September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Dynamism and ultrastructure of subretinal drusenoid deposits revealed by adaptive optics scanning laser ophthalmoscopy over 3.5 years
Author Affiliations & Notes
  • Yuhua Zhang
    Department of Ophthalmology, Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Xiaolin Wang
    Department of Ophthalmology, Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Mark E Clark
    Department of Ophthalmology, Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Cynthia Owsley
    Department of Ophthalmology, Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Christine A Curcio
    Department of Ophthalmology, Univ of Alabama at Birmingham, Birmingham, Alabama, United States
  • Footnotes
    Commercial Relationships   Yuhua Zhang, None; Xiaolin Wang, None; Mark Clark, None; Cynthia Owsley, None; Christine Curcio, Genentech (C), Janssen Cell Therapy (C), Merck (C), Novartis (C)
  • Footnotes
    Support  NIH R01EY024378, R01AG04212, R01EY06109, and institutional support from Research to Prevent Blindness, EyeSight Foundation of Alabama, Buck Trust of Alabama, and NIH P30 EY003039.
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 78. doi:
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      Yuhua Zhang, Xiaolin Wang, Mark E Clark, Cynthia Owsley, Christine A Curcio; Dynamism and ultrastructure of subretinal drusenoid deposits revealed by adaptive optics scanning laser ophthalmoscopy over 3.5 years. Invest. Ophthalmol. Vis. Sci. 2016;57(12):78.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To describe the ultrastructure of subretinal drusenoid deposits (SDD) during progression and regression over 3 years in patients with age-related macular degeneration (AMD); to observe the photoreceptors surrounding SDD, using multimodal imaging including a research adaptive optics scanning laser ophthalmoscope (AOSLO).

Methods : Six eyes of 4 patients with intermediate AMD (grade 5-8 on the AREDS 9-step scale for color fundus photography) were studied 4 times over 3.5 years. No eyes progressed to advanced AMD in this period. Participants underwent infrared reflectance (IR), spectral domain coherence tomography (SD-OCT), and AOSLO with a new-generation research instrument. SDD presence and progression were assessed by multimodal imaging and a 3-stage SD-OCT-based grading system. To evaluate change over time, shapes and ultrastructure of individual SDD lesions identified at baseline were examined by AOSLO. Photoreceptors surrounding SDD were assessed in AOSLO and SD-OCT.

Results : SDD progression was followed by a combination of IR reflectance, AOSLO, and SDOCT. En face imaging revealed an inward spread of SDD towards the fovea over 3.5 years. Stage 3 SDD are typically circular yet we observed stage 3 lesions that were lumpy or bi-lobed, with some changing their shape (Figure 1). A return of characteristic photoreceptor reflectivity in AOSLO (punctate) and in SD-OCT (prominent ellipsoid zone) was observed after regression of some SDD in some individuals.

Conclusions : The dynamism of SDD ultrastructure disclosed by high-resolution AOSLO imaging provides deep insight into the lesion impact on surrounding photoreceptor structure over several years. Whether a return of reflectivity after lesion regression implies a true rejuvenation of photoreceptors is an important question under intensive ongoing investigation.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

AOSLO imaging of SDD and surrounding photoreceptors over 3.5 years in a 73 year old man with non-neovascular AMD. A1-A4, a lesion progressed from stage 2 (04/10/2012) to stage 3 (07/03/2013) with a lumpy structure. B1-B4 shows a stage-3 SDD (baseline) over 3.6 years. C1-C4 shows the regression of 2 SDD. Photoreceptor reflectivity reappeared in the lesion area after the SDD regressed (green arrowheads). D1-D4 are SDD cross-sections imaged by SD-OCT (green arrows in C1-C4). ELM: external limiting membrane. EZ: ellipsoid zone.

AOSLO imaging of SDD and surrounding photoreceptors over 3.5 years in a 73 year old man with non-neovascular AMD. A1-A4, a lesion progressed from stage 2 (04/10/2012) to stage 3 (07/03/2013) with a lumpy structure. B1-B4 shows a stage-3 SDD (baseline) over 3.6 years. C1-C4 shows the regression of 2 SDD. Photoreceptor reflectivity reappeared in the lesion area after the SDD regressed (green arrowheads). D1-D4 are SDD cross-sections imaged by SD-OCT (green arrows in C1-C4). ELM: external limiting membrane. EZ: ellipsoid zone.

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