Optical coherence tomography study of adult vitelliform macular detachment in a patient with basal laminar drusen.

To report the morphological data of adult vitelliform macular detachment in a patient with basal laminar drusen using optical coherence tomography (OCT-3) as an observational case report. A 70-year-old man presented with adult vitelliform macular detachment and basal laminar drusen underwent fundus biomicroscopy, fundus fluorescein angiography and OCT-3. Fundus examination showed bilateral yellow subretinal macula deposits with associated basal laminar drusen. Examination with OCT revealed areas of hyper-reflectivity compatible in size with the subretinal deposits below and elevating the photoreceptor layer. This was accompanied by underlying disruption of the OCT signal from retinal pigment epithelium (RPE) in the more affected left eye. In adult vitelliform macular detachment and basal laminar drusen, OCT may demonstrate that the yellow material is located predominantly below RPE in early disease and between the photoreceptor layer and the retinal pigment epithelium in later disease.

The ChromaTest, a digital color contrast sensitivity analyzer, for diabetic maculopathy: a pilot study.

BACKGROUND: To assess the ability of the Chromatest in investigating diabetic maculopathy. METHOD: Patients with Type 2 diabetes and no concurrent ocular pathology or previous laser photocoagulation were recruited. Visual acuities were assessed followed by colour contrast sensitivity testing of each eye using Chromatest. Dilated fundoscopy with slit lamp biomicroscopy with 78 D lens was then performed to confirm the stage of diabetic retinopathy according to the Early Treatment Diabetic Retinopathy Study. RESULTS: 150 eyes in 150 patients were recruited into this study. 35 eyes with no previous laser photocoagulation were shown to have clinically significant macular oedema (CSMO) and 115 eyes with untreated non-proliferative diabetic retinopathy (NPDR) on fundus biomicroscopy. Statistical significant difference was found between CSMO and NPDR eyes for protan colour contrast threshold (p = 0.01). Statistical significance was found between CSMO and NPDR eyes for tritan colour contrast threshold (p = 0.0002). Sensitivity and specificity for screening of CSMO using pass-fail criterion for age matched TCCT results achieved 71% (95% confidence interval: 53-85%) and 70% (95% confidence interval: 60-78%), respectively. However, threshold levels were derived using the same data set for both training and testing the effectiveness since this was the first study of NPDR using the Chromatest CONCLUSION: The ChromaTest is a simple, cheap, easy to use, and quick test for colour contrast sensitivity. This study did not achieve results to justify use of the Chromatest for screening, but it reinforced the changes seen in tritan colour vision in diabetic retinopathy.

Two retinal vein occlusions in a patient with venous tortuosity at the optic disc.

BACKGROUND: The aetiology of occlusion is thought to differ for branch retinal vein and central retinal vein types. This communication reports on an unusual presentation of two retinal vein occlusions in one eye of a patient with optic disc tortuosity where the occlusion was thought to occur at a site usually seen in central retinal vein occlusion. METHODS: An 88-year-old woman presented with sudden-onset painless loss of central vision. Fundal examination of the affected eye revealed one infero-temporal retinal vein occlusion affecting the macula and a second vein occlusion affecting the supero-nasal quadrant with associated optic disc tortuosity. She was investigated for cardiovascular risk factors. RESULTS: Treatment had already been started for systemic hypertension and blood markers were unremarkable. Conservative management was recommended. 12 weeks later, fluorescein angiography showed no ischaemia. CONCLUSION: We report an unusual case of two co-existent and opposing retinal vein occlusions where obstruction was thought to occur at the trunk of the central retinal vein at or near the level of the lamina cribrosa, a site usually associated with the formation of hemi-vein or central retinal vein occlusion. This had occurred as a result of tortuous vasculature at the optic disc. This unusual case lends weight to previously suggested hypotheses of retinal vein occlusion.

In vivo demonstration of the anatomic differences between classic and occult choroidal neovascularization using optical coherence tomography.

PURPOSE: To determine architectural differences between classic and occult choroidal neovascularization (CNV) in vivo. DESIGN: Prospective observational case series. METHODS: Twenty-two patients with acute CNV underwent fluorescein angiography and optical coherence tomography (OCT), which were analyzed by separate blinded observers. RESULTS: In 87.5% of angiographically labeled "classic" CNV a discreet subretinal lesion corresponding to the neovascular complex could be seen above and separate to the retinal pigment epithelium on OCT. This was found in only 13.3% of "occult" CNV. CONCLUSION: With the latest commercially available OCT equipment it is now possible to confirm in vivo the previously proposed anatomic differences between fluorescein angiographically labeled classic and occult CNV. Classic CNV appear to grow predominantly in the subretinal space, whereas the majority of occult lesions do not. Optical coherence tomography features of CNV may correlate with response to photodynamic therapy or angiostatic treatments, as well as predicting the success of surgical removal.

POCOman: new system for quantifying posterior capsule opacification.

PURPOSE: To describe a new method of measuring posterior capsule opacification (PCO) and intraocular lens (IOL) rotation and report the validation of the method. SETTING: Ophthalmology Department, St. Thomas' Hospital, and Medical Imaging, Department of Physics, King's College, London, United Kingdom. METHOD: A new interactive software program, POCOman, was developed for the semiobjective assessment of PCO. Digital images of the posterior capsule, which can be acquired by any technique, are analyzed by the observer to determine the percentage area of PCO and assign a severity score. The system was validated by comparing it to clinical slitlamp evaluation of PCO and automated POCO system analysis using a library of 100 images taken from archives. The software also measures sequential IOL rotation for the evaluation of toric IOLs. RESULTS: An image could be analyzed in approximately 2 minutes. The results of the POCOman system correlated well with the results of the automated POCO system and clinical evaluation. CONCLUSIONS: The POCOman is an effective, user-friendly system for quantifying PCO. It can be obtained for free and has advantages over other methods.