High Resolution Retinal Imaging of Central Serous Chorioretinopathy Using Adaptive Optics Scanning Laser Ophthalmoscope

Abstract

Purpose: : To describe the high resolution retinal imaging of the pathologic changes in the foveal photoreceptors in eyes with central serous chorioretinopathy (CSC) using adaptive optics scanning laser ophthalmoscope (AO-SLO).

Methods: : A prototype AO-SLO system was fabricated using newly developed liquid crystal on silicon technology (LCOS). The system has a transverse resolution of 3 µm and allows to observe a patient’s retinal pathology directly at a cellular level. A prospective pilot study was conducted at Kyoto University Hospital of consecutive patients diagnosed with CSC and healthy subjects. The images were acquired at multiple locations around the fovea, and compared with the findings obtained by standard clinical tests, including the spectral domain optical coherence tomography (SD-OCT).

Results: : Ten eyes of 10 healthy subjects and 13 eyes of 11 patients with CSC were included in this study. All stages of CSC, including 2 in the acute, 1 in the chronic, 2 in the recurrent phase of retinal detachment, and 8 in the quiescent phase were examined. A well-regulated photoreceptor mosaic was observed in AO-SLO images of healthy subjects. In contrast, the regularity of the photoreceptor mosaic broke down and dark patches of retina (ranging from 10 to 100 cone cell sizes in diameter) devoid of normal cones were observed in images of CSC patients, even in the quiescent phase with good visual acuity. SD-OCT showed disruption of photoreceptor inner and outer segment junction (IS/OS) was seen only three eyes with CSC in the quiescent phase, however, AO-SLO revealed decreased cone densities in all eyes. At the 1° nasal to fixation, the cone density was approximately 12000-32000 cones/mm² in eyes with CSC patients compared to 40000 cones/mm² in healthy subjects.

Conclusions: : AO-SLO showed decreased cone cells even in eyes without apparent disruptions of IS/OS line in SD-OCT images. Comparison of the AO-SLO images and findings obtained by SD-OCT facilitates understanding of anatomic and vision changes that result from CSC.

Keywords: imaging/image analysis: clinical • macula/fovea • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)