Visual Psychophysics / Physiological Optics - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Opticsvisualize microangiopathic features of diabetic microangiopathy invivo at the level of the retinal capillary bed. A number of lesionswere clearly delineated, including a variety of microaneurysms,capillary loops, IRMA, and neovascularization, which could not beseen well in the 790nm channel. These lesions typically appeared asred dots on fundus photography or bright spots on clinical fluoresceinangiography. OCT appearances were typically less distinct.Conclusions: Micro fluorescein angiography can by successfully andsafely achieved using AOSLO in diabetic patients revealing anatomicfeatures previously seen only on pathology slides. This level ofclinical imaging may prove useful for evaluating the impact oftreatment at a the microscopic scale.Figure 1. A:Segment of wide field fundus photograph demonstratingmicroaneurysms, tortuosity, and neovascularization. B:Standard widefield fluorescein angiogram with color coded frames corresponding tomicro angiographic images in figure 2. C:Corresponding SD-OCTslice through the red frame revealing microaneurysmsFigure 2. AOSLO FA images corresponding to frames in figure 1revealing details of microangiopathy including vascular loops(A,B,C) microaneurysms(A,B,C), and capillary dropout( A, B,C).Commercial Relationships: Richard B. Rosen, Opko-OTI (C),Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F),Genetech (F), Optovue (C); Alfredo Dubra, US Patent No:8,226,236 (P); Rishard Weitz, None; Joseph Carroll, Imagine Eyes,Inc. (S); Michael Dubow, None; Alexander Pinhas, None; NishitShah, None; Yusufu N. Sulai, None; Nicole K. Scripsema, None;Joseph B. Walsh, NoneSupport: Marrus Family Foundation, Chairman's Research Fund ofthe New York Eye and Ear Infirmary, Bendheim-Lowenstein FamilyFoundation, Wise Family FoundationProgram Number: 6066 Poster Board Number: B0077Presentation Time: 10:30 AM - 12:15 PMMicroangiopathic Features of Central Retinal Vein OcclusionImaged Using Fluorescence Adaptive Optics Scanning LightOphthalmoscopyAlexander Pinhas 1, 2 , Nishit Shah 1 , Michael Dubow 1, 2 , Mitul Mehta 1 ,Patricia Garcia 1 , Nicole K. Scripsema 1, 3 , Joseph Carroll 4, 5 , YusufuN. Sulai 6 , Alfredo Dubra 4, 7 , Richard B. Rosen 1 . 1 Ophthalmology,New York Eye and Ear Infirmary, New York, NY; 2 Mount SinaiSchool of Medicine, New York, NY; 3 New York Medical College,Valhalla, NY; 4 Ophthalmology, Medical College of Wisconsin,Milwaukee, WI; 5 Cell Biology, Neurology and Anatomy, MedicalCollege of Wisconsin, Milwaukee, WI; 6 The Institute of Optics,University of Rochester, Rochester, NY; 7 Biophysics, MedicalCollege of Wisconsin, Milwaukee, WI.Purpose: Central retinal vein occlusion (CRVO) remains a commoncause of vision loss in retinal vascular disease, second only todiabetic retinopathy. Fluorescein angiography (FA) has remained thegold standard for confirming its diagnosis and assessing the degree ofretinal nonperfusion, macroangiopathic change and macroscopicresponse to treatment. The high transverse resolution of adaptiveoptics scanning light ophthalmoscopy (AOSLO) has allowed for invivo study of retinal micropathology, but has been limited in itscapability to image retinal microvasculature. Here, we demonstratethe use of fluorescence AOSLO (FAOSLO) for imaging microscopicangiopathic features of CRVO.Methods: Reflectance AOSLO (RAOSLO) images (790nm; 1° fieldof view) were collected in five adult CRVO patients to identifymicrovascular points of interest. Patients then ingested 1g fluoresceindye. Simultaneous RAOSLO and FAOSLO images were thencollected between 15 and 60 minutes post-ingestion. Thefluorescence channel used a 488nm light for excitation; and, anemission filter centered at 525nm with a 45nm bandwidth. Forcomparison with conventional imaging techniques, Topcon fundusimaging with and without IV fluorescein was performed.Results: The combination of RAOSLO and FAOSLO enabled us tovisualize CRVO microangiopathic features in vivo in the finestcapillaries of the retinal inner nuclear layer. Among the featuresvisualized were vessel wall thickening, microaneurysms,neovascularization and hemorrhage. FAOSLO showed the full extentand detail of microangiopathy, as opposed to RAOSLO andconventional fundus photography.Conclusions: We believe that the clinical role of FAOSLO hassignificant potential. Comparison with motion contrast-basedtechniques remains to be evaluated. We believe that coupled withRAOSLO and a method to analyze microangiopathic featuresquantitatively, FAOSLO will lead to a better understanding of CRVOpathophysiology, disease progression and a more comprehensivemethod in monitoring tissue response to different treatmentmodalities.©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.