Outer Retinal Layers’ Thickness Changes in relation to Age and Choroidal Thickness in Normal Eyes

Purpose. To identify and correlate age-related changes in outer retinal layers’ thickness and choroidal thickness (CT) in the normal eyes using spectral-domain optical coherence tomography (SD-OCT) and to investigate factors affecting these changes. Study Design. Observational cross-sectional study. Subjects and Methods. We studied 125 healthy Egyptians between 20 and 79 years old. Patients were divided into 3 groups: group 1 (20–40 years), group 2 (40–60 years), and group 3 (>60 years). All patients had full ophthalmic examination. SD-OCT was done to measure the 9 ETDRS macular grid sectors of retinal pigment epithelium and photoreceptor outer segment (RPE-OS), outer nuclear layer and photoreceptor inner segment (ONL-IS), and choroidal thickness (CT) (by enhanced depth imaging). Results. RPE-OS was significantly thinner in group 3 than in the other 2 groups (central: P<0.001). Moreover, the 3 groups were significantly different from each other regarding the CT (central: P<0.001); significant thinning was noticed in the choroid with age. The 3 groups did not show significant difference concerning the ONL-IS thickness. RPE-OS and CT showed statistically significant negative correlation with age (central RPE-OS: r = −0 C.345, P<0.001, and central CT: r = −0.725, P<0.001) while ONL-IS showed statistically nonsignificant correlation with age (central ONL-IS: r = −0.08, P=0.376). Multiple regression analysis revealed that the most important determinant of central 1 mm RPE-OS thickness in this study was age (β = −0.087, P=0.010) rather than choroidal thinning (β = 0.001, P=0.879). Conclusion. RPE-OS layer thickness shows significant thinning with increasing age, and with decrease in CT, however, age is the most determinant factor of this thinning.

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Age-related changes of individual macular retinal layers among Asians

Scientific Reports ◽

10.1038/s41598-019-56996-6 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Jacqueline Chua ◽

Yih Chung Tham ◽

Bingyao Tan ◽

Kavya Devarajan ◽

Florian Schwarzhans ◽

...

Keyword(s):

Axial Length ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Systemic Disease ◽

Imaging Biomarkers ◽

Retinal Layer ◽

Retinal Layers ◽

Age Related ◽

Age Related Changes ◽

Sd Oct

AbstractWe characterized the age-related changes of the intra-retinal layers measured with spectral-domain optical coherence tomography (SD-OCT; Cirrus high-definition OCT [Carl Zeiss Meditec]. The Singapore Epidemiology of Eye Diseases is a population-based, cross-sectional study of Chinese, Malays and Indians living in Singapore. Iowa Reference Algorithms (Iowa Institute for Biomedical Imaging) were used for intra-retinal layer segmentation and mean thickness of 10 intra-retinal layers rescaled with magnification correction using axial length value. Linear regression models were performed to investigate the association of retinal layers with risk factors. After excluding participants with history of diabetes or ocular diseases, high-quality macular SD-OCT images were available for 2,047 participants (44–89 years old). Most of the retinal layers decreased with age except for foveal retinal nerve fiber layer (RNFL) and the inner/outer segments of photoreceptors where they increased with age. Men generally had thicker retinal layers than women. Chinese have the thickest RNFL and retinal pigment epithelium amongst the ethnic groups. Axial length and refractive error remained correlated with retinal layers in spite of magnification correction. Our data show pronounced age-related changes in retinal morphology. Age, gender, ethnicity and axial length need be considered when establishing OCT imaging biomarkers for ocular or systemic disease.

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Ischemic Choroidal Diseases

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1402-7592 ◽

2021 ◽

Author(s):

Teresa Barth ◽

Horst Helbig

Keyword(s):

Lupus Erythematosus ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Age Related Macular Degeneration ◽

Enhanced Depth Imaging ◽

Vascular Structure ◽

Drug Induced ◽

Choroidal Blood Flow ◽

Age Related ◽

Choroidal Ischemia

Abstract Introduction Ischemic choroidal diseases are an underdiagnosed entity. The clinical pattern varies according to the size and the localisation of the affected vascular structure. Clinical Presentation In eyes with occlusion of the long posterior ciliary arteries, characteristic triangular patches of choroidal ischemia (Amalric sign) are seen, which in the course of time merge into well-defined areas of atrophy of the retinal pigment epithelium. Above the non-perfused choroidal areas, hyperpigmented, grouped lines appear (Siegrist streaks). Circumscribed ischemia of smaller choroidal arterioles and capillary vessels appears as multifocal, yellowish lesions in the posterior fundus (Elschnig spots). Vortex vein occlusion becomes manifest as exudative haemorrhagic choroidal swelling in the periphery. Causes of Choroidal Ischemia Apart from arterial hypertension as a major risk factor, some immunological disorders such as giant cell arteritis and systemic lupus erythematosus and haematological pathologies also affect choroidal perfusion. Furthermore, choroidal ischemia occurs due to local inflammation, as found in eyes with acute multifocal posterior placoid pigment epitheliopathy (APMPPE). Rarely, choroidal infarction is of iatrogenic origin or drug-induced. Recent advances in imaging, such as the introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) and OCT angiography (OCT-A), have improved the visualisation of the choroidal vasculature and complement the classical angiographic procedures. In patients with age-related macular degeneration (AMD) and diabetes, some changes in choroidal blood flow and vascular structure have also been noted. While in AMD the choroidal pathologies correlate with the disease progression and the functional prognosis, the pathophysiological relationship between diabetic choroidopathy and retinopathy is currently unclear. Management and Conclusion With regard to the limited therapeutic options for choroidal ischemia, optimisation of the cardiovascular risk profile and the management of accompanying ocular and systemic diseases are essential.

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Optical Coherence Tomography Characteristics of the Choroid Underlying Congenital Hypertrophy of the Retinal Pigment Epithelium

Ocular Oncology and Pathology ◽

10.1159/000504712 ◽

2020 ◽

Vol 6 (4) ◽

pp. 238-243

Author(s):

Jasmine H. Francis ◽

Ethan K. Sobol ◽

Molly Greenberg ◽

Robert Folberg ◽

David H. Abramson

Keyword(s):

Optical Coherence Tomography ◽

Retinal Pigment Epithelium ◽

Choroidal Thickness ◽

Retinal Thickness ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Enhanced Depth Imaging ◽

Optical Coherence ◽

Depth Imaging ◽

Congenital Hypertrophy

Purpose: This study evaluates and characterizes the choroid underlying congenital hypertrophy of the retinal pigment epithelium (CHRPE). Methods: Retrospective observational study of CHRPE at least 2 mm in diameter. Choroidal vascular architecture was qualitatively examined. Choroidal thickness was measured by 2 independent observers using enhanced depth imaging spectral domain optical coherence tomography. Results: Forty-six eyes of 46 patients with CHRPE were included. Thirty-two lesions had imaging sufficient for analysis. Haller’s layer was healthy in 18 (56%), thin in 13 (41%), and absent in 1 (2%). Sattler’s layer was atrophic in 30 (94%), and choriocapillaris was atrophic in 31 (97%). CHRPE with thinned Haller’s layer had significantly larger diameter. The mean sub-CHRPE choroidal thickness was 82.4 ± 7.9 µm, compared to a thickness of 148.4 ± 9.6 µm in the normal adjacent choroid (p < 0.0001). Mean retinal thickness overlying the CHRPE was 77.3 ± 4.3 µm, compared to a retinal thickness of 137.8 ± 2.9 µm overlying the normal adjacent choroid (p < 0.0001). Sub-CHRPE choroidal thickness was a mean of 56.2 ± 3.1% of the adjacent normal choroidal thickness. Conclusion: The underlying choroid CHRPE is thinner than the adjacent normal choroid. All layers of the choroid can be thin with a preference of the inner Sattler’s and choriocapillaris layers.

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Origins of Ghost Drusen: A follow-up Analysis

Ophthalmology Point of Care ◽

10.5301/oapoc.0000011 ◽

2017 ◽

Vol 1 (1) ◽

pp. oapoc.0000011

Author(s):

Caroline Bottin ◽

Olivia Zambrowski ◽

Giuseppe Querques ◽

Salomon Yves Cohen ◽

Mayer Srour ◽

...

Keyword(s):

Pigment Epithelium ◽

Retinal Pigment ◽

Geographic Atrophy ◽

Primary Lesion ◽

Age Related Macular Degeneration ◽

Age Related ◽

Soft Drusen ◽

Initial Lesions ◽

Sd Oct

Purpose Ghost drusen (GD) are pyramidal or dome-shaped retinal pigment epithelium elevations observed in some geographic atrophy (GA) areas in the context of age-related macular degeneration (AMD). The purpose was to investigate the first morphologic features preceding GD on spectral-domain optical coherence tomography (SD-OCT) on patients with GA associated with AMD. Methods A retrospective observational study was performed on a series of patients with GA that had at least 3 years of follow-up. Using the follow-up tool of SD-OCT, we tracked the initial lesions that could lead to GD. Results Among 442 patients with GA, 37 had well defined GD (8%). We included the 17/37 patients (31 eyes) with at least 3 years of follow-up for analysis, which led to a total of 582 counted GD. Most GD were already present at the first visit, and remained stable. However, on 13 of the 582 analyzed GD (2.2%), soft drusen were shown as the initial lesion, which progressively turned into GD. Conclusions GD were observed in less than 10% of eyes with GA. None of the ghost drusen turned into another shaped lesion, suggesting that GD is a possible final stage of evolution. In a few cases, large drusen were shown as the primary lesion that progressed into GD.

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MACULOPATHY AND CHORIORETINOPATHY IN CHILDREN WITH RETINOBLASTOMA RECEIVING CHEMOTHERAPY: CLINICAL TRIALS AND MORPHOMETRIC ANALYSIS

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2018-13-4-167-175 ◽

2018 ◽

Vol 13 (4) ◽

pp. 167-175

Author(s):

S. V Saakyan ◽

Elena В. Myakoshina ◽

V. G Polyakov ◽

T. L Ushakova ◽

D. M Ismailova

Keyword(s):

Optical Coherence Tomography ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Enhanced Depth Imaging ◽

Optical Coherence ◽

Depth Imaging ◽

Chemotherapy Group ◽

Intravitreal Chemotherapy ◽

Group 3 ◽

Group 2

Purpose. This research is to evaluate patients with retinoblastoma, who receive chemotherapy, with Spectralis optical coherence tomography with enhanced depth imaging to compare the signs of chorioretinopathy and maculopathy. Material and methods. 74 patients were examined and treated, 125 eyes with retinoblastoma in age at average of 24 ± 1.6 months. Group 1 - 31 patients, 62 eyes after intravenous chemotherapy, 2 - 24 patients, 25 eyes after intravenous and superselective intraarterial or intravitreal chemotherapy. Group 3 (control) - 19 patients (38 eyes) with primary retinoblastoma. The condition of the retina, choroid and macula was assessed using Ret Cam II and Spectralis optical coherence tomography with enhanced depth imaging. All patients had complete tumor resorption after treatment. Results. In group 1, after 3 courses of chemotherapy Spectralis optical coherence tomography with enhanced depth imaging showed a decrease of caliber of retinal vessels; wavelength of photoreceptors, hyperreflective round foci and calcinates in the retinal pigment epithelium; choriocapillary hyperreflexivity, choroid thinning; in the sclera - hyperreflective foci with visualization of the scleral vessels. In the macula - disorganization of retinal pigment epithelium, cystic edema, smoothness of the papillomacular bundle, coracoid form of the fovea, retinal thickening. After 3 courses of systemic chemotherapy and superselective intraarterial chemotherapy (group 2) - peritumoral increase in the caliber of retinal vessels. After systemic superselective intraarterial and intravitreal chemotherapy (group 2) - epiretinal membranes, punctate hyperreflective foci in the inner layers of the retina. In group 3 (control), before treatment, a normal anatomical and topographic state of the macula was observed with extracentral localization of retinoblastoma. Conclusions. Profound morphometric disturbances that come with combined chemotherapy (intravenous, superselective intraarterial and intravitreal chemotherapy treatments) call for a more careful treatment with methods selected in terms of Spectralis optical coherence tomography with enhanced depth imaging findings and specific chemotherapy contraindications.

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Comparison of Progression Rate of Retinal Pigment Epithelium Loss in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab and Aflibercept

Journal of Ophthalmology ◽

10.1155/2017/7432739 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Juliana Wons ◽

Magdalena A. Wirth ◽

Nicole Graf ◽

Matthias D. Becker ◽

Stephan Michels

Keyword(s):

Retinal Pigment Epithelium ◽

Macular Degeneration ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Age Related Macular Degeneration ◽

Progression Rate ◽

Intravitreal Ranibizumab ◽

Age Related ◽

Significant Difference ◽

One Year

Purpose. Retinal pigment epithelium (RPE) loss in neovascular age-related macular degeneration (nAMD) seem to have a linear progression but might be influenced by the treatment. The purpose of the study is the comparison of RPE loss over three years in patients treated with intravitreal ranibizumab to patients who were switched to aflibercept. Methods. A retrospective analysis with 96 eyes switched to aflibercept was conducted. The progression rate of RPE loss was evaluated in patients who showed atrophy one year prior to switch (n=17) or on switch date (n=19). The RPE loss was evaluated by spectral domain optical coherence tomography (SD-OCT). Further, 22 eyes from patients treated with ranibizumab were compared. Results. The median yearly progression of RPE loss after square root transformation showed no significant difference in the year prior to switch compared to the year after switch (p=0.854). In patients who received only ranibizumab, the median yearly progression of RPE loss was 0.15 mm/y, for aflibercept patients, 0.13 mm/y. This difference was not statistically significant (p=0.172). Conclusions. There seems to be a linear progression rate of RPE loss in patients treated with ranibizumab as well as in patients with aflibercept. No significant increase of progression rate was found after switch to aflibercept.

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Optical Coherence Tomography in Best Vitelliform Macular Dystrophy

European Journal of Ophthalmology ◽

10.5301/ejo.5000878 ◽

2017 ◽

Vol 27 (2) ◽

pp. 201-204 ◽

Cited By ~ 8

Author(s):

Maurizio Battaglia Parodi ◽

Pierluigi Iacono ◽

Francesco Romano ◽

Gianluigi Bolognesi ◽

Francesco Fasce ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Macular Dystrophy ◽

Optical Coherence ◽

Vitelliform Macular Dystrophy ◽

Retinal Layers ◽

Hyperreflective Foci ◽

Sd Oct

Purpose To analyze spectral-domain optical coherence tomography (SD-OCT)-specific findings in the different stages of vitelliform macular dystrophy (VMD). Methods Thirty-seven patients were prospectively recruited. All the patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA), biomicroscopy, and SD-OCT. The examined findings were vitelliform material, neurosensory detachment, intraretinal hyperreflective foci, and the status of external limiting membrane, ellipsoid zone, and retinal pigment epithelium. The primary outcome was the stratification of SD-OCT findings in each VMD stage. Secondary outcomes included the description of different characteristics related to intraretinal hyperreflective foci. Results Outer retinal layers were preserved almost exclusively in stage 1 (range 70%-100%), whereas their disruption and absence were typical of stages 2 to 4 (83%-100%) and stage 5 (67%-83%), respectively. Vitelliform material was found always in stages 2 and 3, 89% of stage 4, and rarely in stage 5 (33%). Neurosensory detachment was to some extent representative of stages 3 and 4 (80% and 72%, respectively) when compared with the other stages (p<0.001). Hyperreflective foci (16% of all eyes) demonstrated a progressive increase across stages 2 to 4, with slightly reduced figure in stage 5. These foci were located in the outer nuclear and plexiform layers, showed different sizes, and were not associated with a visual acuity reduction (p = 0.64). Conclusions A progressive deterioration of the outer retinal layers was noticeable in more advanced stages of VMD. The reduction of vitelliform material from stage 3 to 4 was paralleled by an increased evidence of neurosensory detachment. Although showing different size and location, hyperreflective foci did not correlate with worse BCVA.

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Peripheral Exudative Heamorrhagic Chorioretinopathy

Czech and Slovak Ophthalmology ◽

10.31348/2019/2/4 ◽

2019 ◽

Vol 75 (2) ◽

pp. 80-84

Author(s):

Zdeněk Mazal

Keyword(s):

Early Stage ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Choroidal Melanoma ◽

Age Related Macular Degeneration ◽

Central Vision ◽

Old Patients ◽

Affected Area ◽

Age Related ◽

Subretinal Fibrosis

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is relatively rare and especially less known and therefore less often diagnosed condition of the retina periphery predominantly in patients of higher age. Usually temporal periphery is affected. The finding is bilateral in approximately 30 %. Clinically it manifests by multibulbar prominences in periphery, which can sometimes resemble choroidal melanoma. It concerns exudations and hemorrhages under retina (sub-retinal) or under retinal pigment epithelium (sub-RPE). Within weeks or months hemorrhagy is resorbed and flattened and chorioretinal atrophy of various grade remains in affected area, sometimes combined with retinal fibrosis. If the affected area remains limited to the periphery, the central visual acuity does not have to be reduced. Affection is considered to be peripheral form of wet age-related macular degeneration or peripheral form of idiopathic polypoidal choroidal vasculopathy. By differential diagnosis is necessary to exclude especially malignant choroidal melanoma and choroidal detachment. Case report: Own case of 83 years old patient with bilateral PEHCR is described and photo documented. Creation of new prominence - fresh bleeding under retina and RPE in superior periphery – had been captured. Photo documentation of lesion in early stage and in stage of resorbtion after several weeks. Affected areas remained limited to periphery and did not have influence on central vision. That was influenced by degeneration of macula and vitreomacular traction syndrome with distinct epiretinal membrane. Conclusion: PEHCR is less frequent or less diagnosed condition of the retina periphery in old patients. Ongoing exudation and sub-retinal or sub-RPE bleeding. Within weeks heals with chorioretinal scars and subretinal fibrosis. Central vision does not have to be damaged, if lesions do not spread to macula.

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A Level Set Method with Region-Scalable Fitting Energy for Retinal Layer Segmentation in Spectral-Domain Optical Coherence Tomography Images

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2020.2905 ◽

2020 ◽

Vol 10 (2) ◽

pp. 326-335

Author(s):

Liming Liang ◽

Xiaoqi Sheng ◽

Bowen Liu ◽

Zhimin Lan

Keyword(s):

Optical Coherence Tomography ◽

Level Set ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Spectral Domain ◽

Retinal Layer ◽

Optical Coherence ◽

Retinal Layers ◽

Layer Segmentation ◽

Sd Oct

Retinal layer segmentation of spectral-domain optical coherence tomography images plays an important role during diagnosis and analysis of ophthalmic diseases. In this paper, a novel variational level set framework with region-scalable fitting energy is proposed for automated retinal layer segmentation in SD-OCT. To the best of our knowledge, it is the first time that level set based method succeeds in ten retinal layers segmentation. The proposed framework consists of three steps. First, an anisotropic nonlinear diffusion filter is applied for speckle noise reduction and ROI contrast enhancement. Second, Canny edge detectors are used to extract initial layers: nerve fiber layer, connecting cilia and retinal pigment epithelium. Finally, the rest retinal layers are segmented by means of level set model combined with prior knowledge of retinal thickness and morphology, for which the energy function consists of region-scalable fitting energy data term, area constraint term, regularization term and length penalty term. The proposed method was tested on 50 retinal SD-OCT B-scans from 50 normal subjects. The overall unsigned border position error is 5.92 ± 4.72 μm. The result showed that data terms with border weight terms can keep layer segmentation results in strong border while retaining its fitting capability in weak border. The proposed method achieves better segmentation result than other active contour models.

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Aqueous Levels of Pigment Epithelium-Derived Factor and Macular Choroidal Thickness in High Myopia

Journal of Ophthalmology ◽

10.1155/2015/731461 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Wei Chen ◽

Yubo Guan ◽

Guanghui He ◽

Zhiwei Li ◽

Hui Song ◽

...

Keyword(s):

High Myopia ◽

Choroidal Thickness ◽

Pigment Epithelium ◽

Serum Levels ◽

Enhanced Depth Imaging ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Pigment Epithelium Derived Factor ◽

Significant Difference ◽

And Control

Purpose. To investigate the correlation between aqueous and serum levels of pigment epithelium-derived factor (PEDF) and macular choroidal thickness in high myopia patients, both with and without choroidal neovascularization (CNV).Methods. Serum and aqueous levels of PEDF were measured by enzyme-linked immunosorbent assay in 36 high myopia patients (36 eyes) with no CNV (non-CNV group), 14 high myopia patients (14 eyes) with CNV (CNV group), and 42 nonmyopia patients (42 eyes) (control group). Macular choroidal thickness was measured by enhanced-depth imaging optical coherence tomography.Results. Aqueous levels of PEDF were significantly higher in CNV group compared with non-CNV (P<0.001) and control (P<0.001) groups. Macular choroidal thicknesses were significantly decreased in the non-CNV and CNV groups compared with the control (P<0.001) group. A statistically significant difference (P=0.012) was found between the CNV and non-CNV groups. There was a positive correlation between aqueous PEDF and macular choroidal thickness in the non-CNV group (P=0.005), but no correlation with the CNV group. No correlation between serum PEDF and macular choroidal thickness was detected in the three groups.Conclusion. Variations in aqueous PEDF levels coincide with changes in macular choroidal thickness in high myopia patients with no CNV, while no such relationship exists in high myopia patients with CNV.

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