Abstract
To develop and apply an objective algorithm for analyzing outer retinal layers imaged by spectral-domain optical coherence tomography (SD-OCT) in patients with Stargardt disease (STGD1). Horizontal macular B-scans were acquired from 20 visually normal controls and 20 genetically confirmed stage 1 STGD1 patients. The number of outer retinal bands was quantified using a semiautomated algorithm that detected bands using the second derivative of longitudinal reflectivity profiles. The present analysis focused on the three outermost bands, currently associated with the ellipsoid zone (EZ), cone outer segment interdigitation zone (IZ), and retinal pigment epithelium (RPE) complex. The RPE complex and EZ bands were detected throughout the B-scan in all controls. The RPE complex was detected throughout the B-scan in all patients, but was atrophic appearing in some locations. The EZ band was detected only outside the central lesion. Interdigitation zone band detection varied as a function of eccentricity for both groups, with detection for controls being highest in the para- and perifovea and lowest in the fovea and near periphery. In patients, the IZ band was generally not present in the fovea or para- or perifovea due to the central lesion. Outside of the lesion, the IZ band was detected in 26% of patients (mean detection across the near periphery), which was approximately half of the detection in controls. An objective approach for quantifying the number of outer retinal OCT bands found reduced IZ detection in STGD1 patients. This occurred even outside the central lesion, demonstrating an inability to image the IZ, possibly due to enhanced RPE reflectivity or abnormal outer retinal structure.
Highlights
The present analysis focused on the three outermost bands, currently associated with the ellipsoid zone (EZ), cone outer segment interdigitation zone (IZ), and retinal pigment epithelium (RPE) complex
The RPE complex was detected throughout the B-scan in all patients, but was atrophic appearing in some locations
Interdigitation zone band detection varied as a function of eccentricity for both groups, with detection for controls being highest in the para- and perifovea and lowest in the fovea and near periphery
Summary
Horizontal macular B-scans were acquired from 20 visually normal controls and 20 genetically confirmed stage 1 STGD1 patients. Twenty patients with stage 1 STGD1 (6 males and 14 females) with a mean age (6SD) of 29.7 6 12.2 years participated in this study. The patients’ age, sex, best-corrected visual acuity, number of identified ABCA4 mutations, and the specific mutation(s) identified are summarized in the Table. Twenty control subjects (12 males and 8 females) with a mean age (6SD) of 33.9 6 6.6 years participated in this study. All control subjects had best-corrected visual acuity of 0 logMAR or better (equivalent to Snellen acuity of 20/20 or better), spherical refractive error less than 6.0 diopters, normal Pelli-Robson contrast sensitivity, and no history of visual abnormalities. Informed consent was obtained from each subject before his/her participation
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