ARVO 2012 Annual Meeting Abstracts

Transcrição

268 Imaging of Posterior Eye II
Monday, May 7, 2012, 1:45 PM - 3:30 PM
Hall B/C Poster Session
Program #/Board # Range: 2067-2110/D1131-D1174
Organizing Section: Multidisciplinary Ophthalmic Imaging Group
Program Number: 2067 Poster Board Number: D1131
Presentation Time: 1:45 PM - 3:30 PM
Peripheral Autofluorescence Imaging in Age Related Macular Degeneration
Matthew T. Witmer, Szilard Kiss. Ophthalmology, Weill Cornell Medical College,
New York, NY.
Purpose: To describe the peripheral autofluorescent findings in patients with agerelated macular degeneration using ultra-wide-field imaging.
Methods: We retrospectively reviewed the ultra-wide-field autofluorescent images
of all patients diagnosed with age-related macular degeneration (AMD) or macular
drusen at the Department of Ophthalmology of Weill Cornell Medical College from
July 2010 to September 2011. Peripheral autofluorescent phenotypes included
normal autofluorescence, focal pinpoint hyperfluorescence, granular fluorescent
changes, patchy hypofluorescence, and reticular hypofluorescence.
Results: One hundred and ten consecutive patients (220 eyes) with a diagnosis of
age-related macular degeneration or macular drusen were imaged with ultra-widefield autofluorescent technology during the study period. Eighty-three patients (157
eyes) were included in the final analysis. Peripheral autofluorescent abnormalities
were present in 63.6% of eyes with AMD versus 35.7% of control eyes (p = 0.049).
Granular fluorescent changes (p = 0.0001) and patchy hypofluorescence (p =
0.0015) were more common in eyes with advanced AMD than in eyes with early
AMD or control eyes. Granular fluorescent changes were also more common in
eyes with choroidal neovascularization (p = 0.026) or geographic atrophy (p =
0.0001). Patchy hypofluorescence (0.0001) was more common in eyes with
geographic atrophy.
Conclusions: Peripheral autofluorescent abnormalities are common in eyes with
age-related macular degeneration. The peripheral findings in eyes with AMD may
represent different phenotypes, which may indicate different environmental or
genetic factors in the development of AMD. Characterizing the different peripheral
phenotypes may have implications for diagnosis and treatment of AMD subtypes.
Commercial Relationships: Matthew T. Witmer, None; Szilard Kiss, Optos,
PLC (C)
Support: None
Peripheral Color and Fundus Autofluorescence Imaging in Patients with
Stargardt Disease and Fundus Flavimaculatus
Wadih M. Zein, Brian P. Brooks. Ophthalmic Genetics & Visual Function Branch,
NEI/NIH, Bethesda, MD.
Purpose: Stargardt disease (STGD) has traditionally been thought of as a juvenile
maculopathy with imaging hallmarks of macular / perimacular flecks, beaten-metal
macular atrophy, and a dark choroid on fluorescein angiography. Fundus
flavimaculatus (FF) was initially described as a separate entity with more extensive
flecks extending beyond the macular area but was later recognized as a
manifestation of the same disease.Mutations in the ABCA4 gene were associated
with both. Recently, fundus autofluorescence (AF) has been used extensively to
study STGD / FF. Most reported imaging is limited to the central 50 degrees of the
retina.
Methods: 45 patients with a clinical diagnosis of STGD / FF were examined by
one ophthalmologist (WZ) between August 2010 and November 2011. Datapoints
included demographics with an estimated age-of-onset, psychophysical
measurements including visual acuity and visual field, photopic
electroretinography, and fundus color and AF imaging. Genetic testing for ABCA4
gene mutations was undertaken in all but one patient (refused). We report on the
imaging data that included 3-field static color and AF (Topcon) in 25 patients and
central color and AF in addition to ultra-wide-field imaging (Optos) in 18 patients.
Results: 17 patients (38%) had central lesions only with no changes beyond the
arcades on exam; peripheral AF was normal in these patients. 12 patients (27%)
had foveal sparing with relatively well-preserved central acuity in at least one eye.
33 patients (73%) had evident flecks; 38 patients (84%) had peripapillary sparing.
Flecks beyond the arcades were noted in 28 patients; nine of these had a peculiar
peripheral AF pattern of speckled hypofluorescence. Six of the patients with
speckled AF also had a peripheral pattern of gyrate- like hypofluorescence that was
not evident on color imaging. These tended to be the patients with longest disease
period and most abnormal photopic electroretinography changes. Five patients
(11%) had small deep lacunar lesions very close to the arcades - a finding that, to
our knowledge, has not been described before.
Conclusions: We report on fundus color and AF patterns in patients with STGD /
FF with a focus on peripheral imaging. The data has implications on the presumed
target areas for future treatment trials and would also help with better phenotyping.
Commercial Relationships: Wadih M. Zein, None; Brian P. Brooks, None
Support: None
Identification of Additional Diabetic Retinopathy Lesions using Mydriatic
Wide-field Fundus Imaging: distribution & agreement with ETDRS
photography and dilated retinal examination
Paolo S. Silva1,2, Jerry D. Cavallerano1,2, Jennifer K. Sun1,2, Ahmed Z. Soliman1,
Jerald Wisdom1, Abumare Akinwale1, Lloyd M. Aiello1,2, Lloyd P. Aiello1.
1
Beetham Eye Institute, Joslin Diabetes Center, Boston, MA; 2Ophthalmology,
Harvard Medical School, Boston, MA.
Purpose: To determine if mydriatic ultrawide-field fundus imaging identifies
diabetic retinopathy (DR) lesions not observed w/ ETDRS film fundus photography
(ETDRS photos) or dilated fundus exam (DFE).
Methods: Mydriatic Optos® 200 degree (D200), ETDRS photos and masked retina
specialist DFE were obtained. Two masked readers graded images for
presence/extent of DR lesions and clinical DR severity. Distribution of H/MA,
venous beading (VB), IRMA, and NVE on D200 were compared to ETDRS
photos. A 3rd masked retina specialist adjudicated discrepancies. Unweighted (K)
and weighted (KW) kappa statistics (linear scale) assessed agreement.
Results: 206 eyes (103 diabetic patients) were evaluated. By ETDRS photos there
was no DR in 23 eyes (12%), mild NPDR in 36 (18%), moderate NPDR in 72
(36%), severe/very severe NPDR in 17 (9%), & PDR in 51 (26%). DR severity
between D200 & ETDRS photos matched in 67% (KW=0.74, K=0.57) and was
within 1 level in 91%. D200 & DFE matched in 58% (KW=0.67, K=0.45), and was
within 1 level in 87%. When D200 did not match DFE (N=86), higher agreement
occurred between D200 & ETDRS photos (KW=0.70, K=0.50) than DFE & ETDRS
photos (KW=0.33, K=0.08). Retinal lesions distribution on D200 in relation to
ETDRS photo coverage (within ETDRS fields; outside ETDRS fields; both) was
HMA (68%, 30%, 2%), VB (61%, 13%, 26%), IRMA (69%, 27%, 4%), NVE
(66%, 34%, 0%). NVEs were seen in 29 eyes by ETDRS photos or DFE. NVEs in
12 (41%) eyes were seen by both ETDRS photos & DFE, 11 (38%) by ETDRS
photos and 6 (21%) by DFE. All NVE seen on ETDRS photos were seen on D200.
NVE in 11 (38%) eyes were seen on ETDRS & D200 and not on DFE. NVE in 5
(17%) eyes seen by DFE were not seen in either D200 or ETDRS photos. NVE in 9
(31%) additional eyes were seen on D200 that were not observed on either ETDRS
photos or DFE. Of these, 4 (44%) were within ETDRS fields and did not increase
DR severity. The 5 additional D200 detected NVEs outside ETDRS fields led to
PDR detection in 3 of 9 (33%) eyes. Considering all retinal lesions detected outside
ETDRS fields, 29 eyes (14.5%) would have been graded as more severe DR than
ETDRS photos and none graded as less severe.
Conclusions: D200 images had substantial agreement with ETDRS photos and
DFE in determining DR severity (>91% within 1 step). Agreement was less for
DFE, but validity of DFE findings by ETDRS photos only occurred in 26%. Nearly
1/3 of DR lesions were located outside the ETDRS image area. Ultrawide imaging
increased NVE identification >30% and DR severity grade in >14%. Ultrawide
field imaging may identify more DR lesions than ETDRS photos or DFE (and
perhaps more accurately than DFE), with potential implications for disease
progression.
Commercial Relationships: Paolo S. Silva, None; Jerry D. Cavallerano,
None; Jennifer K. Sun, None; Ahmed Z. Soliman, None; Jerald Wisdom,
None; Abumare Akinwale, None; Lloyd M. Aiello, None; Lloyd P. Aiello, None
Support: Optos, plc (unrestricted)
Impact of Microsaccades on Ultrawide-Field Retinal MHz OCT
Thomas Klein1A, Wolfgang Wieser1A, Raphael André1A, Lukas Reznicek1B, Anselm
Kampik1B, Aljoscha S. Neubauer1B, Robert Huber1A. AFaculty of Physics,
B
Ophthalmology, 1Ludwig-Maximilians-University, Muenchen, Germany.
Purpose: To investigate the impact of involuntary eye movements on ultrawidefield retinal OCT images, which were acquired with a multi-MHz Fourier-domain
mode-locked (FDML) laser OCT system.
Methods: A 1050nm FDML OCT device was constructed with an axial line rate of
1.68MHz, and imaging of 5 normal subjects was performed with a total acquisition
time of only 0.8s for 1100*1100 axial scans. Ultra-wide field en-face fundus
projections spanning ~60° field of view were reconstructed from those datasets and
investigated for motion artifacts. We compared the results with 54 fundus
projections consisting of 1900x1900 axial scans from 11 normal subjects, which
were acquired in 6.1s and 3.0s, at 684kHz and 1.37MHz axial scan rate,
respectively.
Results: For the longer acquisition times, we found that a significant number of
datasets was distorted by fixational instabilities. At 684kHz, 63% of datasets
showed motion artifacts by (micro-) saccades, compared to 42% at 1.37MHz. We
observed a maximum displacement of ~2° and a positive correlation between
Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
saccade duration and amplitude. Saccades were usually composed of a short
displacement period, followed by stable gaze and another fast displacement to the
original position (see Fig. 1). At 1.68MHz and reduced scan time of 0.8s, no
motion artifacts were apparent so far.
Conclusions: Even for MHz axial line rates, densely sampled ultrawide-field OCT
imaging can be severely affected by microsaccades. To reduce the impact of
motion artifacts, two strategies are feasible: (1) Higher axial scan rates and (2)
reduced sampling density. Since both strategies reduce image quality, a scan
protocol at 1.68MHz and 0.8s acquisition time may be a reasonable choice for ultra
wide-field ophthalmic imaging today.
Commercial Relationships: Thomas Klein, None; Wolfgang Wieser,
None; Raphael André, None; Lukas Reznicek, None; Anselm Kampik,
None; Aljoscha S. Neubauer, None; Robert Huber, None
Support: None
Cystoid Macular Edema and Peripheral Vascular Leakage on Ultra-Wide
Field Fluorescein Angiography
Ella H. Leung, Gennady Landa, Richard Rosen. Department of Ophthalmology,
The New York Eye and Ear Infirmary, New York, NY.
Purpose: To determine the relationship between macular edema and peripheral
vascular leakage in the mid-peripheral and far peripheral retina using ultra-wide
field fluorescein angiography.
Methods: An Optos P200 Scanning Laser Ophthalmoscope was used to obtain
200-degree fluorescein angiograms (FA) of the fundus in consecutive patients seen
at the Retina Center in the New York Eye and Ear Infirmary. The ultra-wide field
FAs and macular optical coherence tomography (OCTs) of 156 eyes in 99 patients
with macular leakage were analyzed.
Results: The most common past ocular histories for patients with cystoid macular
edema (CME) were proliferative diabetic retinopathy (67%), central and branch
retinal vein occlusion (18%), and exudative age-related macular degeneration
(13%). The majority of eyes with macular leakage on FA and CME confirmed on
OCT had fluorescein leakage in the mid-periphery (97%) and far periphery (90%)
of the retina. Thirty-six eyes (23%) had greater leakage in the far periphery than in
the central or mid-periphery, and two percent with CME and far peripheral leakage
had no leakage in the posterior fundus. Fifty-six patients (56%) had bilateral
leakage in the macula.
Conclusions: Macular edema is strongly associated with peripheral vascular
leakage. In severe cases, the far peripheral retina and the contralateral eye should
be thoroughly examined. Ultra- wide field angiograms are useful for detecting far
peripheral leakage and may provide an earlier indication of the need for antivascular endothelial growth factor injections or pan-retinal photocoagulation.
Commercial Relationships: Ella H. Leung, None; Gennady Landa, None;
Richard Rosen, Consultant for Opko/OTI/Optos and Clarity and OD-OS
companies (C)
Support: None
Implementation Of An Ocular Telehealth Program Using Ultrawidefield
Images To Increase Diabetic Eye Screening
Shachar Tauber1A, James Gessler1B, James T. Rogers1C, Mary Bourland2, Crystal
Trythall1A, Phillip Finley1D. AOphthalmic Research, BEye Specialists, CInternal
Medicine, DClinic Research, 1Mercy Health System, Springfield, MO; 2Clinic
Intergration, Mercy Health System, St. Louis, MO.
Purpose: The purpose of this ongoing study is analyze the rate at which diabetic
patients are being screened for retinopathy within primary care offices in southwest
Missouri utilizing a novel approach to ocular telehealth and a single electronic
medical record,
Methods: The Ocular Telehealth Program was implemented in four primary care
physician (PCP) clinics at a integrated tertiary care health system in southwest
Missouri. The program includes noninvasive nonmydriatic widefield optomap
retinal images taken of diabetic patients’ eyes while in the PCP offices. These
images are then evaluated by an integrated board certified ophthalmologist for
pathology. The findings and any recommendations for future eye care were sent to
the PCP via the electronic medical record
Results: During the first three months of the program 340 images were obtained
and evaluated. Out of these images, 55 patients showed evidence of eye pathology.
The pathologies identified included diabetic retinopathy - 26 patients, AMD - 5
patients, BRAO or BRVO - 2 patients, asymmetrical cupping - 2 patients,
hypertensive changes - 2 patients, cataract - 1 patient, solitary hemorrhage near disc
- 1 patient, small nevus - 1 patient, RPE changes - 1 patient, Hollenhorst plaque - 1
patient, and other potential pathologies needing further evaluation - 13 patients. Out
of the patients with diabetic retinopathy, 21 were diagnosed with mild, moderate, or
severe non proliferative retinopathy and 5 showed signs of proliferative retinopathy
with neo-vessels
Conclusions: The implementation, within the integrated PCP offices, of the Ocular
Telehealth Program and a single electronic medical record has increased the rate at
which diabetic patients are being screened for retinopathy. Early disease detection
in these patients may have been otherwise missed without the evaluation of
widefield retinal images. However, these results are preliminary; the study will
continue long term to determine the impact of Ocular Telehealth Program on a
larger cohort.
Commercial Relationships: Shachar Tauber, Cameras have been provided by
Optos for a 6 month trial (F), I am a member of Mercy Springfield Health System
Board, I am a member of the Mercy Springfield Research Board (S); James
Gessler, Cameras have been provided by Optos for a 6 month trial (F); James T.
Rogers, Cameras have been provided by Optos for a 6 month trial (F); Mary
Bourland, None; Crystal Trythall, None; Phillip Finley, None
Support: None
Detection Of Proliferative Diabetic Retinopathy: A Comparison Of UltraWidefield With Conventional Fluorescein Angiography
Gregory W. Oldham, Philip Scharper. Ophthalmology, Krieger Eye Institute, Sinai
Hospital of Baltimore, Baltimore, MD.
Purpose: Diabetic retinopathy affects both the peripheral and central retina, but
conventional digital fluorescein angiography only captures 500 of the posterior pole
compared to 2000 with a scanning laser ophthalmoscope. Peripheral proliferative
diabetic retinopathy may therefore go undiagnosed with the use of conventional
imaging, and thwart the opportunity for early intervention. We retrospectively
evaluated whether there is a differing degree of peripheral neovascular disease
detected in diabetic patients with ultra-widefield (Optos 200TX) fluorescein
angiography (FA), versus conventional FA (Zeiss FF 450 plus IR fundus camera)
with peripheral mapping techniques.
Methods: Angiographic features of 15 eyes of 14 diabetic patients were examined
by a single retina specialist. All patients had presumed nonproliferative diabetic
retinopathy, and were presenting for routine exam. Angiography was conducted on
one visit with a single trained technician; first, standard FA (Zeiss FF 450 plus IR
fundus camera) with a single dye injection, followed by immediate ultra-widefield
(Optos 200TX) angiography. A seven-field montage was created from the standard
FA, and compared to one widefield image. Angiograms were individually graded
for the amount of neovascularization utilizing a standardized mapping system with
a calibrated grid placed on the images. The number of grid sectors with
angiographic evidence of retinal neovascularization within each image was
recorded. Main outcome measurements were the total number of grid sectors with
neovascularization, and the number of patients with neovascular disease found with
ultra-widefield alone.
Results: For ultra-widefield FA with the Optos 200TX, the mean number of grid
sectors with retinal neovascular disease was 1.9 ± 1.7, versus 0.73 ± 1.09 grid
sectors with the seven-field montage. Peripheral retinal neovascularization was
evident on ultra-widefield imaging in 4 of 15 eyes (26.7%) that was not visible with
conventional FA.
Conclusions: Ultra-widefield FA with the Optos 200TX is a superior testing
modality for the evaluation of peripheral neovascular disease in diabetic patients
compared to conventional seven-field imaging. Greater recognition of peripheral
angiographic disease could allow for earlier treatment intervention and
consequently prevent blinding complications of diabetic retinopathy.
Commercial Relationships: Gregory W. Oldham, None; Philip Scharper,
None
Support: None
Assessment of Retinal Non-Perfusion in Vascular Retinal Diseases using Single
versus Summarized Ultra Wide-Field Fluorescein Angiography Images
Valentina Franco-Cardenas1, Christopher J. Gee J. Gee1, David Appap1, Kentaro
Nishida1, Adriana Ramirez1, Adriana Perez-Rovira2, Kris Zutis2, Steven D.
Schwartz1, Emmanuel Trucco2, Jean-Pierre Hubschman1. 1Retina, Jules Stein Eye
Institute, Los Angeles, CA; 2Computer Vision and Image Processing, School of
Computing, University of Dundee, United Kingdom.
Purpose: Image summarization via RERBEE (robust efficient registration via
bifurcations and elongated elements) is a novel feature-based registration algorithm
able to correct local deformations in high-resolution ultra wide-field fluorescein
angiogram (UWFFA) sequences of the retina. An overlay of a UWFFA sequence is
used to produce a single summarized image. Creating summarized images may be
used in the future for automated retinal image analysis (ARIA) of ischemic index
(ISI), instead of analyzing each image of the UWFFA. Calculating an ISI, using a
single UWFFA image, is useful for assessing neovascular complications and
macular edema in retinal vascular pathologies; however, it is unknown if a
summarized image provides equivalent results.
Methods: Two sets of images (single vs. summarized) were provided to 6 graders.
Each set consisted of 5 branch retinal vein occlusion (BRVO), 5 central retinal vein
occlusion (CRVO) and 5 diabetic retinopathy (DR) images. Each summarized
image was obtained via RERBEE overlay of 5 images of the different phases of the
UWFFA sequence. Graders were asked to circle the non-perfused areas. A
Wilcoxon signed rank test was done to determine significant difference between
grading single versus summarized images by disease. Intraclass correlation
coefficient (ICC) was used to determine inter-grader agreement.
Results: The detected area of non-perfusion is grater when using single images vs
summarized images in BRVO, CRVO and DR. The retinal non perfusion areas
measured with a single vs a summarized image are equivalent in BRVO and CRVO
(p=0.12, p=0.67), but nor for DR (p=0.005). Overall there is a better agreement
when using the single image.
Conclusions: Calculating an ISI in summarized images obtained via RERBEE
seems to be a viable option. In the future, we consider that using summarized
images for ARIA of non-perfusion may be considered in retinal vein occlusions but
not for DR.
whenever possible. Genetic analysis was offered to many of these patients.
Results: A wide array of FAF patterns were identified. These included
a) normal, b) hypo and hyper FAF of the macula, c) hypo and hyper FAF within the
arcades, d) hypo and hyper FAF of the mid-periphery and d) hypo and hyper FAF
in the far periphery. In retinitis pigmentosa (RP), many patients had bull's eye
maculopathies that were often invisible to ophthalmosocpy and mid-peripheral
zones of hypo FAF (Figure 1). Some RP patients had a completely normal FAF
within the arcades. Stargardt disease was characterized by macular hypo FAF and
mid-peripheral hyper FAF associated with fundus flavimaculatus flecks. Hypo FAF
zones in all diseases correlated highly with absence of the IS/OS junction, or
photoreceptor integrity line (PIL) on SD-OCT. Patients with larger areas of hypo
FAF correlated with constricted peripheral visual fields and reduced or flat ERGs.
Within the same family, FAF patterns were very similar. Certain FAF patterns
emerged that correlated with specific genetic mutations.
Conclusions: Ultra Wide Field FAF images revealed a spectrum of abnormal
patterns, most of which could not be predicted by binocular indirect
ophthalmoscopy. The patterns may correlate with structural and functional
abnormalities as well as with specific genetic mutations in some cases.
Commercial Relationships: Sherry J. Bass, None; Jerome Sherman,
Consultant for Optos, Inc. (C), Received honoraria and travel reimbursement from
Optos, Inc. (R); Daniel Epshtein, None
Support: None
Commercial Relationships: Valentina Franco-Cardenas, None; Christopher J.
Gee J. Gee, None; David Appap, None; Kentaro Nishida, None; Adriana
Ramirez, None; Adriana Perez-Rovira, Developer (P); Kris Zutis, Developer
(P); Steven D. Schwartz, None; Emmanuel Trucco, Inventor (P); Jean-Pierre
Hubschman, None
Support: None
The Spectrum of Fundus Auto Fluorescent (FAF) Patterns in Inherited
Retinal Degenerations as Revealed with Ultra-Wide Field Imaging
Sherry J. Bass1, Jerome Sherman1,2, Daniel Epshtein1. 1Clinical Sciences, SUNY
College of Optometry, New York, NY; 2SUNY Eye Institute, State University of
New York, NY.
Purpose: To document the myriad patterns of hypo and hyper FAF in inherited
retinal degenerations and to contrast the patterns with flash and mf ERGs, central
and peripheral visual fields, Spectral Domain OCT, color fundus images and
genetic analysis.
Methods: A retrospective analysis of 400 ultra wide field fundus autofluorescent
images obtained with an optomap autofluorescent camera (optomap af) was
performed. Of these, 31 pairs of images were identified as having patterns that most
likely represented an inherited retinal degeneration. Charts of these 31 patients
were reviewed and in some cases, patients were recalled for additional testing
including flash ERGs and peripheral visual fields. Family members were evaluated
Usefulness of the Ultra-Widefield Retinal Imaging Device for Fundus
Screening
Satoshi Ishiko1A, Hiroyuki Kagokawa1B, Akira Takamiya1B, Eiichi Sato1B, Tsuneaki
Omae1B, Seigo Nakabayashi1B, Kazuhiro Sugawara1B, Akitoshi Yoshida1B.
A
Medicine and Engineering Comb Res Inst, BOphthalmology, 1Asahikawa Medical
University, Asahikawa, Japan.
Purpose: To study the usefulness of the ultra-widefield (200 degrees of the fundus)
retinal imaging device (Optos 200Tx, Marlborough, MA, USA) for fundus
screening.
Methods: One hundred twenty-eight eyes of 64 medical students (39 men, 25
women; mean age, 26.2±5.2 years) who attended the clinical clerkship for
ophthalmology at Asahikawa Medical University were included. Fundus imaging
using the Optos device and conventional fundus examinations using a fundus scope
and a slit-lamp with a 90-diopter non-contact lens were performed under mydriasis
to facilitate fundus screening for retinal breaks and lattice degeneration.
Results: Fifteen cases of lattice degenerations and seven cases of breaks were
observed in 15 eyes (11.7%) during the fundus examination; seven cases of lattice
degeneration and two cases of retinal breaks in seven eyes (5.5%) were identified
using Optos. Around the equatorial zone, seven of eight pathological findings
(87.5%) were observed using Optos; however, only one of 14 pathological findings
(7.1%) was observed in the far periphery. In one patient with intense photophobia
and the inability to move his eyes, lattice degeneration was detected using Optos,
but it was difficult to detect during conventional fundus examination.
Conclusions: The ultra-widefield retinal imaging device can be useful for fundus
screening for diseases that develop mainly up to and around the equatorial zone.
This device can enable fundus examinations when patient cannot move their eyes.
Commercial Relationships: Satoshi Ishiko, None; Hiroyuki Kagokawa,
None; Akira Takamiya, None; Eiichi Sato, None; Tsuneaki Omae, None; Seigo
Nakabayashi, None; Kazuhiro Sugawara, None; Akitoshi Yoshida, None
Support: None
Panoramic Autofluorescence Identifies Pan-retinal Degenerations In Patients
With Reduced VA
Sarah MacIver1, Samantha Slotnick2,3, Dan Epshtein2, Jerome Sherman2,3. 1Ocular
Disease, University of Waterloo School of Optometry, Waterloo, ON, Canada;
2
Clinical Sciences, SUNY College of Optometry, New York, NY; 3SUNY Eye
Institute, State University of New York, NY.
Purpose: Fundus Autofluorescence (AF) is an indicator of retinal pigment
epithelium (RPE) activity, with Hypo-AF indicating loss of RPE cells, and hyperAF indicating RPE stress. Ultra-Widefield (Panoramic) AF (PAF) imaging with
Optos 200Tx captures a 200 degree image in a minimally invasive, time-effective,
manner. This study utilizes PAF in patients with reduced visual acuity (VA) (a) to
determine whether PAF images correspond with color optomap® images and (b) to
determine the scope and symmetry of retinal degeneration.
Methods: A retrospective review of 100 PAF and color optomap images from 50
patients with either reduced VA or unusual visual symptoms was conducted in an
ocular disease clinic. Based on patterns of AF, the images were categorized as
normal (N) or abnormal, further designated by location: Abnormal centrally (AC),
abnormal peripherally (AP), or abnormal centrally & peripherally (ACP). The
central region was defined as the posterior pole, within 1 DD anterior to sup/inf
arcades and around optic nerve. The images were analyzed for (a) PAF/color
optomap correspondence and (b) OD/OS PAF pattern symmetry within each
patient. Spectral domain optical coherence tomography (SDOCT) was used to
confirm retinal abnormalities in all cases.
Results: 61 of the 100 PAF images reviewed had AF abnormalities: 18(29.5%)
were AC only, 10(16.4%) were AP only, and 33(54.1%) were ACP. 5 patients had
AP in 1 eye with ACP in the fellow eye. Of the 61 abnormal PAF images:
(a)44(72.1%) did not match the appearance of corresponding color optomap image.
(b)48(78.7%) had symmetric patterns OD and OS, suggesting retinal degeneration.
Bilateral, previously undetected bull’s-eye maculopathy was discovered in 12 of
the 61 images. SDOCT confirmed RPE defects in the posterior pole via evaluation
of the outer retina (i.e. Photoreceptor integrity line (PIL) and RPE) in all AC and
ACP eyes.
Conclusions: 1)PAF is a fast, non-invasive procedure that can effectively detect
outer retinal pathology in patients with vision defects. 2)Pan-retinal AF
abnormalities are more common than those isolated to the central or peripheral
retina. However, isolated AP may precede ACP, as several asymmetric cases
suggest. 3)PAF reveals abnormalities throughout the retina that may be invisible to
binocular indirect ophthalmoscopy, fundus photography or similar imaging
modalities. 4)Abnormality in PAF is more extensive than in color images when the
changes are in the outer retina. 5)PAF may be used in the early detection of bull’seye maculopathy, which is known to occur in Retinitis Pigmentosa, cone-rod
dystrophy, and drug toxicity (e.g. Plaquenil, Accutane). 6)SDOCT analysis of the
outer retina confirms RPE involvement in areas of hyper/hypo AF.
Commercial Relationships: Sarah MacIver, None; Samantha Slotnick,
None; Dan Epshtein, None; Jerome Sherman, Lectures for OPTOS (R)
Support: None
Clinical Correlation Of Wide-angle Fluorescein Angiography And Retinal
Oxymetry Findings In The Treatment Response Of Retinal Vein Occlusions
Jay J. Meyer, Veronica Kon-Jara, Maurice B. Landers, Seema Garg, Odette M.
Houghton, Travis A. Meredith, Jan N. Ulrich, Sai H. Chavala. Ophthalmology,
University of North Carolina, Chapel Hill, NC.
Purpose: To study the association of angiographic non-perfusion and retinal
oxygenation status with the treatment response in retinal vein occlusions.
Methods: Prospective case series. Patients with a diagnosis of central retinal vein
occlusion (CRVO) or branch retinal vein occlusion (BRVO) were recruited.
Evaluations were performed every 4 weeks +/- 7 days for 3 months. All subjects
underwent a complete ophthalmologic evaluation, retinal oximetry (RO) and
spectral domain optical coherence tomography (SD-OCT) at every visit. Ultra
wide-field fluorescein angiography (UWFA) was performed at baseline and after 3
months of follow-up. Based on clinical findings, patients received laser and/or antiVEGF treatments. The RO images were graded by hemoglobin oxygen saturation
using the Oxymap software. The UWFA images were graded with the ischemic
index (II) using Adobe Photoshop CS3.
Results: Twenty eyes of 20 patients were studied. Three patients were excluded
due to poor quality of the images. Seventeen patients were included with a mean
age of 72.5 years (range 55-86). Mean follow-up of the vein occlusions was 23.4
months. Ten eyes had residual cystoid macular edema (CME) after failed
treatments. UWFA showed peripheral areas of non-perfusion with an ischemic
index (II) that ranged from 16-33%. RO images demonstrated a low hemoglobin
oxygen saturation in 100% of cases. CRVO patients showed a lower saturation than
BRVO cases and these indices improved after receiving treatment. Persistence of
CME was associated with a higher ischemic index and lower oxygen saturation
levels, and some of these cases seemed to benefit from laser treatment in addition
to intravitreal injections of anti-VEGF.
Conclusions: Hemoglobin oxygen saturation may fluctuate after treatment but its
correlation with CME is weak. Areas of non-perfusion shown in UWFA were
correlated with persistence of CME. Patients with higher II might need a
combination of laser+intravitreal injections of anti-VEGF to improve the clinical
outcome in cases of retinal vein occlusions.
Commercial Relationships: Jay J. Meyer, None; Veronica Kon-Jara,
None; Maurice B. Landers, None; Seema Garg, None; Odette M. Houghton,
None; Travis A. Meredith, None; Jan N. Ulrich, None; Sai H. Chavala, None
Support: None
Outer Retina Pathology in Retinal Diseases: An OCT Study
Veronica A. Kon Jara1A, Matej Polomsky1B, Jay J. Meyer1B, David Fleischman1B,
Hart Moss1A, Maurice B. Landers, III1A. ARetina, BOphthalmology, 1University of
North Carolina at Chapel Hill, Chapel Hill, NC.
Purpose: To evaluate the structure of the outer retina in several retinal diseases and
assess its correlation with visual acuity.
Methods: A cross-sectional study was performed. Spectral domain optical
coherence tomography (Heidelberg OCT) scans of 160 eyes of 80 patients. Retinal
pathologies included diabetic retinopathy with macular edema, retinal vein
occlusion, age-related macular degeneration, epiretinal membrane, dome-shaped
macula, macular foveoschisis, central serous retinopathy and vitreomacular
traction.
The images were graded with Adobe Photoshop CS3. The external limiting
membrane (ELM), inner segment and outer segment (IS/OS) of the photoreceptors,
and outer photoreceptor border were manually delineated to evaluate integrity and
regularity of the layers. If a disruption was found in any of the layers, the length of
the defect was measured in pixels. Thickness of the outer nuclear layer (ONL) and
outer plexiform layer (OPL) were also recorded. After grading the images, they
were subdivided by the topographic changes and then correlated with the visual
acuity.
Results: The visual acuity varied from 20/20 to HM. Irregularities and
discontinuity of the retinal layers were variable and they showed a statistically
significant association (p<0.05) with reduced visual acuity. Thickness of the ONL
also demonstrated high correlation with visual acuity. The highest correlation was
found with the IS/OS boundary and the ELM. The abnormalities in the retinal
layers were seen in 85% of the cases, regardless of the clinical diagnosis.
Conclusions: Spectral domain OCT enables the study of the anatomical structure
of the retina and closely reflects a histological section. Outer retina abnormalities,
especially in the IS of the IS/OS boundary and the ELM, are associated with poorer
visual acuity.
Commercial Relationships: Veronica A. Kon Jara, None; Matej Polomsky,
None; Jay J. Meyer, None; David Fleischman, None; Hart Moss,
None; Maurice B. Landers, III, None
Support: None
Correlation Of Retinal Nerve Fiber Layer Measurements With And Without
Contact Lenses Measured In Patients With Astigmatism
Pooja Jamnadas, Shuchi Patel, Marie Brenner, Peter Russo. Ophthalmology,
Loyola University Chicago, Maywood, IL.
Purpose: The purpose of this study is to see if there is a statistically significant
difference between retinal nerve fiber layer measurements and q value with and
without contact lenses. We compared patient with increasing refractive error, and
patients with astigmatism
Methods: After obtaining IRB approval and consent, patients in the Loyola eye
clinic had their RNFL measured with and without contact lenses using the
Spectralis OCT. The patient's refractive error, axis of astigmatism, RNFL, and Q
value were recorded. A paired t test was used comparing the average RNFL and Q
value with and without contact lenses. For patients with astigmatism, an unpaired ttest was used to compare the change in RNFL with and without contacts, both in
the axis of their astigmatism and 90 degrees away from their axis of astigmatism
Results: There was no overall difference in RNFL or Q value with and without CL.
The mean difference in axis of RNFL was 4.621. 90 degrees away the mean
difference in RNFL with vs without contacts was 7.138. This was not statistically
significant.
Conclusions: When measuring RNFL in contact lens wearers, it is acceptable to
keep their contact lenses, as our study has shown that there is no difference in
quality or RNFL measurements with or without contact lenses. Our study also
demonstrated no statistically significant difference in RNFL wean measuring with
and without contact lenses, in the axis of astigmatism compared to 90 degrees
away.
Commercial Relationships: Pooja Jamnadas, None; Shuchi Patel, None; Marie
Brenner, None; Peter Russo, None
Support: Illinois Society of Blindness Prevention
Widespread Disruption of Photoreceptor Segments with Focal Elevation of
RPE as a Pathogenetic Implication in MEWDS; Time-periodic Evidence by
Multi-modal Imaging
Byung Ro Lee, Won June Lee, Yong Un Shin. Ophthalmology, Hanyang Univ Hosp,
Seoul, Republic of Korea.
Purpose: To determine the exact location of lesions and evaluate time-periodic
changes in multiple evanescent white dot syndrome (MEWDS) with the aid of
spectral domain optical coherence tomography(SD-OCT), fundus
autofluorescence(FAF) and indocyanine green angiography(ICGA).
Methods: Serial SD-OCT, FAF and ICGA were undertaken simultaneously at
diagnosis until clinical resolution in a 36-year-old woman with MEWDS. In depth
correlation between SD OCT, FAF and ICGA according to disease course were
performed. The interpretation for possible pathophysiology of MEWDS was made
with correlation of multiple image modalities and literature reviews.
Results: In the acute phase, SD-OCT revealed widespread disruptions of the
junction between photoreceptor inner and outer segments(IS/OS) with focal diffuse
retinal pigment epithelium(RPE) elevation. FAF revealed diffuse generalized
hyperautofluorescent areas. These findings corresponded precisely to the site of the
diffuse generalized hypofluorescent spots seen on ICGA. During the recovery
phase, disrupted IS/OS junction and was repaired considerably and some of RPE
elevation remained on SD-OCT. FAF revealed considerable shrinkage of
generalized hyperautofluorescent areas and more discrete hyperautofluorescent,
which corresponded precisely to the site of remnant of focal RPE elevation on SDOCT. In the fully resolution phase, there were no RPE-Photoreceptor abnormalities
observed on SD-OCT. On FAF, the intensity and size of hyperautofluorescent dots
was almost normalized and some of them converted to hypoautofluorescent dots.
Conclusions: These detailed serial simultaneous description of SD-OCT and FAF
finding have yet been reported before. We can confirm the widespread disruption
of photoreceptor segments with focal elevation of RPE as a pathogenetic
implication in MEWDS with the aid of multi-modal imaging, which do not
represent choroidal lesions.
Commercial Relationships: Byung Ro Lee, B.R. Lee is the consultant of Nidek
(C); Won June Lee, None; Yong Un Shin, None
Support: None
Analysis of Universal Eye Screening in 3573 Healthy Full-term Neonates in
Kunming, Yunnan Province, China
Paul J. Rychwalski1, Li Li-Hong2, Zhao Jun-Yang3, Li Na2, Guo-ming Zhang4, Tang
Ying2. 1Cleveland Clinic, Cole Eye Institute, Cleveland, OH; 2Ophthalmology,
Maternal and Children's Hospital, Kunming, China; 3Ophthalmology, Tongren
Ophthalmic Center, Capital University of Medical Sciences, Beijing, China;
4
Ophthalmology, Shenzen Eye Hospital, Jinan University, Shenzen, China.
Purpose: This work seeks to establish the effectiveness of a newborn screening
program for detecting ocular pathology in the healthy, full-term neonate. The
screening utilizes the Retcam wide-field digital imaging system (Clarity Medical
Systems, Pleasanton, CA). Early detection may lead to treatments that can prevent
blindness and visual disability.
Methods: Neonates born in the Maternal and Children’s Hospital of Kunming,
China, were screened within seven days after birth using flashlight, retinoscope,
hand-held slit lamp microscope and wide-angle digital retinal image acquisition
system (RetCam 2). External eye, pupillary light reflex, red reflex, the opacity of
refractive media, anterior chamber, and posterior segment were examined.
Results: A total of 3573 healthy neonates were enrolled in the screening program,
with detection of 848 abnormal cases (23.73%). The abnormal exams included 769
retinal hemorrhage (21.52%). Of these there were 215 cases of significant retinal
hemorrhage representing 6.02% of the total. In addition, 67 cases (1.88%) involved
macula hemorrhage. The other 107 cases (2.99%) included: subconjunctival
hemorrhage, lacrimal duct obstruction, congenital microphthalmos, congenital
corneal leucoma, posterior synechia, persistent pupillary membrane, congenital
cataract, enlarged C/D ratio, retinoblastoma, optic nerve defects, abnormal
distribution of macular pigment, and non-specific peripheral retinopathy.
Conclusions: Screening of all healthy newborns leads to detection of a significant
number of ocular pathologies. RetCam photodocumentation is a safe, convenient,
fast, and objective technique to screen newborns, enabling timely treatment and
detailed follow-up including longitudinal observation of lesions.
Commercial Relationships: Paul J. Rychwalski, None; Li Li-Hong,
None; Zhao Jun-Yang, None; Li Na, None; Guo-ming Zhang, None; Tang Ying,
None
Support: None
Automatic Detection Of Exudates In Color Retinal Images
Xiwei Zhang1, Guillaume Thibault1, Etienne Decencière1, Guy Cazuguel2, Ronan
Danno3, Bruno Laÿ3, Ali Erginay4A,5, Zeynep Guvenli-Victor4A, Pascale Massin4B,
Agnès Chabouis4C. 1Mathematics and Systems, Centre for Mathematical
Morphology MINES ParisTech, Fontainebleau, France; 2Laboratoire de Traitement
de l'Information Médicale -- LaTIM U650, INSERM, Brest, France; 3ADCIS,
Saint-Contest, France; AService d' Ophtalmologie, BOphthalmology service,
C
Mission télémédecine, 4hôpital Lariboisière - Assistance Publique - Hôpitaux de
Paris, Paris, France; 5University Paris7, Paris, France.
Purpose: Screening for Diabetic Retinopathy through a telemedicine network can
improve patient follow-up. In the case of the OPHDIAT network, 70% of the
images are considered normal by the readers. To reduce the burden on the
specialists, the aim of the TeleOphta project is to develop an automatic system to
detect normal images going through the network, by combining image processing
and data mining methods. The purpose of the study is to describe the detection of
exudates, one of the important elements of the TeleOphta software environment.
Methods: Firstly, 47 pathological images containing exudates were randomly
extracted from the OPHDIAT database, after excluding bad quality images. The
exudates were accurately outlined by an ophthalmologist. In addition, 35 healthy
images containing structures or artifacts similar to exudates were added to the
database. After pre-processing, a morphological ultimate opening function,
combined with a local variance threshold extracts the main candidates, while the
small candidates are detected using a strain opening function. An original module
was also developed to detect optical reflections along the main vessels. Finally a
classifier took the final decision: about 30 characteristics were extracted from each
candidate, including local, geometrical and textural properties.
Results: The developed algorithm detected exudates in 45 out of 47 pathological
images (the two false negatives correspond to images containing a few small
exudates and reflections) and 10 false positives out of 35 healthy images. For
comparison, the algorithm proposed by Giancardo et al. has been applied to the
same database and it detects presence of exudates in all images for both groups.
Secondly, the algorithm has been tested on the public DiaRetDB1 database: out of
89 images, there was a consensus reached by four experts on 84 images for the
presence of exudates. Our method, without any specific optimization but a
modification of a threshold due to a difference of image quality, detects exudates
on 22% of healthy images, without false negatives.
Conclusions: The method is efficient for detecting exudates, but tends to consider
some artifacts as exudates. The information brought by this detection improves the
performance of the data mining system, which would take the final decision.
Commercial Relationships: Xiwei Zhang, None; Guillaume Thibault,
None; Etienne Decencière, None; Guy Cazuguel, None; Ronan Danno,
None; Bruno Laÿ, None; Ali Erginay, None; Zeynep Guvenli-Victor,
None; Pascale Massin, None; Agnès Chabouis, None
Support: None
Assessing Macular Findings in Infants Screened for Retinopathy of
Prematurity with Spectral Domain-Optical Coherence Tomography
C. Devika Subramaniam1A, Adam M. Dubis1B, Pooja Godara1A, Debra Felzer2,
Cathy Brault2, Joseph Carroll1C, Deborah Costakos1A. AOphthalmology, BCell
Biology, Neurobiology, & Anatomy, COphthalmology and Cell Biology,
Neurobiology, & Anatomy, 1Medical College of Wisconsin, Milwaukee, WI;
2
Neonatal Intensive Care Unit, Children’s Hospital of Wisconsin, Milwaukee, WI.
Purpose: To evaluate subclinical macular findings in premature patients at risk of
retinopathy of prematurity (ROP) with the use of handheld spectral domain-optical
coherence tomography (SD-OCT).
Methods: Thirty-five patients ages 30 weeks gestation to 57 weeks gestation were
imaged using Bioptigen Hand Held Probe SD-OCT (HHP-SDOCT) (Bioptigen,
Research Triangle Park, NC, USA). Images were acquired in non-sedated infants in
the neonatal intensive care unit or outpatient clinic during ROP screening
examinations. Informed consent was obtained and all research was approved by the
local institutional review board. Some subjects were followed and re-imaged over
the course of several weeks. One hundred ninety-six total images were acquired,
and one eye from each patient was evaluated for cystoid macular edema (CME) and
persistence of inner retinal layers.
Results: One hundred eighteen (60.2%) of the images were usable (defined as
having scans passing through the fovea with clearly identifiable retinal layers).
CME was seen in 5 of 17 eyes (29.4%) with stage 0 ROP, 0 of 2 eyes (0%) with
stage 1 ROP, 1 of 5 eyes (20%) with stage 2 ROP, and 0 of 3 eyes (0%) with stage
3 ROP. Persistence of inner retinal layers was seen in 17 of 17 eyes (100%) with
stage 0 ROP, 2 of 2 eyes (100%) with stage 1 ROP, 4 of 5 eyes (80%) with stage 2
ROP, and 3 of 3 eyes (100%) with stage 3 ROP.
Conclusions: Consistent with previous reports (Vinekar A, et al. IOVS
2011;52:5183-5188; Maldonado RS, et al. Ophthalmology 2011;118:2315-2325),
subclinical CME is seen in premature infants; however, CME does not appear to be
correlated with ROP stage. This suggests that there may be other etiologies for the
CME seen in this patient population. Our data suggests there is persistence of inner
retinal layers in premature infants, regardless of ROP stage. Hand-held SD-OCT
imaging is a viable technique for evaluating subclinical macular findings in
premature infants, though much larger datasets are needed from multiple centers to
develop a better understanding of what is “normal” and what truly represents
subclinical pathology.
Commercial Relationships: C. Devika Subramaniam, None; Adam M. Dubis,
None; Pooja Godara, None; Debra Felzer, None; Cathy Brault, None; Joseph
Carroll, None; Deborah Costakos, None
Support: NIH grants EY017607, EY001931, EY014537. RD and Linda Peters
Foundation. Research to Prevent Blindness.
Validation Of Tablet-based Evaluation Of Color Fundus Images
Mark Christopher1, Daniela C. Moga1A, Stephen R. Russell2A, James C. Folk2A,
Todd Scheetz1B, Michael D. Abramoff2B. AEpidemiology, BOphthalmology & Visual
Sciences, 1University of Iowa, IOWA CITY, IA; AOphthalmology,
B
Ophthalmology & Visual Sciences, 2Univ of Iowa Hospitals & Clinics, Iowa City,
IA.
Purpose: To quantitatively compare clinical evaulation of fundus images for
diabetic retinopathy (DR) using a tablet computer to evaluation using a standard
desktop computer.
Methods: Two retinal specialists independently graded a set of 1200 color fundus
images for the presence and severity of DR. Each expert graded the images using
both a tablet computer (iPad) and a desktop computer with a high-definition color
display. The DR grades were assigned based the specialists evaluation of whether
and how urgently the patient should be referred from primary care to a retinal
expert based on the severity of DR indicated by the image. The specialists viewed
the images in a random order and were masked to any previous evaluation of the
images. DR grades assigned using the tablet were compared to desktop-based
grades using cross-platform, intra-platform kappa as the primary outcome measure.
Kappa values were also calculated to determine intra-platform, intra-observer and
inter-observer agreement. Additionally, the sensitivity, specificity, and area under
ROC of the tablet-based grades were determined.
Results: The intra-observer agreement for the two specialists was high
(kappa=0.778 and kappa=0.812) for the comparison of grades assigned using
different the platforms. Intra-platform, intra-observer agreement was comparable
(kappa=0.800 and kappa=0.784). For the two platforms, inter-observer agreement
was similar (kappa=0.544 and kappa=0.625 for tablet and desktop, respectively).
Finally, a sensitivity of 0.848, a specificity of 0.987, and an AUC of 0.950 was
achieved by the tablet-based grades compared to desktop-based grades.
Conclusions: The tablet-based grading of color fundus images for DR was
consistent with desktop-based grading. The results of this pilot study indicate that
tablets are equivalent to standard desktop computers with respect to clinical
evaluation of fundus images for DR and can be reliably used for this task.
Commercial Relationships: Mark Christopher, None; Daniela C. Moga,
None; Stephen R. Russell, None; James C. Folk, None; Todd Scheetz,
None; Michael D. Abramoff, None
Support: None
A Clinical Planning Module For Adaptive Optics Scanning Laser
Ophthalmoscope Imaging
Gang Huang1A, Xiaofeng Qi1A, Toco Y. Chui2, Stephen A. Burns1B. AOptometry
School, BSchool of Optometry, 1Indiana University, Bloomington, IN; 2Optometry,
Indiana University, BLOOMINGTON, IN.
Purpose: To improve the data-collection efficiency of steerable adaptive optics
scanning laser ophthalmoscope imaging by developing a clinical planning module
(CPM). To evaluate the performance of the module by imaging retinal layers over
large regions from healthy and diseased eyes.
Methods: We developed a software-based CPM which consists of two submodules: a navigation module and a montage acquisition module. The navigation
module was developed by mapping the AOSLO to the SLO image from a
Heidelberg Spectralis imager. The navigation module then guided the AOSLO
beam to the desired place on the retina as indicated on the SLO image. The
montage acquisition module systematically moved the AOSLO steering mirrors
across the retina in a programmable predefined pattern. The CPM was tested on
five normal healthy subjects and two patients. Each subject was imaged over a
large region of either the retinal nerve fiber or photoreceptor layer. Accuracy was
determined by the offset between the selected feature and the center of the AOSLO
image. Repeatability was determined in two of the subjects by imaging the same
regions over days.
Results: Within the range of +/-10 degree from the fixation target, the CPM could
direct the AOSLO beam to the desired regions. The localization error on average
was ~100um. With a frame size of 2.79°×1.78°(~800um×500um), a feature
specified on the SLO image always appeared within the AOSLO video frame. On
repeat trials the errors were of similar size. The montage acquisition module
allowed rapid acquisition of contiguous montages. Although for subjects with poor
fixation it sometimes required more time, in normal subjects the imaging of a 15 by
10 degrees montage could be completed in 15-30minutes. A 5 x 10 degree montage
containing an identified defect from a patient was imaged in 15 minutes of patient
time. The data acquisition efficiency was improved ~2x compared to that without
the assistance of CPM.
Conclusions: We have implemented a clinical planning module to accurately guide
the imaging beam to desired locations, and to quickly generate large-scale high
resolution AOSLO montages. The approach is not only friendly for patients and
clinicians, but also convenient for relating imaging data from different imaging
platforms
Commercial Relationships: Gang Huang, None; Xiaofeng Qi, None; Toco Y.
Chui, None; Stephen A. Burns, None
Support: EY04395, EY014375, NEI- P30EY019008
Results Of Brain Mri In Ocular Coloboma: Preliminary Results
Frederic Matonti1, Nadine Girard2, Annie Levy-Mozziconacci1, Julie Berbis1,
Danièle Denis1. 1Ophthalmology, Hopital Nord, Marseille, France;
2
Ophthalmology, Hopital de la Timone, Marseille, France.
Purpose: Congenital ocular colobomas are the result of a failure in closure of the
embryonal fissure during organogenesis. We present a prospective study (20072011) in which we report imaging findings in children with ocular coloboma
Methods: 41 children (64 eyes) were included; 18 boys, 23 girls with media age of
24,0 months (1.0-90.0) at first presentation. 2 or 3 month following a complete
ophthalmologic examination, cerebral MRI was performed
Results: Coloboma was bilateral in 23 cases and unilateral in 18 cases. Eleven
various types of coloboma were distinguished. Of 64 eyes, 74% had papillary
coloboma including 28 severe colobomas. On 41 MRI, abnormalities were present
in 86%: gyration abnormalities (N = 22), ventricular dilatation (N = 18), dilatation
of the perivascular spaces (N = 15), signal abnormalities and malformation of the
brain stem (N = 15), signal abnormalities of white matter (N = 12), abnormalities of
corpus callosum (N = 11). Most of these abnormalities were related. Gyration
abnormalities were the most frequent. There was no significant difference between
the severity of coloboma and abnormalities found (p = 1.0). The same absence of
significant difference was found between gyration abnormalities and the severity of
coloboma in children (p = 1.0)
Conclusions: This study shows, for the first time, the existence of frequent cerebral
abnormalities on MRI in children with eye coloboma with particularly gyration
abnormalities
Commercial Relationships: Frederic Matonti, None; Nadine Girard,
None; Annie Levy-Mozziconacci, None; Julie Berbis, None; Danièle Denis,
None
Support: None
Histogram Decomposition And Quantitative Assessment Of Signal Quality Of
Retinal Optical Coherence Tomography (OCT) Images
Yijun Huang1A, Sapna Gangaputra1A, Kristine E. Lee1B, Ashwini Narkar1A, Ronald
Klein1B, Barbara Klein1B, Stacy Meuer1B, Ronald P. Danis1A. AFundus Photograph
Reading Center, BOcular Epidemiology Reading Center, 1Depart. of Ophthal. &
Vis Sciences, University of Wisconsin-Madison, WI.
Purpose: To develop a histogram decomposition model for retinal OCT images
and to derive a quantitative parameter, maximum tissue contrast index (mTCI), for
assessing OCT signal quality from multiple devices.
Methods: An intensity histogram decomposition model was proposed to separate
the foreground and background information of OCT images and to calculate the
mTCI. 120 multi-frame OCT images from 4 SD OCT devices (Cirrus, Carl Zeiss
Meditec, Inc.; RTVue, Optovue, Inc.; Spectralis, Heidelberg Engineering, Inc.; and
3D OCT-1000, Topcon Corporation) were evaluated quantitatively using mTCI.
The mTCI results were compared to the manufacturer signal index (MSI) provided
by the respective devices, and to a subjective grading scores (SGS) assessed by
trained graders using a subjective grading protocol. The paired methods were tested
for correlation significance using Pearson Correlation, and followed by Deming
regression analysis to establish the correlation parameters.
Results: Statistically significant correlations were observed between the paired
methods (i.e., SGS and MSI, SGS and mTCI, and mTCI and MSI). One-tail
Fisher’s Z transformation showed the Pearson correlation coefficient (ρ ≥ 0.8) for
all devices, indicating a linear relationship between the methods. Using the Deming
regression, correlation parameters between the paired methods were calculated,
which allowed conversion from the proprietary MSI values to SGS and mTCI
values that are universally applicable.
Conclusions: Signal quality of retinal OCT images can be evaluated and correlated
between OCT devices from different manufacturers, both qualitatively through a
subjective grading scheme and quantitatively using the mTCI. Together with the
proposed histogram decomposition model, mTCI may be used as a standardization
metric for OCT signal quality that would impact measurements.
Commercial Relationships: Yijun Huang, None; Sapna Gangaputra,
None; Kristine E. Lee, None; Ashwini Narkar, None; Ronald Klein,
None; Barbara Klein, None; Stacy Meuer, None; Ronald P. Danis, None
Support: Research to Prevent Blindness, NY
Fractal analysis of Optical Coherence Tomography images for the
classification of diabetes-induced retinal damage
Gabor M. Somfai1A, Wei Gao2, Erika Tatrai1A, Lenke Laurik1A, Boglarka Varga1A,
Veronika Olvedy1A, Aniko Somogyi1B, Janos Nemeth1A, William E. Smiddy2, Delia
DeBuc2. ADepartment of Ophthalmology, B2nd Department of Internal Medicine,
1
Semmelweis University, Budapest, Hungary; 2Bascom Palmer Eye Institute,
University of Miami Miller School of Medicine, Miami, FL.
Purpose: Differences in optical properties and irregularity measures of normal and
abnormal retinal tissue may provide additional information of retinopathy
development in diabetic eyes. We evaluated the sensitivity of optical coherence
tomography images to sample diabetic morphology using fractal analysis.
Methods: A total of 74 eyes of healthy subjects (34±12 yrs,), 38 eyes with diabetes
mellitus with no retinopathy (DM, 35±10 yrs) and 43 eyes with mild diabetic
retinopathy (MDR, 43±17 yrs) on biomicroscopy were enrolled. Optical coherence
tomography (OCT) imaging of the macula was performed by Stratus OCT (Carl
Zeiss Meditec, Dublin, CA, USA), and OCTRIMA software was used to extract 7
intraretinal layers. Then, fractal dimension was calculated using a 1D wavelet
algorithm. ANOVA followed by Newman-Keuls post-hoc analyses were used to
test for differences between groups. The level of significance was set at p<0.001.
Receiver operating characteristic (ROC) curves were calculated to assess the
discriminating power between DM and MDR eye. Area under the receiver
operating characteristic curve (AUROC) was used to compare diagnostic power.
Results: Fractal dimension increased for all the layers except the ganglion cell
layer and inner plexiform layer complex (GCL+IPL, Control vs. DM vs. MDR,
1.68±0.01 vs. 1.62±0.06 vs. 1.57±0.05, respectively, p<0.001). The highest
AUROC values estimated for the fractal dimension was observed for GCL+IPL
when comparing MDR with DM eyes (0.77±0.05). The maximum discrimination
value of 0.80 for FD (standard error =0.05) for the GCL+IPL complex was
obtained at a FD ≤ 1.56 (cut off point, asymptotic 95% CI: lower-upper
bound=0.67-0.87). At this value, the sensitivity for the GCL+IPL complex is 65.1%
with a specificity of 76.3%.
Conclusions: Our results suggest that diabetic eyes with and without early
retinopathy may be discriminated by analyzing the OCT signal using fractal
analysis. The decrease of fractal dimension of the GCL+IPL layer may be due to
apoptosis and the consequent cellular structural changes. The use of OCT fractal
analysis for the classification of diabetes-induced retinal damage could potentially
provide an additional diagnostic information for the early detection of DR and the
follow-up of its progression.
Commercial Relationships: Gabor M. Somfai, None; Wei Gao, None; Erika
Tatrai, None; Lenke Laurik, None; Boglarka Varga, None; Veronika Olvedy,
None; Aniko Somogyi, None; Janos Nemeth, None; William E. Smiddy, None;
Delia DeBuc, US 61/139,082 (P)
Support: NIH/NEI-EY020607; JDRF 2007-727, NIH Center Core Grant
P30EY014801, Research to Prevent Blindness Unrestricted Grant, Department of
Defense (DOD- Grant#W81XWH-09-1-0675), MTA Zsigmond Diabetes Fdt.
I-retina Project: Integration Between Ophthalmologists To Sustain Retina
Health Care
Chiara M. Eandi1, Simone Donati2, Muna Al Oum3, Aldo Torreggiani4, Federico
M. Grignolo5, Claudio Azzolini6. 1Eye Clinic, University Torino, Torino, Italy;
2
Department of Morphological and Surgical Sciences, Univ of Insubria-Circolo
Hospital, Varese, Italy; 3Department of Morphological and Surgical Sciences, Univ
of Insubria - Circolo Hospital, Varese, Italy; 4Evaluation board IRCCS (Scientific
Institute of Admission and Care) Foundation, Policlinico San Matteo, Pavia, Italy;
5
Clinica Oculistica, Universita di Torino, Torino, Italy; 6Department of
Morphological and Surgical Sciences, University of Insubria - Circolo Hospital,
Varese, Italy.
Purpose: To evaluate a new way to treat and follow retina patients in an era of lack
of resources in healthcare by the integration between ophthalmologists working in
their offices on the territory and others working on Retina Centers.
Methods: A dedicated iRetina physician-to-physician network has been developed
on a web application platform using IBM Lotus Notes database technology
including an iPad application with a centralised state-of-the-art server and a
dedicated booking service for connections. A dedicated Electronic Medical Records
(EMR) has been created with space for text and bio-images using in-depth special
magnification software. The network system works in asynchrony (off-line), with
notification to consultant and consulted ophthalmologists provided by SMS and email messages. The system has been running since November 2009. The project
also provided each ophthalmologist with Italian Continuous Medical Education
(CME) credits.
Results: Up to now, six groups of ophthalmologists in different Italian cities used
the network for a total of 72 active ophthalmologists. 260 patients were evaluated.
360 electronic medical records and 187 set of images were used for the opinions’
exchange. Access to the project (entering the network), acceptability (technology
satisfaction), data quality and medical efficacy (appropriate care in the right time)
were evaluated positive/very positive by a point classification system. The process
of care was accelerate in about 25% out of the 260 patients.
Conclusions: The project allowed to decrease the number of duplicate visits and
calls that are particularly burdensome (no matter who pays: the state, insurance
companies, the patient himself) in anti-VEGF therapies, where control visits and
therapies have to be carried out on a monthly-basis for years. iHealth could
represents a profitable alternative in this era of worldwide healthcare budgetary
retrenchment.
Commercial Relationships: Chiara M. Eandi, None; Simone Donati,
None; Muna Al Oum, None; Aldo Torreggiani, T&C srl (E); Federico M.
Grignolo, None; Claudio Azzolini, None
Support: None
Montage Images of Spectral Domain-Optical Coherence Tomography in Eyes
with Idiopathic Macular Holes
Keisuke Mori1, Junji Kanno1, Peter L. Gehlbach2, Shin Yoneya1. 1Department of
Ophthalmology, Saitama Medical University, Iruma, Japan; 2Ophthalmology, Johns
Hopkins Wilmer Eye Inst, Baltimore, MD.
Purpose: Montaged images of posterior and peripheral spectral domain-optical
coherence tomography (SD-OCT) studies were used to describe the dynamic,
anatomical vitreoretinal relationships.
Methods: Forty six eyes of thirty six consecutive patients with idiopathic macular
hole and their fellow eyes. Montage images of 4 radial OCT scans (horizontal,
vertical and two oblique scans) through the fovea were obtained in each case.
Results: In fellow eyes, potential precursor changes to macular hole reveal shallow
perifoveal vitreous separation that extends peripherally towards the equator. Two
distinct configurations were noted at the posterior vitreous face; eyes without holes
had a smooth curvature whereas eyes with holes were more likely to have “wavy”,
folded, or scalloped vitreous surfaces. At onset of separation most posterior
vitreous cortex had a smooth curvature but posterior vitreous folds increased with
progressive separation. Also notable were double-layered retinoschises in regions
of adherent posterior vitreous. Resulting granular hyperreflection in the peripheral
vitreous was detectable in 50-60% of stage 1-2 holes but only 33% of stage 3-4
holes.
Conclusions: SD-OCT montages taken during the development of idiopathic
macular holes document distinct configurations of the posterior vitreous face,
granular hyperreflection in the peripheral vitreous and areas of peripheral
retinoschises. Montaging SD-OCT images provides novel cross-sectional images of
the vitreoretinal interface that may have broader application.
Commercial Relationships: Keisuke Mori, None; Junji Kanno, None; Peter L.
Gehlbach, None; Shin Yoneya, None
Support: None
Impact of Retinal Tracking on the Repeatability of Macular Thickness
Measurements from Cirrus HD-OCT
Humberto Ruiz-Garcia1,2A, Tamera Schoeholz3, Hari Iyer4A, Mary K. Durbin4B,
Srinivas R. Sadda2B. 1Ophthalmology and Visual Science, Universidad de
Guadalajara, Guadalajara, Mexico; AOpthalmic Imaging Unit, BOphthalmology,
2
Doheny Eye Institute - USC, Los Angeles, CA; 3Opthalmic Imaging Unit, Doheny
Eye Institute, Los Angeles, CA; AR&D, BR & D, 4Carl Zeiss Meditec, Inc, Dublin,
CA.
Purpose: To determine the repeatability of macular thickness measurements from
eyes with various retinal diseases using a Cirrus HD-OCT with retinal tracking
capability.
Methods: Fifty six (56) eyes with various diseases including age-related macular
degeneration (AMD), epiretinal membrane (ERM), diabetic retinopathy (DR), and
cystoid macular edema (CME) were imaged twice in one session with the Macular
512x128 volume cube scan protocol. The imaging was performed using a prototype
Cirrus HD-OCT instrument with retinal tracking capability to compensate for
retinal motion during scans. The Internal Limiting Membrane (ILM) and the
Retinal Pigment Epithelium (RPE) layers were automatically segmented from the
data cubes using the segmentation algorithms in the Cirrus HD-OCT instrument.
The fovea was automatically segmented from the cube and measurements were
obtained from an ETDRS grid centered on the fovea. For this study, the central
subfield thickness measurement from the ETDRS grid was used as the
measurement parameter of interest. Outliers due to segmentation failures and errors
in fovea detection were excluded from further analysis. Analysis of variance
(ANOVA) was used to determine repeatability standard deviation (SD) for the
measurement parameter.
Results: The repeatability standard deviation obtained with the new tracking
prototype software for the overall cohort including all diseases was 1.54 microns
(Table 1). The table also shows the repeatability standard deviation of the software
without tracking for various retinal diseases. Eyes with AMD appeared to have the
highest variability between scans, particularly when compared with eyes with
vitreo-retinal interface disease.
Conclusions: Tracking improves the repeatability of Cirrus HD-OCT Central
Subfield Macular Thickness measurements in eyes with disease. The benefit may
be most striking for diseases such as AMD and diabetic retinopathy which may
have poor vision and poor fixation.
Commercial Relationships: Humberto Ruiz-Garcia, None; Tamera Schoeholz,
None; Hari Iyer, Carl Zeiss Meditec, Inc (E); Mary K. Durbin, Carl Zeiss
Meditec, Inc (E); Srinivas R. Sadda, Carl Zeiss Meditec, Inc (F), Heidelberg
Engineering (C), Optovue, Inc (F), Topcon Medical Systems (P)
Support: Research to Prevent Blindness Physician Scientist Award
Evaluation Of Indocyanine Green As A Contrast Enhancement Agent For
Intraoperative Optical Coherence Tomography During Vitreoretinal Surgery
Stephen A. McNutt, Sunil K. Srivastava, Gina M. Smith, Justis P. Ehlers. Cole Eye
Institute, Cleveland Clinic, Cleveland, OH.
Purpose: To explore the optical properties of indocyanine green (ICG) as an
optical coherence tomography (OCT) contrast agent during vitreoretinal surgery
with intraoperative OCT (iOCT).
Methods: A retrospective consecutive case series identified 8 eyes undergoing
vitreoretinal surgery for epiretinal membrane and/or full-thickness macular hole
with iOCT scanning following ICG staining. Pre-stain and post-peel iOCT images
were obtained with a microscope-mounted spectral domain OCT device.
Qualititative and quantative analysis was performed of the reflectivity changes
noted on OCT scans. Pre- and post-stain images were compared for contrast
properties at the level of the ILM. Quantitative analysis was performed with ImageJ
software. Using a standardized area of measurement, a series of images for each
eye was evaluated. Measurements were taken at the numerous anatomic levels,
including the ILM and the nerve fiber layer. An OCT contrast ratio was calculated
by dividing the mean intensity of the ILM layer by the mean intensity of the NFL
layer. This measurement was made for both pre- and post-contrast eyes.
Results: All 8 eyes had pre and post-ICG iOCT scans performed. ICG staining
resulted in prominent increased hyperreflectivity at the level of the ILM on iOCT.
Increased shadowing was noted under the area of ICG staining. Increased contrast
enhancement was noted centrally in the parafoveal area. A minimum of five scans
per eye were available for quantitative analysis of both pre- and post-ICG staining.
The mean OCT contrast ratio following ICG staining was 1.42 compared with a
mean pre-ICG ratio of 0.98 (p< 0.001) representing a significant increase in relative
brightness of the ILM layer.
Conclusions: ICG provides significant contrast enhancement during iOCT by
qualitative and quantitative measures.
Commercial Relationships: Stephen A. McNutt, None; Sunil K. Srivastava,
None; Gina M. Smith, None; Justis P. Ehlers, None
Support: None
Repeatability Of Retinal Macular Thickness Measurements In Patients With
Diabetic Clinically Significant Macular Edema Using Two Different Scanning
Protocols Of Spectralis Optical Coherence Tomography
Tito Fiore1, Marco Lupidi1, Barbara Iaccheri1, Gianluigi Tosi1, Daniela Fruttini2,
Amedeo Pieri1, Alessia Iannone1, Antonio Garritano1, Carlo Cagini1.
1
Ophthalmology, Eye Clinic, University of Perugia, Perugia, Italy; 2Economic,
Financial and Statistical, University of Perugia, Perugia, Italy.
Purpose: To determine the repeatability of OCT Spectralis retinal thickness (RT)
measurements in diabetic patients with clinical significant macular edema (CSME)
using two different scanning methods.
Methods: Fifty-four eyes of 54 diabetic patients with CSME were included in the
study. Repeatability and intrasession correlation coefficients were tested with 20 x
15 degree raster scans consisting of 19 (group I) or 37 (group II) high-resolution
line scans that were repeated two times by 1 experienced examiner.
Results: In diabetic patients, examining the five ETDRS inner areas, coefficient of
repeatability was less than 2% for both group. Moreover, intrasession coefficients
of variation for all ETDRS inner areas were less than 0.4% for both scanning
protocols. Average ± SD thickness was found 396 ± 104 µm in group I and 390 ±
104 µm in group II. Mean absolute change in thickness ± SD was 0.5 ± 4.4 in group
I and 0 ± 2.3 in group II. Mean relative change in thickness was 0.14% in group I
and 0.1% in group II. No statistically significant differences were found between
obtained measurement in group I and group II.
Conclusions: RT measurements in diabetic patients with CSME are repeatable
using both scanning protocols (19 or 37 B-scans) with OCT Spectralis. The results
indicate that a change in central subfield thickness exceeding 11 µm is likely to be
real.
Commercial Relationships: Tito Fiore, None; Marco Lupidi, None; Barbara
Iaccheri, None; Gianluigi Tosi, None; Daniela Fruttini, None; Amedeo Pieri,
None; Alessia Iannone, None; Antonio Garritano, None; Carlo Cagini, None
Support: None
The Use of Triamcinolone as a Contrast Agent for Intrasurgical OCT
Carl G. Glittenberg1A, Peggy De Lamar1B, Marieh Esmaeelpour1B, Florian
Zeiler1A, Christiane Falkner Radler1A, Susanne Binder1A. ADept of Ophthalmology,
B
Ludwig Boltzman Institute for Retinology, 1Rudolph Foundation Clinic, Vienna,
Austria.
Purpose: To ascertain the feasibility of using triamcinolone as a contrast agent for
an intrasurgical OCT in order to increase the visibility of the layers of the posterior
hyaloid.
Methods: Using a Carl Zeiss Meditec Cirrus HD-OCT which was adapted to the
optical pathway of a Zeiss OPMI VISU 200 surgical microscope, 512x128 macular
cube scans and HD 5-line scans were performed at various steps of vitreoretinal
surgery. After core vitrectomy, triamcinolone was injected into the bulbus in order
to increase the visibility of the laminar structures of the residual posterior hyaloid
in the OCT. The acquired volume data was post processed and visualized using a
ray-traced three dimensional display system created in the C++ based object
oriented programming language COFFEE (Maxon Inc.TM). Informed consent had
been collected from all patients.
Results: 42 OCT scans were performed of 10 patients after intrasurgical injection
of triamcinolone. In all cases it was possible to increase the visibility of the
remnants of the posterior hyaloid in a surgical setting.
Conclusions: Triamcinolone is a good contrast agent for the intrasurgical
evaluation of the posterior hyaloid using an OCT.
Commercial Relationships: Carl G. Glittenberg, Carl Zeiss Meditec (C); Peggy
De Lamar, None; Marieh Esmaeelpour, None; Florian Zeiler, None; Christiane
Falkner Radler, None; Susanne Binder, None
Support: None
Predictive Value Of Retinal Nerve Fiber Layer Thickness Measured By
Optical Coherence Tomography On Visual Recovery In Dysthiroid Optic
Neuropathy After Decompression Surgery
Francisco J. Munoz Negrete1, Marta Pérez-López1, Gema Rebolleda1, Marco
Sales-Sanz1, Pilar Casas de Llera2. 1Ophthalmology, Hospital Ramon y Cajal
IRYCIS, Madrid, Spain; 2Ophthalmology, VISSUM, Alicante, Spain.
Purpose: To determine whether in vivo retinal nerve fibre layer (RNFL) thickness
measurements predict visual recovery after orbital bone decompression surgery in
patients with dysthiroid optic neuropathy (DON) and visual field defects.
Methods: 28 eyes of 15 patients undergoing orbital bone decompression surgery
for Graves´ orbitopathy were prospectively assessed before orbital decompression
and one month after surgery with a neuro-ophthalmic examination, involving
standard automated visual field (VF) testing and by spectral domain optical
coherence tomography (OCT) measurements of RNFL thickness (Cirrus OCT).
Results: Only in 5 eyes (17,5%) DON was diagnosed. All of them had preoperative
VF defects (median mean deviation -MD- was -8,00 dB and median pattern
standard deviation -PSD- was 6,06 dB). In 4 eyes preoperative RNFL average
thickness was normal and in 1 eye RNFL average thickness was significantly
thinned. After decompression surgery, eyes with preoperative normal RNFL
thickness showed improvement in MD (-10,05 dB and -4,90 dB before and after
surgery respectively p=0,068) and in PSD (5,65 dB before surgery and 2,56 dB
after surgery p=0,06) unlike the only eye with abnormally thin preoperative RNFL
thickness, which had no improvement in visual field index.
Conclusions: Normal baseline RNFL thickness measured with OCT in eyes with
dysthiroid optic neuropathy despite VF defects may predict an improvement in
visual outcome after treatment.
Commercial Relationships: Francisco J. Munoz Negrete, None; Marta PérezLópez, None; Gema Rebolleda, None; Marco Sales-Sanz, None; Pilar Casas de
Llera, None
Support: None
Macular Thickness Examinations By SD-OCT In Healthy Children
Melanie Jaeger, Yaroslava Wenner, Ronny Rambow, Birgit Lorenz. University Eye
Clinic Giessen, Giessen, Germany.
Purpose: To establish normative values of macular thickness and volume in
healthy eyes of children using spectral-domain optical coherence tomography (SDOCT, Heidelberg-Engineering, Heidelberg, Germany) in dependence on gender,
age and refraction.
Methods: A total of 84 children (41 female, 43 male), aged 2-18 years, were
randomly chosen from the outpatient department of the University Eye Clinic.
After clinical eye examination children with no ocular pathologies were examined
with SD-OCT. A volumetric assessment of the central retinal structures consisting
of 25 single horizontal axial scans was performed (scanning area 6x6 mm centered
at the fovea). Only children with visual acuity <0.2 logMAR, spherical equivalent
of -2.5 to +2.5D and astigmatism <3D were included. In 78 (92.9%) children single
scans of good quality could be performed. Mean values for the nine ETDRS areas,
foveal minimum and maximum thickness and macular volume could be calculated
for 54 (64.3%) eyes because of the inability to obtain good quality macular volume
scan.
Results: Thickness measurements of the central, inner and outer macular regions,
as well as the central macular volume were normally distributed. Mean (+/-SD)
thicknesses of the central 1 mm, and temporal, nasal, superior and inferior inner
macular regions were 270.54 +/- 18.1, 333.57 +/- 13.5, 349.31 +/- 14.1, 348.20 +/13.8 and 344.52 +/- 13.9 µm, respectively. The foveal minimum thickness was
218.93 +/- 15.4 µm, the foveal maximum thickness 319.20 +/- 21.6 µm. Only
foveal minimum thickness correlated positively with age. No correlations with
gender or refraction were found.
Conclusions: Except for the foveal minimum thickness macular OCT parameters
were unchanged from early childhood to adolescence. Normative pediatric OCT
data is important to correctly assess pediatric macular diseases with OCT.
Commercial Relationships: Melanie Jaeger, None; Yaroslava Wenner,
None; Ronny Rambow, None; Birgit Lorenz, None
Support: None
False positives in retinal nerve fiber layer color codes from Spectralis Optical
Coherence Tomography
Gema Rebolleda, Marina Leal Fonseca, Francisco J. Munoz-Negrete.
Ophthalmology, Hospital Ramon y Cajal. IRYCIS, Madrid, Spain.
Purpose: To evaluate the false-positive (FP) rate in retinal nerve fiber layer
thickness using both RNFL and axonal-N site protocol color code results from
spectral-domain optical coherence tomography (Spectralis SD-OCT) and to
determine the factors that contribute to this FP rate.
Methods: A prospective, cross-sectional study including 80 eyes from 40 healthy
participants without previous ocular surgery or family history of glaucoma.
Participants who were consecutively enrolled from October 2011 to December
2011, underwent Spectralis OCT and were tested by RNFL and N-site axonal
protocol. Definition of normal eyes was based in global VF parameters. Recorded
demographic and clinical factors included age, gender, eye side, intraocular
pressure, central corneal thickness, spherical equivalent, axial length. Quadrant and
clock-hour maps with ≥ 1 yellow or red sectors were considered abnormal. The
influence of clinical and demographic factors on the incidence of false-positive
RNFL or axonal-N site color codes was assessed using linear mixed model
analysis.
Results: The incidence of FP for the quadrant map was 15% and 18.75% for RNFL
and N-site axonal protocol respectively. The supero-nasal quadrant map exhibited
the highest incidence of FP witn both protocols. There were no significant
correlation between FP rate and central cornea thickness, axial length or spherical
equivalent.
Conclusions: FP rate in RNFL or axonal acquisition protocols of Spectralis-OCT
seems to be lower than previously reported by Kim et al with Cirrus- OCT (26%)
and contrary to that report axial length and spherical equivalent did not affected
that rate. Similar to Cirrus-OCT, the highest FP rate was found in the superior
quadrant.
Commercial Relationships: Gema Rebolleda, None; Marina Leal Fonseca,
None; Francisco J. Munoz-Negrete, None
Support: None
How appropriate is the indication of Spectral - Domain Optical Coherence
Tomography (SD-OCT) and Electroretinography (ERG) in early diagnosis of
cloroquine or hydroxychloroquine ocular toxicity
Roberta Giannini, Simona Altimari, Luigi Zompatori. S.Giovanni Evangelista
Hospital, Rome, Italy.
Purpose: To examine if SD-OCT imaging is giving some more information than
multifocal ERG about retinal toxicity in a group of 25 patients in long term
treatment with hydoxychloroquine.
Methods: SD-OCT and multifocal ERG (Retinoscan) in 25 patients (50 eyes) after
5 years of hydroxychloroquine treatment were examined. In all of them a complete
ophtalmological examination was performed. The entry criteria in both groups were
BCVA 0.67 and better and negative Amsler grid test.
Results: No significant changes in OCT images were observed in 13 patients (22
eyes) with negative multifocal ERG. Small Retinal Pigment Epithelium (EPR)
changes were observed in only 7 patients (10 eyes) of the 12 patients (22 eyes) with
multifocal ERG abnormalities.
Conclusions: The correlation between OCT and multifocal ERG were statistically
observed even if multifocal ERG seems to be a prognostic method more sensitive
and relevant to find morfological and functional alterations from the beginning in
patients with long term treatment with hydrochloroquine.
Commercial Relationships: Roberta Giannini, None; Simona Altimari,
None; Luigi Zompatori, None
Support: None
Motion Compensation Capability of Cirrus HD-OCT Tracking Software
Elnaz Rakhshan1A, Harihar Narasimha-Iyer2, Mary Durbin2, Tamera Schoenholz1,
Srinivas Sadda1A. AOphtalmology, 1Doheny Eye Institute, Los Angeles, CA; 2Carl
Zeiss Meditec Inc., Dublin, CA.
Purpose: To determine the motion compensation capability of retinal tracking
software implemented on Cirrus HD-OCT.
Methods: Twenty (20) subjects with various diseases including age-related
macular degeneration (AMD), branch retinal vein occlusion (BRVO) and diabetic
macular edema (DME) were scanned using a prototype version of the Cirrus HDOCT software that implements retinal tracking to compensate for subject motion
during the scan. Two Optic Disc 200x200 scans with tracking and two scans
without tracking were obtained on each subject for a total of 80 cube scans. The
motion compensation capability of the software was evaluated by visual inspection
of the OCT projection images (a summation of the intensities along each A-scan)
that are presented by the Cirrus HD-OCT instrument (shown in Figure 1). Each of
the cubes was rated in a masked fashion by one of the authors with respect to the
presence or absence of motion artifacts. Motion artifact was defined as a visible
break in any of the major blood vessels in the image exceeding half the diameter of
the vessel.
Results: Table 1 shows the number of cubes that were judged as having visible
motion for both the tracked and the untracked cases. Tracking produced a
significant increase in the cubes with no visible motion. Thirty nine of the forty
cubes with tracking (95%) had no visible motion. This can be compared with only
nineteen of the forty cubes (48%) that had no visible motion without the use of
tracking.
Conclusions: OCT projection images provide a rapid and reliable technique to
evaluate the motion compensation capabilities of a tracking system. Tracking in
Cirrus HD-OCT significantly reduces motion artifacts in the acquired data.
Commercial Relationships: Elnaz Rakhshan, None; Harihar Narasimha-Iyer,
Carl Zeiss Meditec Inc (F); Mary Durbin, Carl Zeiss Meditec Inc (F); Tamera
Schoenholz, None; Srinivas Sadda, Carl Zeiss Meditec Inc (F), Heidelberg
Engineering (C), Optovue, Inc (F), Topcon Medical System (P)
Support: Research to Prevent Blindness Physician Scientist Award and Beckman
Institute for Macular Research
B-scan With 20 Mhz High-resolution Probe In The Diagnosis Of Macular
Edema And Macular Hole
Livio Franco, Antonio Longo, Michele Reibaldi, Antonino Scuderi, Salvatore Faro,
Letizia Randone, Daniela Malannino, Santo Stella, Michele Bellino, Andrea Russo.
Department of Ophthalmology, University of Catania, Catania, Italy.
Purpose: To assess B-scan sensibility and specificity with 20 MHz high-resolution
probe in the diagnosis of macular edema and macular hole stage III-IV
Methods: In a prospective single blinded study, 50 patients affected by macular
edema with Central Retinal Thickness (CRT) ≥ 250 µ diagnosed by Optical
Coherence Tomography (OCT) (Stratus OCT; Carl Zeiss Inc., Dublin, CA, USA)
and 50 healthy controls without morphologic abnormalities on OCT and CRT <
250 µ underwent B-scan echography (Cine Scan S, Quantel Medical SA, Le Brezet,
France) with 20 MHz high resolution probe; also, in 25 patients affected by
idiopathic macular hole stage III-IV diagnosed by OCT, and in 25 healthy subjects,
B-scan echography with 20 MHz high resolution probe was performed.
Echography was performed by a single ophthalmologist who was not aware of the
diagnosis made by OCT
Results: B scan echography allowed to detect macular edema in 45 of 50 eyes
(90%) and macular hole in 23 of 25 eyes (92%). The sensitivity, specificity and
AUC of ROC curves of the B-scan were respectively 90%, 100% and 0.950 for the
diagnosis of macular edema and 92%, 100% and 0.960 for the diagnosis of macular
hole
Conclusions: B-scan with 20 MHz high-resolution probe showed high sensibility
and specificity in the diagnosis of macular edema and macular hole stage III-IV.
This could be a useful diagnostic tool when it’s not possible to perform OCT.
Commercial Relationships: Livio Franco, None; Antonio Longo,
None; Michele Reibaldi, None; Antonino Scuderi, None; Salvatore Faro,
None; Letizia Randone, None; Daniela Malannino, None; Santo Stella,
None; Michele Bellino, None; Andrea Russo, None
Support: None
Oct Changes After Idiopathic Macular Epiretinal Membrane Removal With
Internal Limiting Membrane Peeling: 1 Year Follow Up
Leonardo Colombo, Davide Allegrini, Luca Migliavacca, Stefano De Cillà,
Maurizio Digiuni, Laura Ottobelli, Luca Rossetti. Eye Clinic, Ospedale San Paolo
Milano, Milano, Italy.
Purpose: To analyze long term anatomical outcomes after idiopathic macular
epiretinal membrane (ERM) removal with internal limiting membrane (ILM)
peeling.
Methods: A retrospective, observational case series of 24 eyes that underwent
three-port pars plana vitrectomy for ERM was conducted. In all the eyes ERM
removal and Brilliant Blue G assisted ILM peeling were performed by the same
surgeon (SDC). Visual acuity examination (ETDRS chart) and OCT assessment of
the macular profile were performed preoperatively and postoperatively on day 1, 7
and 14 and at 1, 3, 6 and 12 months after surgery. We divided all patients in 2
groups considering visual acuity. The correlation between the postoperative BCVA
and foveal microstructural findings was evaluated
Results: Visual acuity stayed the same or with 1 line improvement in 7 patients
(29.16%, Group A)and improved by two or more lines of vision in 17 patients
(70.84%, Group B) at twelve months. Central retinal thickness decreased
significantly after surgery: the mean thickness was 453.7+/-115.4 micron before
surgery and 295.4+/-73.2 micron twelve months after surgery. None of the subjects
had increasing foveal thickness twelve months after surgery. Inner hyper-reflective
structure, attributable to the internal limiting membrane, could not be detected in
100% of eyes on day 1 and 7 after surgery in both group. In 71.4% of patients of
group A and 75% of patients in group B a new inner hyper-reflective structure
could be detected at 30+/-14 days after surgery. No recurrence of ERM was
observed.
Conclusions: ERM removal with ILM peeling is nowadays a safe and successful
surgery for vitreoretinal interface syndrome. Many authors described a correlation
between postoperative visual acuity and final foveal thickness. We observed that
inner hyper-reflective structure, attributable to the internal limiting membrane,
becomes newly detectable after 30+/-14 days after surgery in 70.9% of the patients
and this doesn’t seem to have any influence on final visual outcome.
Commercial Relationships: Leonardo Colombo, None; Davide Allegrini,
None; Luca Migliavacca, None; Stefano De Cillà, None; Maurizio Digiuni,
None; Laura Ottobelli, None; Luca Rossetti, None
Support: None
Reproducibility of Peripapillary Retinal Nerve Fiber Layer Thickness
Measurements Using Spectral Domain OCT in Brazilian Patients
Daniela A. Toscano1, Marcos P. Ávila2, Rodrigo A. Santos1, Maria Regina C.
Chalita1. 1Ophthalmology, University of Brasilia - UnB, Joao Pessoa, Brazil;
2
University of Goias - UFG, Goiania, GO, Brazil.
Purpose: To evaluate the reproducibility of peripapillary retinal nerve fiber layer
(RNFL) thickness measurements in eyes without and with glaucoma using spectral
domain optical coherence tomography (SDOCT)
Methods: One eye each from 79 normal and 72 glaucoma patients were analyzed.
All patients underwent a complete ophthalmological examination, including visual
acuity testing; intraocular pressure, slit-lamp examination, indirect
ophthalmoscopy; and the glaucoma group underwent achromatic perimetry with the
24-2 SITA FAST Humphrey Field Analyzer. All patients’ eyes were scanned using
the SDOCT Spectralis and one of them was chosen randomly. Three consecutive
circular B-scan centered at the optic disc were performed in one visit.
Results: The ICC, COV and TRV for the mean RNFL thickness were respectively:
0.94, 2.56% and 4.85µm for the normal group and 0.93, 4.65% and 6.61µm for the
glaucomatous group. The ICC for RNFL thickness in all quadrants were all
excellent in both groups, with the superior quadrant having the highest ICCs
(0.964) in glaucomatous eyes and nasal quadrant measurements having the lowest
(0.800), but still excellent in eyes without glaucoma. The COV was between 2.56%
- 8.74% and between 4.65% - 11.44% in normal and glaucomatous group
respectively. The TRV was between 4.85µm and 11.51µm in the normal group and
between 6.61µm and 14.24 µm in the glaucomatous group. Glaucomatous eyes
were more variable than normal eyes.
Conclusions: Spectral domain OCT showed excellent reproducibility with regard
to RNFL thickness measurements in patients without and with glaucoma.
Commercial Relationships: Daniela A. Toscano, None; Marcos P. Ávila,
None; Rodrigo A. Santos, None; Maria Regina C. Chalita, None
Support: None
Comparison of macular parameters among keratoconic, myopic and nonmyopic individuals using Optical Coherence Tomography
Srujana Sahebjada, Paul Baird, Amirul Islam, Sanj Wickremasinghe.
Ophthalmology, Centre for Eye Research Australia, Melbourne, Australia.
Purpose: To investigate if differences exist in macular parameters between
keratoconic, myopic and nonmyopic individuals, as measured by optical
coherence tomography (OCT).
Methods: Keratoconus patients were recruited from private and public clinics in
Melbourne, Australia. Myopic and nonmyopic individuals were identified from
the Genes in Myopia study. All subjects underwent clinical examination including
objective refraction (NIDEX Autorefractor), biometric measurements (Zeiss IOL
Master), and macular thickness measurements (Stratus OCT). Generalised
Estimation Equation Model was used to estimate the means of the outcome factors
adjusted for age, gender and height using SPSS software.
Results: A total of 96 individuals comprising 56 keratoconus eyes (group 1), 43
eyes with myopia (group 2-spherical equivalent [SE] < −0.5 D to -10D) and 91
non-myopic eyes (group 3-SE > −0.5 D) were analysed. The inner macular
thickness of group 1 had a mean of 284.7 m (95% confidence interval (CI) 279.4,
290), which was significantly different (p=0.007) from the group 2 mean of 275.5
m (95%CI 270.2, 280.8) and group 3 mean of 272.9 m (95%CI 268.7, 277.2).
Mean inner macular volume was also significantly different (p=0.006) with group 1
mean of 0.393 mm3 (95% CI 0.386, 0.401) compared to group 2 mean of 0.38 mm3
(95% CI 0.372, 0.387) and group 3 mean of 0.376 mm3 (95% CI 0.369, 0.382) .The
mean axial length of group 1 was 23.9mm (95%CI 23.2, 24.6) and was statistically
different (p=0.004) to the group 2 mean of 24.1mm (95%CI 23.4, 24.8) and group 3
mean of 22.7mm (95% CI 22.2, 23.3).
Conclusions: Keratoconus patients have thicker inner maculae and greater macular
volume compared to mild/moderate myopia or non-myopia individuals. This study
suggests that important differences may exist in keratoconic eyes in addition to
anterior changes. In addition, mean axial length differed between keratoconus and
myopia groups by only 0.08%, while the change in mean macular thickness
differed by 5.3%. This finding suggests that axial elongation does not necessarily
correlate with thinner maculae in keratoconus eyes.
Commercial Relationships: Srujana Sahebjada, None; Paul Baird,
None; Amirul Islam, None; Sanj Wickremasinghe, None
Support: None
Agreement Between Cirrus HD-OCT Circumpapillary Retinal Nerve Fiber
layer Thickness (RNFLT) Analysis and a Novel Computation Algorithm for
Analysis of the RNFLT Over a 6 × 6 mm2 Peripapillary Area
Belal H. Bakir, Giovanni Taibbi, James Kim, William Pearce, Gregory Taroyan,
Orry Birdsong, Emma Loucks, Gianmarco Vizzeri. Ophthalmology, University of
Texas Medical Branch, Galveston, TX.
Purpose: To evaluate the agreement between Cirrus HD-OCT circumpapillary
retinal nerve fiber layer thickness (RNFLT) analysis and a novel computation
algorithm for analysis of the RNFLT over a 6 × 6 mm2 peripapillary area.
Methods: One Cirrus HD-OCT optic nerve scan was obtained weekly from healthy
participants and glaucoma patients for four consecutive weeks. The RNFLT map
displays the pattern of peripapillary RNFLT using a color-coded scale, ranging
from black (0 µm) to white (350 µm). RGB pixel values of the map were
automatically obtained using ImageJ (ver. 1.44P, NIH, Bethesda, MD). Custom
Perl scripts matched RGB pixel values with the RGB of the color-coded scale and
assigned the RNFLT value in order to obtain average and quadrant RNFLT over
the 6 × 6 mm2 peripapillary area. Agreement between peripapillary area RNFLT
map and circumpapillary RNFLT analysis was calculated using the limits of
agreement (LoA), and the coefficient of determination (R2) was calculated.
Results: 27 eyes from 19 glaucoma patients and 22 eyes from 13 healthy
individuals were included. 95% LoA and R2 between the two RNFLT analysis
methods for average and quadrant RNFLT in the two groups are shown in Table 1.
RNFLT analysis was strongly correlated in both groups except moderately
correlated in the nasal quadrant. Agreement was good in both groups with closer
agreement in temporal and nasal quadrants than superior and inferior quadrants.
Mean circumpapillary RNFLT analysis was consistently higher than mean
peripapillary RNFLT Map analysis.
Conclusions: Further study should be done to evaluate the diagnostic performance
of the Cirrus HD-OCT peripapillary RNFLT Maps and their ability to monitor
glaucomatous RNFLT progression.
Commercial Relationships: Belal H. Bakir, None; Giovanni Taibbi,
None; James Kim, None; William Pearce, None; Gregory Taroyan, None; Orry
Birdsong, None; Emma Loucks, None; Gianmarco Vizzeri, None
Support: None
Prevalence of Macular Anatomic Abnormalities in Eyes with High Myopia
Andree Henaine-Berra, Igal Meir Zand-Hadas, Fernando Schoonewolff, J. Jans
Fromow-Guerra, Gerardo Garcia-Aguirre. Ophthalmology, Asoc Para Evitar la
Ceguera en Mexico, Mexico, Mexico.
Purpose: To determine the prevalence of foveoschisis, foveal detachment, vascular
traction, epiretinal membrane and macular hole in eyes with high myopia, assessed
by Spectral Domain OCT.
Methods: Cross-sectional study. Eyes with myopia over 8 diopters were included.
Axial lenght was measured using optical coherence biometry (IOL Master, Carl
Zeiss Meditec). Spectral domain OCT images from the macula were obtained using
the Spectralis HRA-OCT (Heidelberg Engineering). A 6x6 mm macular cube
centered on the fovea was evaluated using 50 horizontal and 50 vertical evenlyspaced scans. Images were analyzed looking for foveoschisis, foveal detachment,
vascular traction, epiretinal membrane, macular hole and/or posterior staphyloma.
Eyes with keratoconus, previous ocular surgery, choroidal neovascularization
and/or significant media opacities were excluded. Results were analyzed using the
Chi-squared test.
Results: One hundred and sixteen eyes of 72 patients were included. Female to
male ratio was 3:1. Age ranged from 11 to 70 years. Mean best-corrected visual
acuity was -0.49 (logMAR). Mean spherical equivalent was -15.04 ± 5.33 D. Mean
axial length was 28.88 ± 2.31 mm. Foveoschisis was observed in 17 eyes (14.65%),
vascular traction in 17 eyes (14.65%), epiretinal membrane in 13 eyes (11.2%),
lamellar macular hole in 2 eyes (1.72%), and posterior staphyloma in 41 eyes
(35.34%). No eyes with foveal detachment were observed. The presence of
foveoschisis, vascular traction and epiretinal membrane was more frequent in eyes
with posterior staphyloma (p=0.0001).
Conclusions: Macular anatomic abnormalities were observed in 22.41% of eyes
with myopia of 8 diopters or higher, and in 53.65% of patients with posterior
staphyloma. Our study suggests that the presence of posterior staphyloma is a
predisposing factor for macular anatomic abnormalities.
Commercial Relationships: Andree Henaine-Berra, None; Igal Meir ZandHadas, None; Fernando Schoonewolff, None; J. Jans Fromow-Guerra,
None; Gerardo Garcia-Aguirre, None
Support: None
Associations between Metamorphopsia and Foveal Microstructure by
Spectral-Domain Optical Coherence Tomography in Patients with Epiretinal
Membrane
Fumiki Okamoto, Yoshimi Sugiura, Yoshifumi Okamoto, Takahiro Hiraoka,
Tetsuro Oshika. Dept of Ophthalmology, University of Tsukuba, Tsukuba, Japan.
Purpose: To quantify metamorphopsia in patients with epiretinal membrane
(ERM), and to investigate the relationship between the severity of metamorphopsia
and the foveal microstructure by spectral-domain optical coherence tomography
(SD-OCT).
Methods: This study included 53 eyes of 53 patients with idiopathic ERM and agematched 18 normal controls. We examined the logarithm of the minimum angle of
resolution best-corrected visual acuity (logMAR BCVA) and the severity of
metamorphopsia with M-CHARTS® and SD-OCT. Central foveal thickness (CFT),
central retinal thickness at the fovea (CRT 1mm) and parafovea (CRT 3mm) and
macular volume (MV) were measured with SD-OCT software. Based on the
obtained OCT image, we divided the 0.5mm x 0.5mm area centered around the
fovea into 9 sections and quantified the following parameters using an imageprocessing program: mean thickness of the ganglion cell layer (GCL), inner nuclear
layer (INL) and outer retinal layer (ONL+OPL: outer nuclear layer and outer
plexiform layer), the degree of the photoreceptor inner and outer segment junction
(IS/OS) and external limiting membrane (ELM) disruption.
Results: CFT, CRT 1mm, CRT 3mm, MV, mean GCL, INL and ONL+OPL
thickness were significantly larger in patients with ERM than in normal controls.
Multiple regression analysis revealed that the severity of metamorphopsia was
significantly related to the mean INL thickness (p < 0.0001). LogMAR BCVA had
a significant correlation with the degree of ELM disruption (p = 0.007), whereas
other parameters were not relevant.
Conclusions: Metamorphopsia was associated with the INL thickness, and visual
acuity was associated with ELM in patients with idiopathic ERM.
Commercial Relationships: Fumiki Okamoto, None; Yoshimi Sugiura,
None; Yoshifumi Okamoto, None; Takahiro Hiraoka, None; Tetsuro Oshika,
None
Support: None
An SD-OCT Assessment of Retinal Pigment Epithelium Tears Risk in Pigment
Epithelium Detachment
Francesco Pichi1, Andrea Lembo1, Mariachiara Morara2, Lucia Vitale1, Antonio P.
Ciardella3, Paolo Nucci4. 1San Giuseppe Hospital, University Eye Clinic, Milan,
Italy; 2Ophthalmology, Ospedale S.Orsola Malpighi, Bologna, Italy;
3
Ophthalmology, Policlinico S Orsola Malpighi, Bologna, Italy; 4Ophthalmology,
SAN GIUSEPPE HOSPITAL University of Milan, Milan, Italy.
Purpose: Pigment epithalium detachment (PED) is a common finding in agerelated macular degeneration (AMD); RPE tears are a rare but well-documented
sequela, which occur either spontaneously or following treatment. The aim of this
study is to identify tomographic features which could be predictive of PED rip
predisposition.
Methods: 92 patients were examined retrospectively; every patient presented with
a diagnosis of serous or vascular PED secondary to AMD. Of these patients, 42
(45.6%) had been treated with intravitreal bevacizumab (Avastin®), and received a
mean of 1.38 ± 0.65 injections (range, one to three). The remaining 50 subjects
(54.3%) had been followed closely without any treatment. The mean follow-up was
12.3 ± 10.3 weeks (range, 4 to 28 weeks). We examined the OCT scan at baseline
(diagnosis), measuring the PED height, the base diameter of the PED, the position
of the CNV relative to the PED, volume index (defined as PED height multiplied
by PED surface area in mm3), and amount of subretinal fluid (defined as none,
mild, moderate, and marked).
Results: Of the whole 92 patients, 12 (13%) developed a rip of the PED (Group 1),
8 (19 %) in the treatment arm and 4 (8%) in the control arm, with subsequent
massive drop in visual acuity. Significantly greater mean PED height was found in
Group 1 in comparison to non-complicated eyes (Group 2) (624.9 ± 216.0 µm vs.
312.1 ± 201.9 µm; P = 0.001, t test), while the base diameter was >5000 µm in
Group 1. There was higher mean volume index for Group 1 eyes compared with
Group 2 eyes (8.9 ± 5.7 vs. 3.1 ± 4.0 mm3; P = 0.001, t test); as far as the position
of the CNV in respect to the PED is concerned, in the non-complicated group 87%
of the CNV (either type 1,type 2 or type 3) were located at least 70 µm inside the
PED, whereas in the RPE tear group, 94% were located at the margin of the PED
and the remaining 6% were located inside the PED within 50 µm to the margin.
Chi-square analysis showed significantly more SRF in Group 1 in comparison to
Group 2 eyes (P = 0.002).
Conclusions: Univariate analyses in this study showed increased PED height, PED
base diameter and greater amount of SRF in PED eyes that developed RPE tears
(Group 1) in comparison to PED eyes without RPE tears (Group 2). Increased
volume index associated with a tendency for RPE tears is an interesting finding too.
The presence of a CNV at the margin of the PED is associated with an increased
risk of postinjection tear due to the enhanced mechanical contraction of the
membrane.
In conclusion, SD-OCT measurement of a PED might help in decision-making.
Commercial Relationships: Francesco Pichi, None; Andrea Lembo,
None; Mariachiara Morara, None; Lucia Vitale, None; Antonio P. Ciardella,
None; Paolo Nucci, None
Support: None
Differentiation Between Peripheral Senile Retinoschisis And Retinal
Detachment, The Additional Value Of OCT Scans Of The Peripheral Retina
Obtained With The SL Scan-1 (Topcon)
Marilette Stehouwer1A, Stevie Tan1A, Ton G. van Leeuwen1B, Frank D. Verbraak1C.
A
Ophthalmology, BBiomedical Engineering and Physics, COphthalmology Biomedical Engineering and Physics, 1Academic Medical Center - University of
Amsterdam, Amsterdam, The Netherlands.
Purpose: Senile retinoschisis is sometimes difficult to distinguish from a local
retinal detachment by clinical examination alone. This study evaluated SD-OCT
scans of the peripheral retina to improve the differentiation between retinal
detachment and senile retinoschisis.
Methods: Patients with a peripheral lesion, diagnosed as senile retinoschis or as
difficult to distinguish between retinal detachment and retinoschisis, were recruited
from the outpatient clinic of the Academic Medical Center. OCT scans of the far
peripheral retinal lesions were obtained with the SL SCAN-1, through a 3 mirror
contact lens, while the lesions were simultaneously observed with the slitlamp. The
SL SCAN-1 is a SD-OCT integrated into a common Topcon slitlamp, SLD light
source, ∆λ 30 nm, central wavelength 830 nm, scan resolutions 8-9 micron in
tissue, scan depth 2 mm, scan speed 5000 A-scans per second and 1024 A-scans
per B-scan.
Results: Twenty patients were included into this study,in five of them the clinical
diagnosis was unclear. In these five individuals, the OCT scans visualized
retinoschisis in two patients and retinal detachment in three patients. Of the fifteen
patients diagnosed with senile retinoschisis, the OCT scans showed a characteristic
retinoschisis in only seven. Five patients had a combination of retinoschisis and
retinal detachment and three patients had a retinal detachment without signs of
retinoschisis. Cystoid alterations of the detached neurosensoric retina were seen on
the OCT scan in three out of the six patients with a retinal detachment.
Conclusions: Senile retinoschisis may mimic a peripheral retinal detachment and
vice versa when differentiated by funduscopic or biomicroscopic examination
alone. Differentiation is important with respect to therapeutic decisions. OCT scans
of the far peripheral retina, which can be made with the SL SCAN-1 through a 3
mirror contactlens, can contribute significantly in this differentiation. The obtained
scans clearly visualised the anatomic differences between a retinoschisis, a local
retinal detachment, and visualised even a combination of a retinoschisis with a
local, possible secondary, retinal detachment.
Commercial Relationships: Marilette Stehouwer, None; Stevie Tan, None; Ton
G. van Leeuwen, Topcon Europe Medical B.V. (F); Frank D. Verbraak, None
Support: None
Retinal Nerve Fiber Layer Measurement In Normal Children: A Comparative
Study Of Spectral-domain Optical Coherence Tomography And Scanning
Laser Polarimetry
Di Ma, Mingzhi Zhang, Kunliang Qiu, Shibin Lin, Taiping Li. ophthalmology, Joint
Shantou International Eye Center (JSIEC), Shantou, China.
Purpose: To evaluate the retinal nerve fibre layer (RNFL) thickness in children
with normal vision by using spectral domain optical coherence tomography (Cirrus
HD OCT) and scanning laser polarimetry with enhanced corneal compensator
(GDx ECC).
Methods: A total of 45 eyes from 45 healthy Chinese children with normal vision
(8-17 years) were recruited. The RNFL in each eye was imaged sequentially with
the Cirrus OCT and GDx ECC. The relationship between CirrusOCT and GDx
ECC RNFL measurements was examined with linear regression analysis.
Results: The mean age, axial length, and spherical equivalent were 12.53± 1.80
years (range, 8-17), 24.62 ±1.10 mm (range, 22.11-27.36mm), and -2.41± 1.80 D
(range, 0.25 to -6.38D), respectively. Both Cirrus OCT and GDx ECC showed
double hump patterns in the RNFL profiles. The average RNFL thickness was
100.53 +/- 10.56 by Cirrus OCT and 56.42 +/- 6.39 um by GDx ECC. Significant
differences were found in the average RNFL thickness between Cirrus OCT and
GDx ECC (p<0.01). The average RNFL thickness measured with CirrusOCT and
GDx ECC correlated significantly with each other (r = 0.59, p<0.01).
Conclusions: Both Cirrus OCT and GDx ECC showed double hump patterns in the
RNFL profiles in normal children. Despite the substantial differences in RNFL
thicknesses among the children, significant correlations were observed between
CirrusOCT and GDx ECC RNFL measurements, indicating both technologies to be
robust.
Commercial Relationships: Di Ma, None; Mingzhi Zhang, None; Kunliang
Qiu, None; Shibin Lin, None; Taiping Li, None
Support: None

ARVO 2012 Annual Meeting Abstracts

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