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P. Charbel Issa, E. Troeger, R. P. Finger, F. G. Holz, R. Wilke, H. P. N. Scholl; Structure-Function Correlation of the Human Central Retina. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1040.
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To precisely correlate high resolution structural and functional maps of the human macula.
A custom-made software tool (MultiModalMapper) allowed for co-registration of fundus-mapped microperimetry (MP1, Nidek) and spectral domain optical coherence tomography (SD-OCT; Spectralis HRA+OCT, Heidelberg Engineering) datasets. The transformation model features mapping of 2D microperimetry data on 3D-OCT datasets using corresponding landmarks on both fundus images. The software accounts for different radial lens distortion of both systems. Well-defined features of structure-function correlation are exemplified in macular telangiectasia (MacTel) type 2. Longitudinal data were analyzed from the RAMA-trial (ranibizumab for MacTel type 2; ClinicalTrials identifier: NCT00504400). The study received ethical approval by the local committee and each patient gave written informed consent to participate.
While damage to the outer retina (photoreceptors) was accompanied by a loss of retinal sensitivity as measured by microperimetry, similar changes to the inner retina usually showed a normal corresponding function. There was a significant correlation between thickness of outer retina and retinal sensitivity (r=0.8; p<0.001, two-tailed Pearson correlation coefficient). Longitudinal data from the RAMA-trial revealed that small lesions affecting the outermost neurosensory retina typically precede functional detection but later cause severe loss of light sensitivity.
There can be remarkable functional compensation if the macular pathology spares the outer neurosensory retina. There is a general need for surrogate endpoints to diagnose disease in its early stages, when treatment is most effective and irreversible (functional) damage can be prevented or delayed. Since SD-OCT is becoming more widely available, surrogate endpoints derived from structure-function correlation may become highly relevant in future clinical trials.
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