June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Novel microscopic foveal pit pathology in multiple sclerosis revealed with adaptive optics ophthalmoscopy
Author Affiliations & Notes
  • Aubrey Hargrave
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Nripun Sredar
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Moataz M Razeen
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Fareshta Khushzad
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Jennifer Yarp
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Lakshmi Leishangthem
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Anna Tomczak
    Neurology & Neurological Sciences, Stanford University, California, United States
  • Lucas Kipp
    Neurology & Neurological Sciences, Stanford University, California, United States
  • May Han
    Neurology & Neurological Sciences, Stanford University, California, United States
  • Bartlomiej Kowalski
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Alfredo Dubra
    Ophthalmology, Stanford University, Palo Alto, California, United States
  • Heather Moss
    Ophthalmology, Stanford University, Palo Alto, California, United States
    Neurology & Neurological Sciences, Stanford University, California, United States
  • Footnotes
    Commercial Relationships   Aubrey Hargrave, None; Nripun Sredar, None; Moataz Razeen, None; Fareshta Khushzad, None; Jennifer Yarp, None; Lakshmi Leishangthem, None; Anna Tomczak, None; Lucas Kipp, None; May Han, None; Bartlomiej Kowalski, None; Alfredo Dubra, None; Heather Moss, None
  • Footnotes
    Support  Myelin Repair Foundation; NIH grants P30 026877, EY02523, EY025477 and EY028287; RPB Challenge Grant
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5101. doi:
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      Aubrey Hargrave, Nripun Sredar, Moataz M Razeen, Fareshta Khushzad, Jennifer Yarp, Lakshmi Leishangthem, Anna Tomczak, Lucas Kipp, May Han, Bartlomiej Kowalski, Alfredo Dubra, Heather Moss; Novel microscopic foveal pit pathology in multiple sclerosis revealed with adaptive optics ophthalmoscopy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5101.

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

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Abstract

Purpose : Multiple sclerosis (MS) is characterized by inflammation and axonal degeneration, affecting retinal ganglion cells and their axons, as well as retina microvasculature. However, these changes do not fully account for the visual function deficits reported by multi-focal electroretinogram (Landau, et al. IOVS 2018; 59(1):549-60). In this study we report the presence and appearance of novel microscopic structures in the foveal avascular zone (FAZ) that may contribute to visual dysfunction in MS.

Methods : One eye without history of optic neuritis in each of 7 female subjects with stable multiple sclerosis (4 relapsing-remitting, 3 secondary progressive, age 56±15 yrs) underwent standard clinical examination, followed by adaptive optics scanning light ophthalmoscopy (AOSLO). Simultaneous reflectance AOSLO confocal and non-confocal split-detection image sequences of the fovea were acquired using 790 nm light. Registered images were averaged and tiled to cover the FAZ, where the Feret’s diameter and area of manually segmented structures were recorded.

Results : Abnormal hyper-reflective structures (Fig. 1) were observed at the bottom of the foveal pit within the FAZ in both confocal and non-confocal split-detection images of 5 subjects. Their diameter ranged from 9.6 to 94.7 µm and area ranged from 48 to 3416 µm2. The structures had a raised, textured appearance, with visible sub-structures within them. These structures appeared to cast a shadow at the corresponding location over the photoreceptor mosaic. Additionally, foveal punctate reflectivity, previously seen in normal and diseased retinas (Scoles, et al. IOVS 2014; 55(7):4015-29), was observed in the confocal images of 3 eyes. Unlike the larger structures, these seem to be largely absent in the corresponding split-detection images, and do not appear to cast shadows on the photoreceptor mosaic.

Conclusions : Previously unreported microscopic features, not detectable with clinical examination, were observed in the foveal pit of 5 out of 7 MS subjects. Monitoring these structures may be useful as a biomarker for evaluating ocular disease progression in MS.

This is a 2020 ARVO Annual Meeting abstract.

 

Reflectance confocal (A,B) and split-detection (C) AOSLO images of the foveal pit bottom (B,C) and photoreceptor mosaic (A) at the corresponding retinal location showing novel structures (arrows) in a multiple sclerosis subject.

Reflectance confocal (A,B) and split-detection (C) AOSLO images of the foveal pit bottom (B,C) and photoreceptor mosaic (A) at the corresponding retinal location showing novel structures (arrows) in a multiple sclerosis subject.

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