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William R Freeman - One of the best experts on this subject based on the ideXlab platform.
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effect of change in drusen evolution on Photoreceptor Inner Segment outer Segment junction
Retina-the Journal of Retinal and Vitreous Diseases, 2012Co-Authors: Kathrin Hartmann, Maria Laura Gomez, Dirkuwe G Bartsch, Alexander K Schuster, William R FreemanAbstract:Purpose:To evaluate the integrity of Photoreceptor Inner Segment/outer Segment (IS/OS) junction after change of drusen size in age-related macular degeneration using spectral-domain optical coherence tomography.Methods:Drusen volume raster scans were performed with the Spectralis spectral-domain opt
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scanning laser ophthalmoscope imaging stabilized microperimetry in dry age related macular degeneration
Retina-the Journal of Retinal and Vitreous Diseases, 2011Co-Authors: Kathrin Hartmann, Dirkuwe Bartsch, Lingyun Cheng, Jae S Kim, Maria Laura Gomez, Helaina Klein, William R FreemanAbstract:Purpose To determine the effect of drusen and geographic atrophy (GA) in dry age-related macular degeneration on retinal sensitivity using an eye tracking scanning laser ophthalmoscope microperimetry. Methods A total of 44 eyes from 22 patients with dry age-related macular degeneration and drusen and 11 patients with GA were imaged with scanning laser ophthalmoscope microperimetry (OPKO Health, Miami, FL). A custom microperimetry pattern was used to evaluate retinal sensitivity to a Goldmann III size target (108 μm on the retina). The perimetry used a 4-2 stepladder algorithm to determine maximal sensitivity. Microperimetry and optical coherence tomography were performed using a standardized protocol. Twenty-eight eyes with drusen and 16 eyes with GA were analyzed. Results Retinal sensitivity overlying drusen was significantly reduced compared with the adjacent uninvolved retina. There was a significant correlation between retinal sensitivity and drusen volume, as well as the grading of the Photoreceptor Inner Segment/outer Segment junction score. In patients with GA, an absolute scotoma was confirmed. Retinal sensitivity at the margin of GA was significantly decreased compared with the adjacent uninvolved retina. Conclusion Scanning laser ophthalmoscope microperimetry is able to detect changes in retinal sensitivity in AMD patients overlying drusen and at the margin of GA. It is a useful device to grade focal retinal sensitivity in patients with dry age-related macular degeneration.
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the association between percent disruption of the Photoreceptor Inner Segment outer Segment junction and visual acuity in diabetic macular edema
American Journal of Ophthalmology, 2010Co-Authors: Anjali S Maheshwary, Lingyun Cheng, Stephen F Oster, Francesca Mojana, R M S Yuson, William R FreemanAbstract:Purpose To evaluate the integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. Design Retrospective, comparative, consecutive case series. Methods Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. Results A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found ( P = .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found ( P = .07). Conclusions Disruption of the Photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients.
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, Ritchie Yuson, William R FreemanAbstract:Purpose:The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs).Methods:This is a retrospective
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, R M S Yuson, William R FreemanAbstract:Purpose The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs). Methods This is a retrospective consecutive case series of 54 eyes from 48 patients with primary ERMs who underwent spectral domain-optical coherence tomography scans. Regression analysis was used to calculate the relative contribution of several variables, including Photoreceptor IS/OS disruption, grade of IS/OS disruption, macular thickness, and ERM grade on fundus imaging to visual acuity. Results The strongest individual predictor of visual acuity among patients with ERM was central retinal thickness on spectral domain-optical coherence tomography (r(2) = 0.16, P = 0.0024), but the most efficient model was the combination of macular thickness and presence or absence of Photoreceptor IS/OS disruption (r(2) = 0.24, P = 0.0008). Additional measured variables did not significantly contribute to visual acuity prediction. Inner Segment/outer Segment layer integrity was also an independent predictor of visual acuity, and patients with IS/OS disruption were 6.88 times as likely to have 20/50 or worse vision than patients with intact Photoreceptor layers (odds ratio: 6.88, confidence interval: 1.56-30.43, P = 0.01). Conclusion Disruption of the Photoreceptor IS/OS junction is a statistically significant predictor of poor visual acuity among patients with ERM and is most useful when combined with central retinal thickness measurement.
Lingyun Cheng - One of the best experts on this subject based on the ideXlab platform.
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scanning laser ophthalmoscope imaging stabilized microperimetry in dry age related macular degeneration
Retina-the Journal of Retinal and Vitreous Diseases, 2011Co-Authors: Kathrin Hartmann, Dirkuwe Bartsch, Lingyun Cheng, Jae S Kim, Maria Laura Gomez, Helaina Klein, William R FreemanAbstract:Purpose To determine the effect of drusen and geographic atrophy (GA) in dry age-related macular degeneration on retinal sensitivity using an eye tracking scanning laser ophthalmoscope microperimetry. Methods A total of 44 eyes from 22 patients with dry age-related macular degeneration and drusen and 11 patients with GA were imaged with scanning laser ophthalmoscope microperimetry (OPKO Health, Miami, FL). A custom microperimetry pattern was used to evaluate retinal sensitivity to a Goldmann III size target (108 μm on the retina). The perimetry used a 4-2 stepladder algorithm to determine maximal sensitivity. Microperimetry and optical coherence tomography were performed using a standardized protocol. Twenty-eight eyes with drusen and 16 eyes with GA were analyzed. Results Retinal sensitivity overlying drusen was significantly reduced compared with the adjacent uninvolved retina. There was a significant correlation between retinal sensitivity and drusen volume, as well as the grading of the Photoreceptor Inner Segment/outer Segment junction score. In patients with GA, an absolute scotoma was confirmed. Retinal sensitivity at the margin of GA was significantly decreased compared with the adjacent uninvolved retina. Conclusion Scanning laser ophthalmoscope microperimetry is able to detect changes in retinal sensitivity in AMD patients overlying drusen and at the margin of GA. It is a useful device to grade focal retinal sensitivity in patients with dry age-related macular degeneration.
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the association between percent disruption of the Photoreceptor Inner Segment outer Segment junction and visual acuity in diabetic macular edema
American Journal of Ophthalmology, 2010Co-Authors: Anjali S Maheshwary, Lingyun Cheng, Stephen F Oster, Francesca Mojana, R M S Yuson, William R FreemanAbstract:Purpose To evaluate the integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. Design Retrospective, comparative, consecutive case series. Methods Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. Results A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found ( P = .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found ( P = .07). Conclusions Disruption of the Photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients.
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, Ritchie Yuson, William R FreemanAbstract:Purpose:The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs).Methods:This is a retrospective
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, R M S Yuson, William R FreemanAbstract:Purpose The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs). Methods This is a retrospective consecutive case series of 54 eyes from 48 patients with primary ERMs who underwent spectral domain-optical coherence tomography scans. Regression analysis was used to calculate the relative contribution of several variables, including Photoreceptor IS/OS disruption, grade of IS/OS disruption, macular thickness, and ERM grade on fundus imaging to visual acuity. Results The strongest individual predictor of visual acuity among patients with ERM was central retinal thickness on spectral domain-optical coherence tomography (r(2) = 0.16, P = 0.0024), but the most efficient model was the combination of macular thickness and presence or absence of Photoreceptor IS/OS disruption (r(2) = 0.24, P = 0.0008). Additional measured variables did not significantly contribute to visual acuity prediction. Inner Segment/outer Segment layer integrity was also an independent predictor of visual acuity, and patients with IS/OS disruption were 6.88 times as likely to have 20/50 or worse vision than patients with intact Photoreceptor layers (odds ratio: 6.88, confidence interval: 1.56-30.43, P = 0.01). Conclusion Disruption of the Photoreceptor IS/OS junction is a statistically significant predictor of poor visual acuity among patients with ERM and is most useful when combined with central retinal thickness measurement.
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the association between percent disruption of the Photoreceptor Inner Segment outer Segment junction and visual acuity in diabetic macular edema
Investigative Ophthalmology & Visual Science, 2010Co-Authors: Anjali S Maheshwary, Lingyun Cheng, Stephen F Oster, Francesca Mojana, Ritchie Yuson, William R FreemanAbstract:● PURPOSE: To evaluate the integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. ● DESIGN: Retrospective, comparative, consecutive case series. ● METHODS: Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. ● RESULTS: A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found (P .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found (P .07). ● CONCLUSIONS: Disruption of the Photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients. (Am J Ophthalmol 2010;150:63‐67. © 2010 by Elsevier Inc. All rights reserved.)
Stephen F Oster - One of the best experts on this subject based on the ideXlab platform.
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the association between percent disruption of the Photoreceptor Inner Segment outer Segment junction and visual acuity in diabetic macular edema
American Journal of Ophthalmology, 2010Co-Authors: Anjali S Maheshwary, Lingyun Cheng, Stephen F Oster, Francesca Mojana, R M S Yuson, William R FreemanAbstract:Purpose To evaluate the integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. Design Retrospective, comparative, consecutive case series. Methods Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. Results A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found ( P = .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found ( P = .07). Conclusions Disruption of the Photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients.
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, Ritchie Yuson, William R FreemanAbstract:Purpose:The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs).Methods:This is a retrospective
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, R M S Yuson, William R FreemanAbstract:Purpose The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs). Methods This is a retrospective consecutive case series of 54 eyes from 48 patients with primary ERMs who underwent spectral domain-optical coherence tomography scans. Regression analysis was used to calculate the relative contribution of several variables, including Photoreceptor IS/OS disruption, grade of IS/OS disruption, macular thickness, and ERM grade on fundus imaging to visual acuity. Results The strongest individual predictor of visual acuity among patients with ERM was central retinal thickness on spectral domain-optical coherence tomography (r(2) = 0.16, P = 0.0024), but the most efficient model was the combination of macular thickness and presence or absence of Photoreceptor IS/OS disruption (r(2) = 0.24, P = 0.0008). Additional measured variables did not significantly contribute to visual acuity prediction. Inner Segment/outer Segment layer integrity was also an independent predictor of visual acuity, and patients with IS/OS disruption were 6.88 times as likely to have 20/50 or worse vision than patients with intact Photoreceptor layers (odds ratio: 6.88, confidence interval: 1.56-30.43, P = 0.01). Conclusion Disruption of the Photoreceptor IS/OS junction is a statistically significant predictor of poor visual acuity among patients with ERM and is most useful when combined with central retinal thickness measurement.
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the association between percent disruption of the Photoreceptor Inner Segment outer Segment junction and visual acuity in diabetic macular edema
Investigative Ophthalmology & Visual Science, 2010Co-Authors: Anjali S Maheshwary, Lingyun Cheng, Stephen F Oster, Francesca Mojana, Ritchie Yuson, William R FreemanAbstract:● PURPOSE: To evaluate the integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. ● DESIGN: Retrospective, comparative, consecutive case series. ● METHODS: Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. ● RESULTS: A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found (P .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found (P .07). ● CONCLUSIONS: Disruption of the Photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients. (Am J Ophthalmol 2010;150:63‐67. © 2010 by Elsevier Inc. All rights reserved.)
Francesca Mojana - One of the best experts on this subject based on the ideXlab platform.
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the association between percent disruption of the Photoreceptor Inner Segment outer Segment junction and visual acuity in diabetic macular edema
American Journal of Ophthalmology, 2010Co-Authors: Anjali S Maheshwary, Lingyun Cheng, Stephen F Oster, Francesca Mojana, R M S Yuson, William R FreemanAbstract:Purpose To evaluate the integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. Design Retrospective, comparative, consecutive case series. Methods Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. Results A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found ( P = .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found ( P = .07). Conclusions Disruption of the Photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients.
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, Ritchie Yuson, William R FreemanAbstract:Purpose:The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs).Methods:This is a retrospective
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disruption of the Photoreceptor Inner Segment outer Segment layer on spectral domain optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Stephen F Oster, Lingyun Cheng, Francesca Mojana, Manpreet Brar, R M S Yuson, William R FreemanAbstract:Purpose The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs). Methods This is a retrospective consecutive case series of 54 eyes from 48 patients with primary ERMs who underwent spectral domain-optical coherence tomography scans. Regression analysis was used to calculate the relative contribution of several variables, including Photoreceptor IS/OS disruption, grade of IS/OS disruption, macular thickness, and ERM grade on fundus imaging to visual acuity. Results The strongest individual predictor of visual acuity among patients with ERM was central retinal thickness on spectral domain-optical coherence tomography (r(2) = 0.16, P = 0.0024), but the most efficient model was the combination of macular thickness and presence or absence of Photoreceptor IS/OS disruption (r(2) = 0.24, P = 0.0008). Additional measured variables did not significantly contribute to visual acuity prediction. Inner Segment/outer Segment layer integrity was also an independent predictor of visual acuity, and patients with IS/OS disruption were 6.88 times as likely to have 20/50 or worse vision than patients with intact Photoreceptor layers (odds ratio: 6.88, confidence interval: 1.56-30.43, P = 0.01). Conclusion Disruption of the Photoreceptor IS/OS junction is a statistically significant predictor of poor visual acuity among patients with ERM and is most useful when combined with central retinal thickness measurement.
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the association between percent disruption of the Photoreceptor Inner Segment outer Segment junction and visual acuity in diabetic macular edema
Investigative Ophthalmology & Visual Science, 2010Co-Authors: Anjali S Maheshwary, Lingyun Cheng, Stephen F Oster, Francesca Mojana, Ritchie Yuson, William R FreemanAbstract:● PURPOSE: To evaluate the integrity of the Photoreceptor Inner Segment/outer Segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. ● DESIGN: Retrospective, comparative, consecutive case series. ● METHODS: Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. ● RESULTS: A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found (P .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found (P .07). ● CONCLUSIONS: Disruption of the Photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients. (Am J Ophthalmol 2010;150:63‐67. © 2010 by Elsevier Inc. All rights reserved.)
Christine A Curcio - One of the best experts on this subject based on the ideXlab platform.
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bacillary layer detachment multimodal imaging and histologic evidence of a novel optical coherence tomography terminology literature review and proposed theory
Retina-the Journal of Retinal and Vitreous Diseases, 2021Co-Authors: Prithvi Ramtohul, Christine A Curcio, Michael Engelbert, Ariane Malcles, Edward Gigon, Elisabetta Miserocchi, Giulio Modorati, Eduardo Cunha De Souza, Cagri G Besirli, Bailey K FreundAbstract:Purpose To clarify the histologic basis of bacillary layer detachment (BALAD) through a review of the current literature and an analysis of retinal imaging. Methods The literature for previous reports of BALAD were reviewed. An analysis of retinal images was performed to support anatomical conclusions. Results A total of 164 unique patients with BALAD on optical coherence tomography (OCT) were identified from the published literature. Twenty-two underlying etiologies, all associated with subretinal exudation, were identified. Forty-one different OCT terminologies were found. The defining OCT feature of BALAD was a split at the level of the Photoreceptor Inner Segment myoid creating a distinctive intraretinal cavity. Resolution of BALAD was followed by a rapid restoration of the ellipsoid zone. Histology of age-related macular degeneration eyes suggests that individual Photoreceptors can shed Inner Segments. Furthermore, detachment of the entire layer of Inner Segments is a common postmortem artifact. It is proposed that BALAD occurs when outwardly directed forces promoting attachment of Photoreceptor outer Segments to the retinal pigment epithelium exceed the tensile strength of the Photoreceptor Inner Segment myoid. Conclusion This review serves to strengthen the OCT nomenclature "bacillary layer detachment," based on specific reflectance information obtained by OCT and previously published histologic observations.
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presumed foveal bacillary layer detachment in a patient with toxoplasmosis chorioretinitis and pachychoroid disease
Retinal Cases & Brief Reports, 2021Co-Authors: Nitish Mehta, Christine A Curcio, Jillian Chong, Jacque L Duncan, Yasha S ModiAbstract:Purpose To report a detachment that apparently separated Photoreceptor Inner Segment myoids from Inner Segment ellipsoids as a manifestation of toxoplasmosis chorioretinitis in a patient with pachychoroid spectrum disease. Methods Multimodal imaging including fundus photography, spectral domain and enhanced-depth imaging optical coherence tomography (OCT), indocyanine green angiography, and OCT angiography. Results A 33-year-old man with a history of toxoplasmosis chorioretinitis reported 1 week of decreased vision to 20/200 in his right eye. Examination of the right eye demonstrated mild vitritis with recurrent chorioretinitis inferior to the fovea and adjacent to a chorioretinal scar. A dome-shaped, foveal Photoreceptor layer-splitting detachment was noted on OCT. Because degenerating cone Photoreceptors are capable of shedding their Inner Segments, we inferred the location of the detachment at the level of the Inner Segment myoid and provided a histological example of such from an unrelated donor case. In addition, multimodal imaging revealed dilated choroidal veins (pachyvessels) with attenuation of the Inner choroid in both eyes and asymptomatic findings of central serous chorioretinopathy in the left eye. After 1 month of antibiotic and steroid therapy, the chorioretinitis resolved, as did the detachment. Hyperreflective foci on the vitreoretinal interface were appreciated with en face OCT that appeared to aggregate throughout the course of therapy, induce Inner retinal striae, and resolve without inducing epiretinal membrane formation. Conclusion Patients with preexisting pachychoroid spectrum disease may manifest a more significant retinal fluid accumulation in the setting of superimposed chorioretinal inflammation. In this case of macular toxoplasmosis chorioretinitis, inflammation manifested as a retinal detachment at the level of Photoreceptor Inner Segment myoids that we named as a bacillary layer detachment. In this case, inflammatory sequelae of toxoplasmosis reactivation responded well to oral and intravitreal therapy.
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histology of geographic atrophy secondary to age related macular degeneration a multilayer approach
Retina-the Journal of Retinal and Vitreous Diseases, 2018Co-Authors: Miaoling Li, Jeffrey D Messinger, Rosa Dolzmarco, Daniela Ferrara, Carrie Huisingh, Bailey K Freund, Christine A CurcioAbstract:PURPOSE: To systematically characterize histologic features of multiple chorioretinal layers in eyes with geographic atrophy, or complete retinal pigment epithelium (RPE) and outer retinal atrophy, secondary to age-related macular degeneration, including Henle fiber layer and outer nuclear layer; and to compare these changes to those in the underlying RPE-Bruch membrane-choriocapillaris complex and associated extracellular deposits. METHODS: Geographic atrophy was delimited by the external limiting membrane (ELM) descent towards Bruch membrane. In 13 eyes, histologic phenotypes and/or thicknesses of Henle fiber layer, outer nuclear layer, underlying supporting tissues, and extracellular deposits at four defined locations on the non-atrophic and atrophic sides of the ELM descent were assessed and compared across other tissue layers, with generalized estimating equations and logit models. RESULTS: On the non-atrophic side of the ELM descent, distinct Henle fiber layer and outer nuclear layer became dyslaminated, cone Photoreceptor Inner Segment myoids shortened, Photoreceptor nuclei and mitochondria translocated inward, and RPE was dysmorphic. On the atrophic side of the ELM descent, all measures of Photoreceptor health declined to zero. Henle fiber layer/outer nuclear layer thickness halved, and only Muller cells remained, in the absence of Photoreceptors. Sub-RPE deposits remained, Bruch membrane thinned, and choriocapillaris density decreased. CONCLUSION: The ELM descent sharply delimits an area of marked gliosis and near-total Photoreceptor depletion clinically defined as Geographic atrophy (or outer retinal atrophy), indicating severe and potentially irreversible tissue damage. Degeneration of supporting tissues across this boundary is gradual, consistent with steady age-related change and suggesting that RPE and Muller cells subsequently respond to a threshold of stress. Novel clinical trial endpoints should be sought at age-related macular degeneration stages before intense gliosis and thick deposits impede therapeutic intervention.
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Authors
2016Co-Authors: Christine A Curcio, Gerald A Fishman, Drew Scoles, Yusufu N Sulai, Christopher S LangloAbstract:NOT THE PUBLISHED VERSION; this is the author’s final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. [Citation: Journal/Monograph Title, Vol. XX, No. X (yyyy): pg. XX-XX. DOI. This article is © [Publisher’s Name] and permission has been granted for this version to appear in e-Publications@Marquette. [Publisher] does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from [Publisher].] 1 In vivo Imaging of Human Cone Photoreceptor Inner Segment
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in vivo imaging of human cone Photoreceptor Inner Segments
Investigative Ophthalmology & Visual Science, 2014Co-Authors: Drew Scoles, Christine A Curcio, Gerald A Fishman, Yusufu N Sulai, Christopher S Langlo, Joseph Carroll, Alfredo DubraAbstract:Purpose An often overlooked prerequisite to cone Photoreceptor gene therapy development is residual Photoreceptor structure that can be rescued. While advances in adaptive optics (AO) retinal imaging have recently enabled direct visualization of individual cone and rod Photoreceptors in the living human retina, these techniques largely detect strongly directionally-backscattered (waveguided) light from normal intact Photoreceptors. This represents a major limitation in using existing AO imaging to quantify structure of remnant cones in degenerating retina. Methods Photoreceptor Inner Segment structure was assessed with a novel AO scanning light ophthalmoscopy (AOSLO) differential phase technique, that we termed nonconfocal split-detector, in two healthy subjects and four subjects with achromatopsia. Ex vivo preparations of five healthy donor eyes were analyzed for comparison of Inner Segment diameter to that measured in vivo with split-detector AOSLO. Results Nonconfocal split-detector AOSLO reveals the Photoreceptor Inner Segment with or without the presence of a waveguiding outer Segment. The diameter of Inner Segments measured in vivo is in good agreement with histology. A substantial number of foveal and parafoveal cone Photoreceptors with apparently intact Inner Segments were identified in patients with the inherited disease achromatopsia. Conclusions The application of nonconfocal split-detector to emerging human gene therapy trials will improve the potential of therapeutic success, by identifying patients with sufficient retained Photoreceptor structure to benefit the most from intervention. Additionally, split-detector imaging may be useful for studies of other retinal degenerations such as AMD, retinitis pigmentosa, and choroideremia where the outer Segment is lost before the remainder of the Photoreceptor cell.