Combined Confocal Scanning Laser Ophthalmoscopy and Spectral-Domain Optical Coherence Tomography Imaging of Reticular Drusen Associated with Age-Related Macular Degeneration
Steffen Schmitz-ValckenbergJulia S. SteinbergMonika FleckensteinSivatharisini VisvalingamChristian K. BrinkmannFrank G. Holz
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Drusen
Reticular connective tissue
Scanning laser ophthalmoscopy
In an 11-year-old girl suffering from decreased vision in he right eye, drusen of the optic nerve head were revealed by ophthalmoscopy and fluorescein angiography in this eye. The fellow eye had good vision and looked normal ophthalmoscopically. An abnormal VER led to further investigation, and asymptomatic buried drusen of the optic nerve head were confirmed by fluorescein angiography.
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To evaluate cone spacing using adaptive optics scanning laser ophthalmoscopy (AOSLO) in eyes with nonneovascular AMD, and to correlate progression of AOSLO-derived cone measures with standard measures of macular structure.Adaptive optics scanning laser ophthalmoscopy images were obtained over 12 to 21 months from seven patients with AMD including four eyes with geographic atrophy (GA) and four eyes with drusen. Adaptive optics scanning laser ophthalmoscopy images were overlaid with color, infrared, and autofluorescence fundus photographs and spectral domain optical coherence tomography (SD-OCT) images to allow direct correlation of cone parameters with macular structure. Cone spacing was measured for each visit in selected regions including areas over drusen (n = 29), at GA margins (n = 14), and regions without drusen or GA (n = 13) and compared with normal, age-similar values.Adaptive optics scanning laser ophthalmoscopy imaging revealed continuous cone mosaics up to the GA edge and overlying drusen, although reduced cone reflectivity often resulted in hyporeflective AOSLO signals at these locations. Baseline cone spacing measures were normal in 13/13 unaffected regions, 26/28 drusen regions, and 12/14 GA margin regions. Although standard clinical measures showed progression of GA in all study eyes, cone spacing remained within normal ranges in most drusen regions and all GA margin regions.Adaptive optics scanning laser ophthalmoscopy provides adequate resolution for quantitative measurement of cone spacing at the margin of GA and over drusen in eyes with AMD. Although cone spacing was often normal at baseline and remained normal over time, these regions showed focal areas of decreased cone reflectivity. These findings may provide insight into the pathophysiology of AMD progression. (ClinicalTrials.gov number, NCT00254605).
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Abstract Purpose To document cases of drusen and age‐related geographic atrophy(GA) at the microscopic scale using adaptive optics(AO). Methods Four cases of age‐related drusens, 2 cases of familial drusen and 7 patients of GA underwent en face retinal imaging by AO retinal camera(rtx1, Imagine Eyes, Orsay, France). AO images were confronted to high‐resolution spectral‐domain optical coherence tomography(OCT) and scanning laser ophthalmoscopy(SLO) examinations. Results In AO images, most drusen appeared as doughnut‐shaped highly reflective zones, and were better delineated than by color fundus photograph. The overlying cone mosaic could be detected over most of them, including their top. Between drusen, the cone photoreceptor mosaic appeared normal. In GA cases, AO images revealed irregular patches of multiple cone‐like bright spots as well as larger dark disks in atrophic areas. Conclusion AO provided images of microscopic structures in various types of AMD, including GA. Local losses in cone contrast at the drusen slopes confirmed a strong relation between cone visibility and their orientation. There was no evidence of cone loss in association to drusen. In GA patients, our findings suggest that photoreceptors with shortened outer segments may survive within atrophic areas, which may lead to the development of novel therapeutic strategies aimed at restoring the function of surviving cones. These results demonstrate that AO retinal camera can detect isolated residual photoreceptors, and hence that it will be a powerful tool for quantifying spontaneous or therapeutic changes in AMD patients. Supported by ANR through Tecsan Program (project iPhot n° ANR‐09‐TECS‐009)
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Combined adaptive optics (AO) optical coherence tomography (OCT) scanning laser ophthalmoscopy (SLO) imaging allows simultaneous en face and cross sectional views of the retina. We describe improvements to our AO-OCT-SLO system and highlight its resolution capability and clinical utility by presenting results from 3 control and 4 dry agerelated macular degeneration (AMD) subjects. From a group of subjects with healthy eyes, OCT A-scans were grouped as originating from cones or rods and were averaged. The resulting reflectance profiles were then used to identify the location of cone and rod segments. Results for rods and cones were compared, with the focus on inner segment (IS) and outer segment (OS) structures and where these cells embed into the retinal pigment epithelium (RPE). In the AMD patients, cone IS and OS lengths were measured over and around drusen for two retinal regions (fovea–2° and 2°–4°), and those results were correlated to drusen height. For the fovea–2° region, the drusen height that caused statistically significant shortening of cone ISL and OSL compared to the unaffected adjacent area were 40 μm and 50 μm respectively (p = 0.009, and p < 0.001, respectively). For the 2°–4° region, the equivalent drusen heights that caused significant shortening of segment length were 60 μm for IS (p = 0.017) and 80 μm for OS (p < 0.001)
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Ultra-widefield scanning laser ophthalmoscopy is an imaging technique that can take the 200-degree wide field of fundus image with non-mydriatic,which has been widely used in ophthalmology.Studies have shown that the ultra-widefield scanning laser ophthalmoscopy is sensitive in the screening of diabetic retinopathy and has the superiority to detect the peripheral retinal lesions compare to the traditional 7field fundus photography.In addition,the ultra-widefield scanning laser ophthalmoscopy has great significance for the screening,diagnosis and follow-up of other peripheral chorioretinopathy.
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Ultra-widefield scanning laser ophthalmoscopy; diabetic retinopathy; screening; peripheral chorioretinopathy
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To observe fundus autofluorescence (FAF) lifetimes and peak emission wavelength (PEW) of drusen with respect to the pathology of the overlying RPE in the follow-up of AMD-patients.Forty eyes of 38 patients (age: 75.1 ± 7.1 years) with intermediate AMD were included. FAF lifetimes and PEW were recorded by fluorescence lifetime imaging ophthalmoscopy (FLIO). Twenty-six eyes had a follow-up investigation between months 12 and 36, and 10 at months 37-72. AMD progression was retrieved from color fundus photography (CFP) and OCT. Drusen were classified with respect to changes in the overlying RPE into groups no, questionable or faint, and apparent hyperpigmentation based on CFP.Among the 210 hyperautofluorescent drusen found at baseline, those with hyperpigmentation had longer lifetimes and shorter PEW than those without. Drusen without hyperpigmentation had shorter lifetimes and PEW than neighboring RPE (all p < 0.001) at baseline, but drusen lifetimes increased, and PEW shortened further over follow-up. Eyes, showing AMD progression, had significantly longer FAF lifetimes at baseline than non-progressing eyes: 282 ± 102 ps versus 245 ± 98 ps, p < 0.001 and 365 ± 44 ps vs. 336 ± 48 ps, p = 0.025 for short and long wavelength FLIO channel, respectively.Depending on hyperpigmentation properties, drusen show lifetimes and PEW different from that of adjacent RPE which change over the natural history of AMD. This difference and change, however, might reflect progressive dysmorphia of the RPE rather than representing fluorescence of drusen material itself. Nevertheless, the observed FAF changes could make FLIO a useful tool for the early detection of AMD progression risk.
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With the development of the optic coherent tomography technology the scanning laser ophthalmoscopy, though almost always present in every such device, as well as in fluorescent angiography laser systems, is not used efficiently enough. The possibility to use the scanning laser ophthalmoscopy for screening of the optic nerve pathology is analyzed.
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To investigate longitudinal changes in the retinal nerve fiber bundle in eyes with primary open angle glaucoma using adaptive optics scanning laser ophthalmoscopy.A prospective observational case series. Fourteen eyes from 12 patients with primary open angle glaucoma that exhibited retinal nerve fiber layer defects on fundus photography were imaged with adaptive optics scanning laser ophthalmoscopy over time.The expansion of retinal nerve fiber bundle narrowing was observed on adaptive optics scanning laser ophthalmoscopy in 8 eyes (57.1%) over a period of 1.44 ± 0.42 years. Retinal nerve fiber bundle narrowing expanded horizontally in 2 eyes and vertically in 6 eyes. In 3 eyes, changes in the retinal nerve fiber layer were only detectable on adaptive optics scanning laser ophthalmoscopy images.The expansion of retinal nerve fiber bundle narrowing was observed using adaptive optics scanning laser ophthalmoscopy. Accordingly, this tool may be a useful tool for detecting glaucoma-related changes in retinal nerve fibers in a short time.
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Nerve fiber
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