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P. Batta, O. Sahnas, E. Reichel, T. R. Hedges, III; Ultra-High Resolution OCT Analysis of Subtle Maculopathy Diagnosed With Multifocal ERG. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2211. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To utilize ultrahigh resolution OCT (UHR-OCT) to identify structural changes in the macula of patients with central progressive visual loss, evidence of macular dysfunction on multifocal ERG (mfERG), and minimal findings on examination, including fundoscopy, fluorescein angiography, and Stratus OCT.
Charts were retrospectively reviewed for all patients with UHR-OCT scans performed at New England Eye Center from January 1, 2006 through November 1, 2009. Inclusion criteria were as follows: history of slow-onset progressive (>6 months) visual loss in one or both eyes; best-corrected visual acuity of 0.3 (logMAR) or worse in the affected eye(s); no findings on ocular examination, fluorescein angiography, or Stratus OCT of the macula to explain the visual loss; and foveal depression on mfERG. Exclusion criteria included presence of an afferent pupillary defect, loss of nerve fiber layer on OCT, or diffuse retinal dysfunction on mfERG or full-field ERG.
Thirteen eyes of eight patients were included in the study. The mean age of patients was 55 years (range 31 to 81 years). The average visual acuity on presentation was 0.62 (range 0.3 to 1.3), with average time period of visual loss prior to presentation 22 months (range 9 to 36 months). Seven of the thirteen eyes had structural macular abnormalities on UHR-OCT imaging. All seven had disruption of the photoreceptor inner and outer segment (IS/OS)junction at the fovea. Four eyes had thinning of the outer nuclear layer (ONL). Six eyes did not have any structural abnormalities on UHR-OCT.
Multifocal ERG is a useful tool in detecting macular dysfunction in patients with progressive visual loss in whom ocular examination and conventional testing are non-localizing. We found that ultrahigh resolution OCT is able to visualize distinct anatomical changes in the IS/OS and ONL in some of these patients, signifying a structural abnormality involving foveal photoreceptors. Our study also suggests that functional deficits, detectable on mfERG, may exist without discernible structural damage on OCT. The cause of photoreceptor loss in such patients remains elusive, though the differential includes macular dystrophies as well as immune processes.
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