In vivo microscopic inner retinal phenotypes of retinal and neurologic disease

Abstract

 

Purpose

 

Reflectance/backscattering adaptive optics scanning light ophthalmoscopy (AOSLO) has been used extensively to study the healthy and diseased photoreceptor mosaic. With the exception of recent work on vascular imaging, the inner retina remains largely unexplored with this imaging modality. In this study, we investigate the potential of AOSLO for non-invasive study of the inner retina.

 

Methods

 

Inner-retinal AOSLO images from 60 patients representing over 24 different retinal diseases (see Table for full list), acquired over the period of three years were identified. All images were collected using 790 nm (13-15 nm FHWM bandwidth) light sources, on three similar AOSLO instruments. Subjects thought to be free of eye disease were also imaged for comparison.

 

Results

 

Inner retinal phenotypes were classified into 8 groups based on appearance, with most diseases demonstrating three or more distinct features. The two most common findings, punctate reflectivity and Gunn’s Dots were found in 88% and 54% of diseases respectively, as well as normal volunteers. Spectral domain optical coherence tomography, obtained on the day of AOSLO imaging in nearly all patients, did not identify all AOSLO findings.

 

Conclusions

 

Reflectance AOSLO imaging revealed a diverse set of inner-retinal phenotypes across these varied diseases. Interestingly, seemingly disparate diseases (e.g., post-operative macular hole and optic atrophy as well as commotio retinae and Best’s disease respectively) showed similar inner retinal findings. Common microscopic inner retinal phenotypes of retinal pathologies might point towards common pathways of disease or repair/defense mechanisms, and even suggest common treatment modalities.

 

 

A) Punctate reflectivity in rubella retinopathy. B) Gunn’s Dots in healthy volunteer. C) Granular reflectivity in Parkinson’s disease. D) Waxy reflectivity in cone-rod dystrophy. E) Abnormal nerve fiber layer in a patient with macular hole. F) Abnormal vessels in a patient with macular hole. G) Microcysts in dominant optic atrophy. H) Striate reflectivity in Best’s Disease. All scalebars 50 μm.

 

 

Retinal diseases and phenotypes observed in this study. Letters in column headers refer to the descriptions in the figure caption. The absence of a feature (empty square) should not be interpreted as an absolute absence, rather not yet found.

 

Keywords: 688 retina • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)