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A. S. Maheshwary, S. F. Oster, R. M. S. Yuson, L. Cheng, F. Mojana, W. R. Freeman; The Association Between Percent Disruption of the Photoreceptor Inner Segment/Outer Segment and Visual Acuity in Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4661.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the integrity of the photoreceptor inner segment/outer segment (IS/OS) junction using spectral domain optical coherence tomography (SD-OCT) in patients with diabetic macular edema (DME), and to correlate the relationship between the integrity of the IS/OS junction and visual acuity.
Records of patients with DME who underwent SD-OCT scanning were retrospectively reviewed. Only patients with evidence of edema clinically, FA leakage, or OCT thickening from DME were included in the study. Patients with macular edema from other causes were excluded. For each patient two experienced observers masked to visual acuity measured several SD-OCT variables included central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Best corrected visual acuity recorded as number of ETDRS letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD-OCT variables as predictors.
62 eyes from 38 patients were studied. Mean visual acuity was 48.1 ETDRS letters (20/50-2) and median was 53 ETDRS letters (20/40-2). 24 eyes out of the 62 eyes (38.7%) had no disruption while the remaining 38 eyes (61.9%) had a mean grade of disruption of 1.67 and a mean percentage disruption of 26.9%. 19 eyes (30%) had not had treatment while 43 eyes (69.8%) were treated with various methods. A statistically significant correlation between percent disruption and visual acuity was found with a p value of 0.0312 (p<0.05). There was no significant difference in the treated versus untreated patients. GEE analysis also found that visual acuity declines with increasing disruption of the IS/OS layer of the photoreceptors. The regression coefficient was -0.30 after adjusting for volume effect, indicating that for each percent increase of IS/OS disruption vision decreases by 0.3 ETDRS letters.
Disruption of the photoreceptor IS/OS junction evaluated by SD-OCT is an important predictor of visual acuity among DME patients.
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