The significance of external limiting membrane status for visual acuity in age-related macular degeneration.
ABSTRACT To evaluate status of the external limiting membrane (ELM) as a contributor of visual acuity (VA) in age-related macular degeneration (AMD).
Hospital-based, cross-sectional study.
We retrospectively reviewed spectral-domain optical coherence tomography images of 158 patients with AMD who had undergone photodynamic therapy and classified them based on the status of the ELM: absent, discontinuous, or complete. We simultaneously assessed foveal thickness, presence or absence of subretinal fluid/mass, presence or absence of subretinal pigment epithelium fluid/mass, status of the inner segment/outer segment (IS/OS) junction, and status of the intermediate line between the IS/OS junction and retinal pigment epithelium. Correlation coefficients between each parameter and VA were analyzed.
There was a strong correlation between ELM status and VA (r = -0.75, P < .001), and that was higher than that of the IS/OS (r = -0.69, P < .001). Multivariate analysis showed that ELM status is the most important factor for VA. Other parameters that correlated with VA included age, status of the intermediate line, and presence of subretinal or subretinal pigment epithelium fibrosis. Foveal thickness showed V-shaped correlation, with the dividing line around 200 mum.
ELM status may be more useful than is IS/OS status in evaluation of retinal morphology and function in patients with AMD.
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ABSTRACT: To investigate the correlation between hyperreflective foci (HF) on spectral-domain optical coherence tomography at baseline and visual outcomes after intravitreal bevacizumab injection (IVB) in branch retinal vein occlusion. We retrospectively studied 97 eyes of 97 patients with macular edema secondary to BRVO, who were treated with IVB. The eyes were divided into three groups according to the location of HF on SD-OCT: HF in outer retinal layers, HF in inner retinal layers, and no HF. The baseline and final best-corrected visual acuity (BCVA), foveal thickness (FT), external limiting membrane (ELM) status, junction between photoreceptor inner and outer segments (IS/OS) status, and the number of HF were evaluated and compared among three groups. Baseline BCVA was correlated with baseline FT (R = 0.366, p < 0.001), but final BCVA was not correlated with final FT (R = -0.008, p = 0.942). Baseline BCVA was significantly better in eyes with intact ELM at baseline (p = 0.006), and final BCVA was significantly better in eyes with intact ELM and IS/OS at final visit (p < 0.001, p = 0.003 respectively). At the final visit, 15 of 37 eyes (40.5 %) with HF in outer retinal layers had a disrupted ELM (p = 0.001), while 28 of 37 eyes (75.7 %) with HF in outer retinal layers had a disrupted IS/OS (p < 0.001). Final BCVA was poorer in eyes with HF in outer retinal layers groups than those in the other two groups (p < 0.001), although baseline BCVA was not different between them. HF on SD-OCT at baseline might predict the photoreceptor status and final VA after IVB in BRVO.Albrecht von Graæes Archiv für Ophthalmologie 03/2014; · 1.93 Impact Factor
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ABSTRACT: To investigate the relationship between foveal morphology and self-perceived visual function in patients with neovascular age-related macular degeneration (AMD) and whether foveal characteristics are associated with Ranibizumab treatment response on the self-perceived visual function. This prospective cohort study included patients with newly diagnosed neovascular AMD found eligible for treatment with Ranibizumab. Foveal morphology of both eyes was assessed using spectral-domain optical coherence tomography and all patients were interviewed using the 39-item National Eye Institute Visual Function Questionnaire (VFQ). Patients were re-interviewed 3 and 12 months after initiation of treatment with Ranibizumab. We evaluated foveal morphology at baseline in relation to VFQ scores at baseline and clinically meaningful changes in VFQ after 3 and 12 months. VFQ scores correlated with central foveal thickness, central foveal thickness of neuroretina (CFN), foveal RPE elevation, foveal integrity of the photoreceptor inner segment/outer segment junction (IS/OS), and external limiting membrane. In a multiple linear regression model, only best-corrected visual acuity of the better eye (p<0.001) and the IS/OS status in the better eye (p = 0.012) remained significant (Adjusted R2 = 0.418). Lower baseline VFQ and a baseline CFN within 170-270 µm in the better eye were both associated with a clinically meaningful increase in the VFQ scores after 3 and 12 months. An absent foveal IS/OS band in the better eye was associated with a clinically meaningful decrease in the VFQ scores at 12 months. Foveal morphology in the better eye influences the self-perceived visual function in patients with neovascular AMD and possesses a predictive value for change in the self-perceived visual function at 3 and 12 months after initiation of treatment. These findings may help clinicians provide patients more individualized information of their disease and treatment prognosis from a patient-perceived point-of-view.PLoS ONE 03/2014; 9(3):e91227. · 3.73 Impact Factor
Dataset: CSC_SD_OCT @ Retina