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S. F. Oster, F. Mojana, M. Brar, R. M. S. Yuson, L. Cheng, W. R. Freeman; Retinal Photoreceptor Layer Disruption on Spectral Optical Coherence Tomography Is a Strong Predictor of Poor Visual Acuity in Patients With Epiretinal Membranes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3257.
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Epiretinal membrane (ERM) is a common macular pathology causing decreased vision. We used high-resolution spectral domain optical coherence tomography (SD-OCT) (OTI Inc, Toronto, Canada and Heidelberg Spectralis, Vista, CA), which allows detailed imaging of the retinal architecture, to better understand how ERMs lead to visual disturbance. Our goal was to assess the relationship in ERM patients between retinal features on SD-OCT and visual acuity, and to specifically test the hypothesis that disruption of the photoreceptor layer is a strong predictor of poor vision in eyes with ERMs.
A retrospective review of 54 consecutive patients with epiretinal membranes in whom SD-OCT imaging was performed. All patients had primary epiretinal membranes, with no history of concurrent retinal disease, uveitis, or prior vitrectomy. Best corrected visual acuity was used as the study outcome, and measured variables included the presence or absence of photoreceptor disruption, a grade of that disruption, macular volume, foveal thickness, and ERM severity based on fundus images.
39 patients had an intact photoreceptor layer on SD-OCT with mean logmar visual acuity of 0.19 (median 0.17, standard deviation 0.18), and 15 patients had photoreceptor disruption with mean logmar visual acuity of 0.34 (median 0.4, standard deviation 0.18). Univariate analysis showed statistically worse vision in the photoreceptor disruption group (T-test p=0.007), and a significantly higher percentage of patients with acuity worse than 20/40 in the disruption group (53% vs 13% Chi-squared test p=0.005). Additionally, multivariate regression analysis including all measured variables revealed that the combination of photoreceptor disruption on SD-OCT and macular thickness measurement was the optimal model to predict visual acuity (R2 = 0.24; macular thickness p=0.0066, SD-OCT photoreceptor disruption p=0.025). Finally, visual acuity was dichotomized (at 20/50 or worse) and used for logistic regression over the variables measured. Using this regression, patients with photoreceptor disruption were 6.7 times more likely to have visual acuity of 20/50 or worse than those with intact outer retinal layers on SD-OCT.
In patients with epiretinal membranes, photoreceptor layer disruption on SD-OCT is strongly correlated with poor vision and adds significant predictive value to traditional OCT measures such as macular thickness. This suggests that diseases of the retinal surface, or inner retina, may cause visual disturbance by affecting the outer retinal architecture.
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