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Brandon J. Lujan, Jan Kristine T. Bayabo, Jason Croskrey, Robert F. Cooper, Adam M. Dubis, Joseph Carroll, Austin Roorda; Interpretation of SDOCT Photoreceptor Bands Sometimes Depends On How You Look At Them. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3169.
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© ARVO (1962-2015); The Authors (2016-present)
Spectral Domain Optical Coherence Tomography (SDOCT) images acquired through multiple pupil entry positions using the eccentric (eOCT) technique show marked variation in the reflectivity of specific retinal layers. In some eyes containing macular pathology there is attenuation of the 2nd and 3rd hyper-reflective outer retinal bands (PR bands), which may be interpreted clinically as photoreceptor loss. However, this appearance may be due to the alteration of photoreceptor orientation, which emulates the expected directional reflectivity observed in eOCT images of normal subjects. We sought to quantify these reflectivity changes, and apply these findings to images of macular pathology obtained with eOCT and the Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO).
While maintaining central fixation, frame-averaged B-scans were acquired with the SDOCT beam passing through the optical center and then through eccentric pupil positions in 32 normal subjects using Cirrus HD-OCT. These eOCT image sets were registered, normalized, and segmented manually to demarcate several retinal regions, one containing the PR bands. Total pixel values within each region were calculated from each image in the set. AOSLO and eOCT imaging were performed in patients with Best’s disease and age-related macular degeneration.
In normal subjects, reflectivity from the PR bands was uniformly maximal through the optical center and demonstrated a high degree of variance (CV=24%) compared to the inner retina (CV=5%) and the true outer nuclear layer (CV=4%) in eOCT image sets. Images of a 20/40 patient in the pseudo-hypopyon stage of Best’s disease acquired through the optical center demonstrated a severely attenuated appearance of the parafoveal second hyper-reflective outer retinal band. However, when imaged eccentrically, this band was revealed to be intact (figure). Registered AOSLO images verified the presence of an unambiguous cone mosaic within these locations.
The pupil position through which SDOCT images are acquired and the presence of retina-deforming pathology can alter the appearance of the PR bands. Utilization of eOCT may enhance the clinical assessment of photoreceptor integrity.
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