The association between percent disruption of the photoreceptor inner segment-outer segment junction and visual acuity in diabetic macular edema.

PURPOSE: 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 and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. DESIGN: Retrospective, comparative, consecutive case series. METHODS: Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors. RESULTS: A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found (P = .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found (P = .07). CONCLUSIONS: Disruption of the photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients.

Spectral domain optical coherence tomography for imaging ERM, retinal edema, and vitreomacular interface.

PURPOSE: To evaluate images taken with OTI-OPKO Spectral domain optical coherence tomography (OCT; OTI-OPKO Health Inc, Miami, FL)/scanning laser ophthalmoscope (resolution of 5-8 microm) and compare them with conventional StratusOCT (Carl Zeiss Meditec Inc, Dublin, CA) in eyes with epiretinal membranes (ERMs), macular edema, and vitreoretinal interface abnormalities. METHODS: We evaluated 79 consecutive eyes with retinal pathologies using Spectral OCT/scanning laser ophthalmoscope and StratusOCT at the Jacobs Retina Center, University of California San Diego, CA. Pathologies included ERM, macular edema, and vitreomacular traction. Two masked reviewers graded the pathologic findings on the basis of visibility (scale 0-III). A quantitative continuous scale grading system was also used. RESULTS: Statistical analysis showed significant differences in ERM visibility between the spectral OCT/scanning laser ophthalmoscope and StratusOCT (P < 0.0001; signed-rank test). Furthermore, posterior hyaloid visibility was significantly different (P < 0.0001) as was the macular edema grading (P < 0.0001). The Gaussian noise grading system was performed for a smaller subset of 40 eyes and it gave the same results. Spectral OCT was particularly useful in the diagnosis of subtle ERM, minimal diffuse macular edema, and morphology of macular cystic spaces, posterior vitreous detachment, and attachments of the posterior hyaloid. CONCLUSION: The Spectral OTI-OPKO instrument allows significantly better visualization of vitreoretinal surface diseases like ERM, posterior hyaloid, and retinal edema than StratusOCT. High-speed Spectral OCT/scanning laser ophthalmoscope allows rapid image acquisition, higher number of cuts, and better sampling yielding superior imaging of retinal pathology.

Disruption of the photoreceptor inner segment/outer segment layer on spectral domain-optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes.

PURPOSE: The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the photoreceptor inner segment/outer segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs). METHODS: This is a retrospective consecutive case series of 54 eyes from 48 patients with primary ERMs who underwent spectral domain-optical coherence tomography scans. Regression analysis was used to calculate the relative contribution of several variables, including photoreceptor IS/OS disruption, grade of IS/OS disruption, macular thickness, and ERM grade on fundus imaging to visual acuity. RESULTS: The strongest individual predictor of visual acuity among patients with ERM was central retinal thickness on spectral domain-optical coherence tomography (r(2) = 0.16, P = 0.0024), but the most efficient model was the combination of macular thickness and presence or absence of photoreceptor IS/OS disruption (r(2) = 0.24, P = 0.0008). Additional measured variables did not significantly contribute to visual acuity prediction. Inner segment/outer segment layer integrity was also an independent predictor of visual acuity, and patients with IS/OS disruption were 6.88 times as likely to have 20/50 or worse vision than patients with intact photoreceptor layers (odds ratio: 6.88, confidence interval: 1.56-30.43, P = 0.01). CONCLUSION: Disruption of the photoreceptor IS/OS junction is a statistically significant predictor of poor visual acuity among patients with ERM and is most useful when combined with central retinal thickness measurement.