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Tu JH, Foote KG, Lujan BJ, et al. Dysflective cones: Visual function and cone reflectivity in long-term follow-up of acute bilateral foveolitis. Am J Ophthalmol Case Rep. 2017;7:14-19doi: 10.1016/j.ajoc.2017.04.001.
Tu, J. H., Foote, K. G., Lujan, B. J., Ratnam, K., Qin, J., Gorin, M. B., Cunningham, E. T., Tuten, W. S., Duncan, J. L., & Roorda, A. (2017). Dysflective cones: Visual function and cone reflectivity in long-term follow-up of acute bilateral foveolitis. American journal of ophthalmology case reports, 714-19. https://doi.org/10.1016/j.ajoc.2017.04.001
Tu, Joanna H, et al. "Dysflective cones: Visual function and cone reflectivity in long-term follow-up of acute bilateral foveolitis." American journal of ophthalmology case reports vol. 7 (2017): 14-19. doi: https://doi.org/10.1016/j.ajoc.2017.04.001
Tu JH, Foote KG, Lujan BJ, Ratnam K, Qin J, Gorin MB, Cunningham ET, Tuten WS, Duncan JL, Roorda A. Dysflective cones: Visual function and cone reflectivity in long-term follow-up of acute bilateral foveolitis. Am J Ophthalmol Case Rep. 2017 Sep;7:14-19. doi: 10.1016/j.ajoc.2017.04.001. Epub 2017 Apr 12. PMID: 29057371; PMCID: PMC5644392.
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Am J Ophthalmol Case Rep. 2017 Sep;7:14-19. doi: 10.1016/j.ajoc.2017.04.001. Epub 2017 Apr 12.

Dysflective cones: Visual function and cone reflectivity in long-term follow-up of acute bilateral foveolitis.

American journal of ophthalmology case reports

Joanna H Tu, Katharina G Foote, Brandon J Lujan, Kavitha Ratnam, Jia Qin, Michael B Gorin, Emmett T Cunningham, William S Tuten, Jacque L Duncan, Austin Roorda

Affiliations

  1. Department of Ophthalmology, 10 Koret Way, University of California San Francisco, San Francisco, CA, USA.
  2. College of Physicians and Surgeons, Columbia University, New York, NY, USA.
  3. School of Optometry and Vision Science Graduate Group, University of California Berkeley, Berkeley, CA, USA.
  4. West Coast Retina Medical Group, San Francisco, CA, USA.
  5. Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA.
  6. Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA.
  7. Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.
  8. The Francis I. Proctor Foundation, University of California San Francisco, School of Medicine, San Francisco, CA, USA.

PMID: 29057371 PMCID: PMC5644392 DOI: 10.1016/j.ajoc.2017.04.001

Abstract

PURPOSE: Confocal adaptive optics scanning laser ophthalmoscope (AOSLO) images provide a sensitive measure of cone structure. However, the relationship between structural findings of diminished cone reflectivity and visual function is unclear. We used fundus-referenced testing to evaluate visual function in regions of apparent cone loss identified using confocal AOSLO images.

METHODS: A patient diagnosed with acute bilateral foveolitis had spectral-domain optical coherence tomography (SD-OCT) (Spectralis HRA + OCT system [Heidelberg Engineering, Vista, CA, USA]) images indicating focal loss of the inner segment-outer segment junction band with an intact, but hyper-reflective, external limiting membrane. Five years after symptom onset, visual acuity had improved from 20/80 to 20/25, but the retinal appearance remained unchanged compared to 3 months after symptoms began. We performed structural assessments using SD-OCT, directional OCT (non-standard use of a prototype on loan from Carl Zeiss Meditec) and AOSLO (custom-built system). We also administered fundus-referenced functional tests in the region of apparent cone loss, including analysis of preferred retinal locus (PRL), AOSLO acuity, and microperimetry with tracking SLO (TSLO) (prototype system). To determine AOSLO-corrected visual acuity, the scanning laser was modulated with a tumbling E consistent with 20/30 visual acuity. Visual sensitivity was assessed in and around the lesion using TSLO microperimetry. Complete eye examination, including standard measures of best-corrected visual acuity, visual field tests, color fundus photos, and fundus auto-fluorescence were also performed.

RESULTS: Despite a lack of visible cone profiles in the foveal lesion, fundus-referenced vision testing demonstrated visual function within the lesion consistent with cone function. The PRL was within the lesion of apparent cone loss at the fovea. AOSLO visual acuity tests were abnormal, but measurable: for trials in which the stimulus remained completely within the lesion, the subject got 48% correct, compared to 78% correct when the stimulus was outside the lesion. TSLO microperimetry revealed reduced, but detectible, sensitivity thresholds within the lesion.

CONCLUSIONS AND IMPORTANCE: Fundus-referenced visual testing proved useful to identify functional cones despite apparent photoreceptor loss identified using AOSLO and SD-OCT. While AOSLO and SD-OCT appear to be sensitive for the detection of abnormal or absent photoreceptors, changes in photoreceptors that are identified with these imaging tools do not correlate completely with visual function in every patient. Fundus-referenced vision testing is a useful tool to indicate the presence of cones that may be amenable to recovery or response to experimental therapies despite not being visible on confocal AOSLO or SD-OCT images.

Keywords: Adaptive optics scanning laser; Functional testing; Microperimetry; Multimodal imaging; Optical coherence tomography; ophthalmoscopy

Conflict of interest statement

Conflict of interest Austin Roorda has two patents on technology related to the Adaptive Optics Scanning Laser Ophthalmoscope. (USPTO #7,118,216 #6,890,076) These patents are assigned to both the Univ

References

  1. Invest Ophthalmol Vis Sci. 2009 May;50(5):2328-36 - PubMed
  2. Invest Ophthalmol Vis Sci. 2007 Jul;48(7):3283-91 - PubMed
  3. Eye (Lond). 2012 Jan;26(1):61-9 - PubMed
  4. Invest Ophthalmol Vis Sci. 2011 Sep 09;52(10):7141-7 - PubMed
  5. J Refract Surg. 2005 Sep-Oct;21(5):S575-80 - PubMed
  6. Invest Ophthalmol Vis Sci. 2013 Aug 28;54(8):5836-47 - PubMed
  7. Arch Ophthalmol. 2011 Nov;129(11):1475-82 - PubMed
  8. Invest Ophthalmol Vis Sci. 2011 Mar 18;52(3):1486-92 - PubMed
  9. Opt Express. 2007 Oct 17;15(21):13731-44 - PubMed
  10. Percept Psychophys. 1983 Feb;33(2):113-20 - PubMed
  11. Nature. 1987 Jan 29-Feb 4;325(6103):439-41 - PubMed
  12. Retina. 2016 Jan;36(1):91-103 - PubMed
  13. Ophthalmic Physiol Opt. 2016 May;36(3):218-39 - PubMed
  14. Invest Ophthalmol Vis Sci. 2011 Apr 06;52(5):2219-26 - PubMed
  15. Optom Vis Sci. 2012 May;89(5):563-74 - PubMed
  16. Retina. 2013 Sep;33(8):1650-8 - PubMed
  17. Invest Ophthalmol Vis Sci. 2015 Jan 13;56(2):778-86 - PubMed
  18. Biomed Opt Express. 2011 Apr 05;2(5):1106-14 - PubMed
  19. Invest Ophthalmol Vis Sci. 2006 Sep;47(9):4160-7 - PubMed
  20. Opt Express. 2008 Apr 28;16(9):6486-501 - PubMed
  21. Retina. 2015 Aug;35(8):1511-20 - PubMed
  22. Biomed Opt Express. 2011 Aug 1;2(8):2189-201 - PubMed
  23. Graefes Arch Clin Exp Ophthalmol. 2016 May;254(5):855-64 - PubMed
  24. Annu Rev Vis Sci. 2015 Nov;1:19-50 - PubMed
  25. Ophthalmic Surg Lasers Imaging Retina. 2014 Nov-Dec;45(6):562-9 - PubMed
  26. Invest Ophthalmol Vis Sci. 2012 Feb 21;53(2):833-40 - PubMed

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