNTF implant for retinitis pigmentosa. We recommend corroboration of our findings with Neurotech sponsored clinical trial results.

AO-OCT with reference arm phase shifting for complex conjugate artifact-free imaging of in vivo retinal structures

We describe results of retinal imaging with a novel instrument that combines adaptive optics - Fourier-domain optical coherence tomography (AO-OCT) with an adaptive optics scanning laser ophthalmoscope (AO-SLO). One of the benefits of combining Fd-OCT with SLO includes automatic co-registration between the two imaging modalities and the potential for correcting lateral and transversal eye motion resulting in motion artifact-free volumetric retinal imaging. Additionally this allows for direct comparison between retinal structures that can be imaged with both modalities (e.g., photoreceptor mosaics or microvasculature maps). This dual imaging modality could provide insight into some retinal properties that could not be accessed by a single imaging system. Additionally, extension of OCT and SLO beyond structural imaging may open new avenues for diagnostics and testing in ophthalmology. In particular, non-invasive vasculature mapping with these modalities holds promise of replacing fluorescein angiography in vascular identification. Several new improvements of our system are described, including results of testing a novel 97-actuator deformable mirror and AO-SLO light intensity modulation.