Investigative Ophthalmology & Visual Science Cover Image for Volume 58, Issue 14
December 2017
Volume 58, Issue 14
Open Access
Letters to the Editor  |   December 2017
Author Response: Intraretinal Correlates of Reticular Pseudodrusen Revealed by Autofluorescence and En Face OCT
Author Affiliations & Notes
  • Janet R. Sparrow
    Department of Ophthalmology, Columbia University, New York, New York, United States.
  • Maarjallis Paavo
    Department of Ophthalmology, Columbia University, New York, New York, United States.
Investigative Ophthalmology & Visual Science December 2017, Vol.58, 6194. doi:https://doi.org/10.1167/iovs.17-23215
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      Janet R. Sparrow, Maarjallis Paavo; Author Response: Intraretinal Correlates of Reticular Pseudodrusen Revealed by Autofluorescence and En Face OCT. Invest. Ophthalmol. Vis. Sci. 2017;58(14):6194. https://doi.org/10.1167/iovs.17-23215.

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      © ARVO (1962-2015); The Authors (2016-present)

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We are grateful to Sacconi and Querques1 for their interest in our work,2 and we thank them for their insightful remarks regarding the target-like features exhibited by reticular pseudodrusen (RPD) in short wavelength fundus autofluorescence (SW-AF) and infrared reflectance (IR-R) images. As described by Querques et al.,3 targets commonly are visible as hyperautofluorescent or isoautofluorescent spots in the center of the hypoautofluorescent foci. We have been asked to comment on this trait in relation to the changes in RPE and photoreceptor cells we reported. 
We have observed, as has Querques et al.3 and others,4 that targets are most noticeable when the conical-shaped RPD lesion visible in spectral domain-optical coherence tomography (SD-OCT) images projects through the ellipsoid zone (EZ). Bearing in mind that bisretinoid lipofuscin forms due to reactions of vitamin A aldehyde in photoreceptor cells, the abnormal autofluorescence of the target lesion could emanate from the cluster of degenerating photoreceptor cells represented by the pyramidal-shaped hyperreflective lesions in the SD-OCT scans. Observations of anomalous hyperautofluorescence under conditions of photoreceptor cell degeneration have led us to propose previously that bisretinoid lipofuscin can undergo increased formation as a secondary feature of photoreceptor cell impairment. Examples of this mechanism include the SW-AF rings in retinitis pigmentosa,5 abrupt elevations in SW-AF observed in acute macular neuroretinopathy,6 and fundus flecks that are present in recessive Stargardt disease at locations where an absence of NIR-AF indicates a loss of RPE.7 Under experimental conditions, we also have observed elevated SW-AF in association with outer segments that form the core of photoreceptor cell rosettes in degenerating mouse retina.8 
References
Sacconi R, Querques G. Intraretinal correlates of reticular pseudodrusen revealed by autofluorescence and en face OCT. Invest Ophthalmol Vis Sci. 2017; 58: 6193.
Paavo M, Lee W, Merriam J, et al. Intraretinal correlates of reticular pseudodrusen revealed by autofluorescence and en face OCT. Invest Ophthalmol Vis Sci. 2017; 58: 4769–4777.
Querques G, Querques L, Martinelli D, et al. Pathologic insights from integrated imaging of reticular pseudodrusen in age-related macular degeneration. Retina. 2011; 31: 518–526.
Steinberg JS, Gobel AP, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Reticular drusen in eyes with high-risk characteristics for progression to late-stage age-related macular degeneration. Br J Ophthalmol. 2015; 99: 1289–1294.
Schuerch K, Woods RL, Lee W, et al. Quantifying fundus autofluorescence in patients with retinitis pigmentosa. Invest Ophthalmol Vis Sci. 2017; 58: 1843–1855.
Gelman R, Chen R, Blonska A, Barile G, Sparrow JR. Fundus autofluorescence imaging in a patient with rapidly developing scotoma. Retin Cases Brief Rep. 2012; 6: 345–348.
Sparrow JR, Marsiglia M, Allikmets R, et al. Flecks in Recessive Stargardt disease: short-wavelength autofluorescence, near-infrared autofluorescence, and optical coherence tomography. Invest Ophthalmol Vis Sci. 2015; 56: 5029–5039.
Flynn E, Ueda K, Auran E, Sullivan JM, Sparrow JR. Fundus autofluorescence and photoreceptor cell rosettes in mouse models. Invest Ophthalmol Vis Sci. 2014; 55: 5643–5652.
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