Ellipsoid Band Research Articles

Multifocal electroretinogram and en‐face OCT in patients who underwent retinal detachment surgery

PurposeTo study the anatomical and functional recovery after retinal detachment surgery (RD) by studying the reflectivity of the ellipsoid band (ISe) measured in en‐face OCT and multifocal electroretinography (M‐ERG) and investigate the factors involved in the results.MethodsProspective study of 39 patients operated successfully of RD and examined at baseline and at 3 (M3) and 6 months (M6). SD‐OCT and M‐ERG were performed at each visit. A coronal view of the ganglion cell layer (GCL) and the cone inner segment ellipsoid (ISe) band were reconstructed on en‐face OCT. The mean reflectivity in the 2 central degrees was calculated using image J and expressed as a gray level ranging from 0 (black) to 256 (white).ResultsM‐ERG waves amplitudes were reduced in RD involving the macula (p < 0.05). Best corrected visual acuity (BCVA) was correlated to the M‐ERG amplitudes at 6 months (p < 0.01). CGL and ISe reflectivity were lower in the group with macular involvement (p < 0.05). ISe reflectivity was correlated with the BCVA at M3 and M6 (p < 0.001). ISe reflectivity was also related to the duration of the macular detachment (p = 0.01). However, we did not observe any correlation between GCL reflectivity and BCVA. While, the GCL reflectivity was correlated with the RMS amplitudes (p = 0.03), there was no correlation between M‐ERG amplitudes and ISe reflectivity.ConclusionsM‐ERG represents a valuable tool in the assessment of visual function after RD. En‐face OCT brings new insight on the integrity of the retinal structures after surgery, and shows that both inner and outer retinal layers are impaired after RD reattachment.

Nitric oxide and oxidative stress is associated with severity of diabetic retinopathy and retinal structural alterations.

The aim of the study was to determine plasma nitric oxide (NO) and lipid peroxide (LPO) levels in diabetic retinopathy and its association with severity of disease. Prospective observational study. A total of 60 consecutive cases and 20 healthy controls were included. Severity of retinopathy was graded according to early treatment diabetic retinopathy study (ETDRS) classification. Photoreceptor inner segment ellipsoid band (ISel) disruption and retinal pigment epithelium (RPE) alteration were graded using spectral domain optical coherence tomography. Data were statistically analyzed. Plasma thiobarbituric acid reactive substances, NO assay and reduced glutathione (GSH) were measured using standard protocol. Increased severity of diabetic retinopathy was significantly associated with increase in plasma levels of LPO (P < 0.05), NO (P < 0.001) and decrease in plasma levels of GSH (P < 0.0001), ISel disruption (P < 0.001) and RPE topographic alteration (P < 0.01). Increased plasma NO levels are associated with increased severity of diabetic retinopathy. For the first time, it has been demonstrated that increased plasma LPO, NO and decreased GSH levels are associated with in vivo structural changes in inner segment ellipsoid and RPE.

Reflectivity of the Outer Retina on Spectral-Domain Optical Coherence Tomography as a Predictor of Photoreceptor Cone Density

To investigate the relationship between outer retinal reflectivity on spectral-domain optical coherence tomography and cone density in the corresponding area. Prospective cross-sectional observational study. In this institutional-based study, 20 eyes of 10 patients presenting maculopathies with various degrees of impairment of the photoreceptor layer (central serous chorioretinopathy, chronic central serous chorioretinopathy, maculopathy associated with hydroxychloroquine, and healthy eyes) were studied. Selection criteria were intended to ensure good image quality. Inner segment ellipsoid band reflectivity, global retinal reflectivity, and relative inner segment ellipsoid reflectivity (defined as the ratio of inner segment ellipsoid band reflectivity on overall retinal reflectivity) were measured on a longitudinal reflectance profile extracted from the spectral-domain optical coherence tomography B-scan. The cone metrics were measured in the same region of interest, located in the perifoveal area, using an adaptive optics retinal camera. Inner segment ellipsoid and relative ellipsoid reflectivity were closely correlated with cone density (Pearson r: 0.72 and 0.70, respectively, P < .01). Outer retinal reflectivity on the transversal optical coherence tomography scan can be correlated to adaptive optics in terms of photoreceptor density. This quantitative approach using optical coherence tomography images could have important implications in the management of maculopathies.

Retinal degeneration in autoimmune polyglandular syndrome type 1: a case series

BackgroundAutoimmune polyglandular syndrome type 1 (APS1) is a rare autosomal recessive disorder due to mutations in the AIRE gene.AimTo report the ocular features and characterise the retinal phenotype in molecularly...

Homozygous Nonsense Mutations in RBP3 Gene Cause Early-Onset Retinal Dystrophies Associated With High Myopia.

The very detailed report by Arno et al. 1 of early-onset autosomal recessive dystrophies associated with high myopia occurring in young children carrying homozygous nonsense mutations of the RBP3 gene highlights the power of the combination of meticulous phenotyping and whole-exome sequencing analysis in the field of inherited retinal dystrophies. A homozygous missense mutation of the RBP3 gene was previously associated with autosomal recessive retinitis pigmentosa (RP) and high myopia in adult patients. 2 The recent findings emphasize the importance of longitudinal phenotypic studies based on the addition of the most modern methods of investigation, such as fundus autofluorescence imaging and spectral-domain optical coherence tomography (OCT), to the classical methods used for the diagnosis of retinal dystrophies. The authors not only have discovered novel phenotypes of retinal dystrophies caused by different mutations in the same gene RBP3, but also show unequivocally that the loss of the inner segment ellipsoid band over peripheral macular areas is a key marker of the novel dystrophies found. Whether these novel phenotypes will evolve toward RP remains to be demonstrated by rigorous follow-up studies of each affected patient. This report illustrates the necessity of increasing our knowledge on the unknown and probably diverse functions of the interphotoreceptor retinoid binding protein (IRBP). 3 The roles of IRBP in the normal development of human eye and retina are far from being fully understood. The exploration of the role of IRBP in the pathophysiology of nonsyndromic myopia requires the urgent implementation of cleverly designed innovative experiments. Finally, this important study points toward the possibility of a window of opportunity for gene therapy or pharmacological therapies in some patients affected by RBP3 homozygous mutations.

ASSOCIATION BETWEEN MACULAR PERFUSION AND PHOTORECEPTOR LAYER STATUS IN DIABETIC MACULAR EDEMA

To evaluate the relationship between the photoreceptor layer status (inner segment ellipsoid band and external limiting membrane) and the foveal avascular zone size, as a result of macular perfusion, in patients with diabetic macular edema. This observational case series study included 151 eyes of 118 patients with naive diabetic macular edema. The length of the disrupted photoreceptor layer was assessed by optical coherence tomography. The foveal avascular zone diameter was measured on fluorescein angiogram. No significant association was found between the foveal avascular zone size and the mean lengths of the disrupted inner segment ellipsoid band nor the external limiting membrane in patients with naive diabetic macular edema. Macular ischemia, which lengthens the distance from the perifoveal vessels to the center of the fovea and may disrupt the normal flow of nutrients by simple diffusion to the photoreceptor line, does not seem to influence on inner segment ellipsoid band nor external limiting membrane integrity. Future studies may evaluate the effect of choroidal vascularization on the photoreceptor layer status to enhance the knowledge about the photoreceptor layer nutrients source.

CHORIORETINAL ATROPHY IN ALAGILLE SYNDROME

To describe multimodal imaging findings in a patient with Alagille syndrome and associated chorioretinopathy. In this case report, clinical examination and multimodal imaging, including fundus photography, spectral domain optical coherence tomography, and fundus autofluorescence (AF) and wide-field AF, are presented. An 18-year-old Iranian-American girl with known history of Alagille syndrome reported diminished vision in both eyes. Color photographs depicted diffuse hypopigmentation of the fundus and atrophy of the macular retinal pigment epithelium with foveal sparing. Spectral domain optical coherence tomography revealed attenuation of the retinal pigment epithelium and overlying ellipsoid band. Fundus AF imaging of the macula revealed a geographic area of decreased AF that extended to the peripapillary region and inferotemporal arcade and contained discernable ovoid areas of deep AF loss in the nasal macula. Wide-field AF revealed a continuous and circumferential area of well-delineated decreased AF in the retinal periphery of both eyes. This case represents a severe manifestation of posterior and peripheral chorioretinopathy in a patient with Alagille syndrome. This is the first documentation of significant peripheral chorioretinal atrophy as assessed by wide-field AF imaging in this condition.

Photoreceptor inner segment ellipsoid band integrity on spectral domain optical coherence tomography.

Spectral domain optical coherence tomography cross-sectional imaging of the macula has conventionally been resolved into four bands. However, some doubts were raised regarding authentication of the existence of these bands. Recently, a number of studies have suggested that the second band appeared to originate from the inner segment ellipsoids of the foveal cone photoreceptors, and therefore the previously called inner segment-outer segment junction is now referred to as inner segment ellipsoidband. Photoreceptor dysfunction may be a significant predictor of visual acuity in a spectrum of surgical and medical retinal diseases. This review aims to provide an overview and summarizes the role of the photoreceptor inner segment ellipsoid band in the management and prognostication of various vitreoretinal diseases.

Relation between the retinal reflectivity on SD‐OCT and the cone density measured using adaptive optics

AbstractPurpose To assess the relation between the relative reflectivity of the inner segment ellipsoid (ISe) band on Spectral domain (SD)‐OCT and the cone density measured using adaptive optics.Methods Twenty eyes of 10 subjects were studied. Two subjects were healthy and the others were randomly chosen from a pool of patients presenting retinal diseases impairing bilaterally the ISe layer. Horizontal B‐scans were acquired using SD‐OCT (Spectralis, Heidelberg, Germany). The relative reflectivity, defined as the ratio between the reflectivity of the ISe layer and the reflectivity of the full retinal thickness was measured, together with ISe thickness, using ImageJ. Cone counts were performed at 2° eccentricity from the fovea (nasal, temporal, superior and inferior areas) using an Adaptive Optics retinal camera (RTX1, Imagine Eyes, Orsay, France) and its dedicated software (AOdetect v0.1™ ,Imagine Eyes, Orsay, France). Correlation coefficients (Pearson r) between the cone density and the others parameters were calculated for each area.Results Cone densities were significantly correlated with the ISe relative reflectivity (r = 0,70 [0,59 ; 0,79] p&lt;0,01), and to a lesser extent with the ISe thickness (r = 0,32 [0,04 ; 0,56] p&lt;0,01) and with BCVA (logMAR) (r = ‐0,38 [‐0,55;‐0,21] p&lt;0,01).Conclusion The reflectivity on SD‐OCT of the outer retina brings valuable information on photoreceptor density in absence of adaptive optics camera. Further developments in OCT software enabling it uses in a clinical setting would be a useful advance.

Complete retinal fluid resorption with low visual acuity in patients with diabetic macular edema (DME) over the course of ranibizumab treatment: OCT analysis

AbstractPurpose Intravitreal ranibizumab injections in DME often leads to resorption of edema. Nevertheless, complete resorption of DME is weakly correlated with good visual acuity (VA). The purpose of our study was to investigate the anatomical OCT features of patients treated with ranibizumab for DME with low VA despite of complete dry retina.Methods We included in a retrospective fashion all patients over the course of ranibizumab treatment for DME at Avicenne Hospital (Bobigny, France) with a dry retina after treatment (central foveal thickness (CFT) ≤ 250 μm and presence of foveal pit). We analyzed the characteristics of outer retinal layers in spectral‐domain OCT (Optos OCT SLO) in case of low final VA (best‐corrected VA (BCVA) with dry retina &lt; 5/10 after at least 3 injections).Results We included 40 patients. Complete retinal fluid resorption was achieved for 24 patients (60%). Among these patients, half of them (12 patients ie 30 % of our cohort) had low VA (group 1) and 12 patients had good VA ( group 2). Mean CFT was 713 μm in group 1 (G1) and 666μm (p = 0.64) in group 2 (G2). After treatment, mean CFT in G1 was 165 μm against 174 μm (p = 0.6) in G2. For all patients in G1, anatomical changes were noted on OCT pictures after treatment: loss or thinning of ellipsoid band (n = 6), atrophic cyst (n = 6), exudates (n = 3), epiretinal membrane (n = 2).Conclusion Insufficient improvement of BCVA after complete retinal fluid resorption happened in about 30% of patients over the course of ranibizumab treatment for DME, and was often associated in our study with alterations of outer retinal layers in SD‐OCT imaging.

The external limiting membrane in early-onset Stargardt disease.

To describe pathologic changes of the external limiting membrane (ELM) in young patients with early-onset Stargardt (STGD1) disease. Twenty-six STGD1 patients aged younger than 20 years with confirmed disease-causing adenosine triphosphate-binding cassette, subfamily A, member 4 (ABCA4) alleles and 30 age-matched unaffected individuals were studied. Spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (AF), and color fundus photography (CFP) images, as well as full-field electroretinograms were obtained and analyzed for one to four visits in each patient. The ELM in all patients exhibited a distinct thickening that was not observed in unaffected individuals. In addition, accumulations of reflective deposits were noted in the outer nuclear layer in every patient. Four patients exhibited a concave protuberance or bulging of a thickened and hyperreflective ELM band within the fovea containing preserved photoreceptors. Longitudinal SD-OCT data in several patients revealed the persistence of this ELM abnormality over a period of time (1-4 years). Furthermore, the edges of the inner segment ellipsoid band appeared to recede earlier than the ELM band in active lesions. Structural changes seen in the ELM of this cohort may reflect a gliotic response to cellular stress at the photoreceptor level in early-onset STGD1.

Reticular macular lesions: a review of the phenotypic hallmarks and their clinical significance

Reticular macular lesions, also known as 'reticular macular disease', 'reticular drusen', 'reticular pseudodrusen', or 'subretinal drusenoid deposits', are a pattern of lesions commonly found in age-related macular degeneration and best visualized using at least two imaging techniques in combination. Reticular lesions have four stages of progression observable on spectral domain optical coherence tomography, but they do not show the usual signs of regression of soft drusen (calcification and pigment changes). Furthermore, reticular lesions correlate histologically with subretinal drusenoid deposits localized between the retinal pigment epithelium and the inner segment ellipsoid band. Reticular lesions are most commonly seen in older age groups of female patients with age-related macular degeneration and are usually bilateral. They are not clearly associated with known age-related macular degeneration genes and are highly associated with late-stage age-related macular degeneration and an increased mortality rate. They are also associated with alterations in the neural retina and choroid.

Multimodal imaging and multifocal electroretinography demonstrate autosomal recessive Stargardt disease may present like occult macular dystrophy.

To describe multimodal imaging and electrophysiologic characteristics of an unusual subset of patients with genetically confirmed autosomal recessive Stargardt disease (STGD1) who exhibited a central form of cone dysfunction resembling occult macular dystrophy that preceded the development of lipofuscin flecks, atrophy of retinal pigment epithelium (RPE), or full-field electroretinography abnormalities. Retrospective, observational descriptive case series. Five patients with compound heterozygous ABCA4 mutations presented with bilateral visual acuity reduction, normal-appearing fundi, and blocked choroidal fluorescence on fluorescein angiography. One sibling each of two probands with identical genotypes was also included for analysis. Full-field electroretinography testing was normal in all patients, but multifocal electroretinography demonstrated centripetally depressed amplitudes exceeding areas of fundus autofluorescence, infrared imaging, and spectral domain optical coherence tomography abnormalities. Spectral domain optical coherence tomography initially revealed disruption of the inner segment ellipsoid band accompanying an ovoid hypofluorescent foveolar lesion. Progression to later stages was accompanied by the loss of the foveal photoreceptor outer segments, creating foveal cavitation with preservation of the RPE. Fundus autofluorescence and infrared imaging demonstrated corresponding bull's eye lesions. Over time, the foveal potential space on spectral domain optical coherence tomography collapsed, and three patients developed RPE atrophy and visible lipofuscin flecks. The flecks were detectable by fundus autofluorescence and infrared imaging earlier than by biomicroscopy. From these findings, a staging system for this subset of Stargardt disease presenting with central cone dysfunction was developed and presented herein. Autosomal recessive Stargardt disease may present as a central cone dysfunction syndrome before the development of lipofuscin flecks, atrophy of RPE, or full-field electroretinography abnormalities. If emerging therapies for Stargardt disease succeed, early recognition and treatment of patients with preserved foveal photoreceptor and RPE cell bodies may yield a more favorable visual prognosis.

Quantification of cone loss after surgery for retinal detachment involving the macula using adaptive optics

AimsTo image the cones in eyes with anatomically successful repair of retinal detachment (RD) involving the macula and in healthy fellow eyes using an adaptive optics (AO) camera and to...

Theory of band warping and its effects on thermoelectronic transport properties

Optical and transport properties of materials depend heavily upon features of electronic band structures in proximity to energy extrema in the Brillouin zone (BZ). Such features are generally described in terms of multi-dimensional quadratic expansions and corresponding definitions of effective masses. Multi-dimensional expansions, however, are permissible only under strict conditions that are typically violated by degenerate bands and even some non-degenerate bands. Suggestive terms such as "band warping" or "corrugated energy surfaces" have been used to refer to such situations and ad hoc methods have been developed to treat them. While numerical calculations may reflect such features, a complete theory of band warping has not been developed. We develop a generally applicable theory, based on radial expansions, and a corresponding definition of angular effective mass. Our theory also accounts for effects of band non-parabolicity and anisotropy, which hitherto have not been precisely distinguished from, if not utterly confused with, band warping. Based on our theory, we develop precise procedures to evaluate band warping quantitatively. As a benchmark demonstration, we analyze the warping features of valence bands in silicon using first-principles calculations and we compare those with previous semi-empirical models. We use our theory and angular effective masses to generalize derivations of tensorial transport coefficients for cases of either single or multiple electronic bands, with either quadratically expansible or warped energy surfaces. From that theory we discover the formal existence at critical points of transport-equivalent ellipsoidal bands that yield identical results from the standpoint of any transport property. Additionally, we illustrate the drastic effects that band warping can induce on thermoelectric properties using multi-band models.

Relationship between Retinal Microstructures on Optical Coherence Tomography and Microperimetry in Age-Related Macular Degeneration

To determine the relationship between structural parameters of the outer retina on spectral-domain optical coherence tomography (SD-OCT) and microperimetric retinal sensitivity in early stages of age-related macular degeneration (AMD). Prospective, observational study. Seventy-five eyes of 75 participants with early stages of AMD (drusen ≥ 125 μm, with/without pigmentary abnormalities) and 25 control participants of a similar age. Participants underwent microperimetry testing and high-resolution SD-OCT scans. Structural parameters at 5 central points (0°, 1°, and 2.33° nasal and temporal to the fovea along the horizontal axis) corresponding to areas tested by microperimetry were compared. Structural parameters included outer segment (OS) length, thickness and elevation of the retinal pigment epithelium (RPE) band, grading of the inner-segment ellipsoid (ISe) band integrity, and presence of hyperreflective foci (HF). Relationship between structural parameters and retinal sensitivity. Retinal sensitivity was significantly correlated with RPE elevation (P<0.001), ISe grading (P<0.001), and presence of HF (P ≤ 0.018) at all test points, but not with OS length (P ≥ 0.093) or RPE thickness (P ≥ 0.125). However, multiple linear regression analyses revealed that only ISe grading (P ≤ 0.011) and RPE elevation (P ≤ 0.030) remained significantly associated with retinal sensitivity at all points. By using a simple linear model incorporating ISe grading and RPE elevation to predict values of retinal sensitivity, the 95% limits of agreement between the predicted and the actual value was ± 3.83 dB. The integrity of the ISe band and drusen-associated RPE elevation are significant independent predictors of microperimetric retinal sensitivity. Our findings imply that these 2 structural parameters may be surrogate markers of retinal function in the early stages of AMD.

Inner segment ellipsoid band and cone outer segment tips changes preceding macular hole development in a young patient.

Purpose. Pathophysiology of macular hole (MH) is not yet well defined but the advances of spectral domain optical coherence tomography (SD-OCT) give us access to further detailed imaging. We report a case with macular inner segment ellipsoid (ISe) band loss and cone outer segment tips (COST) line changes seen in SD-OCT preceding MH appearance in a young patient. Methods. 21-year-old woman presented with a partial central scotoma, metamorphopsia, and a 20/25 vision in her right eye. Past medical history was positive for laser assisted in situ keratomileusis (LASIK) surgery 7 months ago with no complications. Macular SD-OCT showed ISe band loss and COST line elevation. She was followed a month later with visual acuity deteriorating to 20/200 and a full thickness MH. Results. The patient underwent a pars plana vitrectomy with internal limiting membrane peeling. Her visual acuity 2 months later was 20/20. Conclusion. SD-OCT can identify preliminary changes, yet to be described, preceding MH formation. Our patient demonstrated ISe band loss and COST abnormalities on SD-OCT a month prior to MH development. SD-OCT should be considered in young patients with subtle visual symptoms and mild changes in visual acuity that are not readily explained by ophthalmological exam.

Optical Coherence Tomography Findings in Ocular Argyrosis

A 68-year-old Caucasian man with a remote history of daily colloidal silver ingestion presented for ophthalmic examination in which he was noted to have a distinct slate gray skin discoloration. Funduscopy revealed confluent perimacular drusenoid deposits bilaterally, most of which localized at the level of or anterior to the inner segment ellipsoid band by optical coherence tomography (OCT) imaging. Enhanced depth imaging OCT demonstrated marked choroidal thinning. Fluorescein angiogram displayed a dark or silent choroid. Confirmatory serum silver levels were found to be markedly elevated. This report describes a unique geographic maculopathy with large drusenoid deposits anterior to the ellipsoid layer and severe choroidal thinning in association with ocular argyrosis. [ Ophthalmic Surg Lasers Imaging Retina. 2013;44:E20–E22.]

Macular Cone Abnormalities in Retinitis Pigmentosa with Preserved Central Vision Using Adaptive Optics Scanning Laser Ophthalmoscopy

PurposeTo assess macular photoreceptor abnormalities in eyes with retinitis pigmentosa (RP) with preserved central vision using adaptive optics scanning laser ophthalmoscopy (AO-SLO).MethodsFourteen eyes of 14 patients with RP (best-corrected visual acuity 20/20 or better) and 12 eyes of 12 volunteers underwent a full ophthalmologic examination, fundus autofluorescence, spectral-domain optical coherence tomography (SD-OCT), and imaging with a prototype AO-SLO system. Cone density and spatial organization of the cone mosaic were assessed using AO-SLO images.ResultsIn 3 eyes with RP and preserved central vision, cones formed a mostly regular mosaic pattern with small patchy dark areas, and in 10 eyes, the cone mosaic patterns were less regular, and large dark regions with missing cones were apparent. Only one eye with RP demonstrated a normal, regular cone mosaic pattern. In eyes with RP, cone density was significantly lower at 0.5 mm and 1.0 mm from the center of the fovea compared to normal eyes (P<0.001 and 0.021, respectively). At 0.5 mm and 1.0 mm from the center of the fovea, a decreased number of cones had 6 neighbors in eyes with RP (P = 0.002 for both). Greater decrease in cone density was related to disruption of the photoreceptor inner segment (IS) ellipsoid band on SD-OCT images (P = 0.044); however, dark regions were seen on AO-SLO even in areas of continuous IS ellipsoid on SD-OCT. Decreased cone density correlated thinner outer nuclear layer (P = 0.029) and thinner inner segment and outer segment thickness (P = 0.011) on SD-OCT.ConclusionsCone density is decreased and the regularity of the cone mosaic spatial arrangement is disrupted in eyes with RP, even when visual acuity and foveal sensitivity are good. AO-SLO imaging is a sensitive quantitative tool for detecting photoreceptor abnormalities in eyes with RP.

Assessing the Cone Photoreceptor Mosaic in Eyes with Pseudodrusen and Soft Drusen In Vivo Using Adaptive Optics Imaging

To investigate the cone photoreceptor mosaic in eyes with pseudodrusen as evidenced by the presence of subretinal drusenoid deposits (SDD) and conventional drusen using adaptive optics (AO) imaging integrated into a multimodal imaging approach. Observational case series. Eleven patients (11 eyes) with pseudodrusen and 6 patients (11 eyes) with conventional drusen. Consecutive patients were examined using near-infrared reflectance (IR) confocal scanning laser ophthalmoscopy (SLO) and eye-tracked spectral-domain optical coherence tomography (SD-OCT) and flood-illuminated retinal AO camera of nonconfluent pseudodrusen or conventional drusen. Correlations were made between the IR-SLO, SD-OCT, and AO images. Cone density analysis was performed on AO images within 50 × 50-μm windows in 5 regions of interest overlying and in 5 located between SDD or conventional drusen with the same retinal eccentricity. Cone densities in the regions of interest. The pseudodrusen correlated with subretinal accumulations of material in SD-OCT imaging and this was confirmed in the AO images. Defects in the overlying ellipsoid zone band as seen by SD-OCT were associated with SDD but not conventional drusen. The mean ± standard deviation cone density was 8964 ± 2793 cones/mm(2) between the SDD and 863 ± 388 cones/mm² over the SDD, a 90.4% numerical reduction. By comparison the mean cone packing density was 9838 ± 3723 cones/mm² on conventional drusen and 12,595 ± 3323) cones/mm² between them, a 21.9% numerical reduction. The difference in cone density reduction between the two lesion types was highly significant (P <0.001). The pseudodrusen in these eyes correlated with subretinal deposition of material in multiple imaging modalities. Reduced visibility of cones overlying SDD in the AO images can be because of several possible causes, including a change in their orientation, an alteration of their cellular architecture, or absence of the cones themselves. All of these explanations imply that decreased cone photoreceptor function is possible, suggesting that eyes with pseudodrusen appearance may experience decreased retinal function in age-related macular degeneration independent of choroidal neovascularization or retinal pigment epithelial atrophy.