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Yuhua Zhang, Pooja Godara, Tianjiao Zhang, Ernesto Blanco, Alexander Meadway, Xiaolin Wang; Imaging of Age-related Macular Degeneration (AMD) in Eyes with Cataract or Pseudophakic Intraocular Lens with Adaptive Optics Scanning Laser Ophthalmoscopy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5235.
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To assess the performance of the adaptive optics scanning laser ophthalmoscopy (AOSLO) in eyes with cataract or intraocular lens.
Patients with various degrees of AMD and age-similar subjects in normal retinal health were recruited. Color fundus photographs, infrared, autofluorescence images, and SD-OCT volumes were obtained. AMD presence and severity were determined by the AREDS 11-step fundus grading system. AOSLO was performed to image the maculae of both eyes over a 20 degree x 20 degree area. Retinal image montages were created for eyes in which AOSLO successfully acquired videos. The quality of AOSLO images was classified as good, useful, or non-useful. Good = a contiguous montage was made, retinal structure, in particular, cone photoreceptors, were resolved across whole montage. Useful = cones could be resolved at pitchy areas, or a large montage could be made. Non-useful = although AOSLO acquired continuous videos, but the processed static images were blurry such that quantitative analysis is impossible. Pupil size, cataract severity, and clarity of lenses or IOLs were assessed by fundus reflex photographs and reviewed from participants’ clinical charts.
A total of 80 subjects (41 males and 39 females, aged 72.51 ± 11.46 years) were enrolled. 159 eyes were studied. 77 eyes with IOLs, 66 eyes with cataracts graded as nuclear, cortical, and posterior subcapsual cataract, 16 eyes with clear phakic lenses. Pupil size with dilation was 5.25 ± 0.92 mm. AOSLO produce Good images in 87 eyes (54.72%), Useful images in 23 eyes (14.47%), Non-useful images in 14 eyes (8.81%), AOSLO failed to obtain images in 34 eyes (21.38%).
Adaptive optics retinal imaging is challenged by less pristine optical characteristics of the aging eye due to media opacities such as cataracts and development of anterior or posterior capsular opacification or fibrosis over the intraocular lens (IOL). This study demonstrated that cone photoreceptors structure can be imaged with the AOSLO in various stages of AMD in old subjects with cataracts or IOLs. Detailed analysis of the relationship between image quality and ocular conditions is underway. The imaging strategy developed in this study can facilitate the translation of the AOSLO to clinic management of retinal diseases for elderly patients.
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