Transscleral Optical Imaging (TOI) in Central Serous Chorioretinopathy – A novel imaging tool in retinal pigment epithelium visualization

Abstract

Purpose : Imaging of the retinal pigment epithelium (RPE) monolayer in various retinal diseases poses a challenge considering the limited lateral resolution of commercially available devices and high reflectivity of the overlying photoreceptor layer in adaptive optics (AO) based imaging systems. We performed a prospective observational study to image the RPE using transscleral optical imaging (TOI) (Cellularis^®, prototype), in patients with a clinical diagnosis of central serous chorioretinopathy (CSCR).

Methods : Twelve patients (mean age 43.3±4 years; 3 females, 9 males) with a clinical diagnosis of CSCR, in one or both eyes, underwent a comprehensive eye exam which included best corrected visual acuity, refractive error spherical equivalent and axial length. Demographic data included age and gender of the patient. A trained operator captured six 5.04^° x 5.04^° high resolution RPE images at different locations of each eye. All patients also underwent clinical imaging with color and autofluorescence fundus imaging as well as optical coherence tomography (OCT).

Results : TOI was successfully performed on 21 eyes with CSCR and one normal contralateral eye. Resolved CSCR eyes (N=15)showed an altered pattern of RPE mosaic in regions with RPE changes. Eyes with active CSCR (N=6) showed poor resolution of TOI imaging in regions with retinal detachment. TOI images revealed hyperreflective dots corresponding to areas of RPE hyperplasia or RPE detachments with hyperreflective content, and dark dots in some areas. Interestingly altered foveal RPE patterns were seen in some cases, even when the retinal morphology was normal on OCT.

Conclusions : TOI circumvents the drawbacks of conventional transpupillary AO imaging to perform cellular level imaging of RPE in CSCR. Various qualitative features such as altered mosaic pattern and hyperreflective dots help define sequelae at the level of RPE and inner choroid. Further understanding of the various qualitative signs on TOI and their correlation with multimodal imaging in CSCR is needed to explore the role of TOI in diagnosis, prognostication and treatment of various retinal conditions such as CSCR.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.