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Comparative Study
, 150 (1), 63-67.e1

The Association Between Percent Disruption of the Photoreceptor Inner Segment-Outer Segment Junction and Visual Acuity in Diabetic Macular Edema

Affiliations
Comparative Study

The Association Between Percent Disruption of the Photoreceptor Inner Segment-Outer Segment Junction and Visual Acuity in Diabetic Macular Edema

Anjali S Maheshwary et al. Am J Ophthalmol.

Abstract

Purpose: To evaluate the integrity of the photoreceptor inner segment/outer segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity.

Design: Retrospective, comparative, consecutive case series.

Methods: Sixty-two eyes from 38 patients with diabetic macular edema underwent SD OCT imaging. For each patient, 2 experienced observers masked to visual acuity measured several SD OCT variables, including central macular thickness, retinal volume, global disruption scale of outer retina, percentage disruption of the outer retina, and history of previous treatments. Visual acuity recorded as number of Early Treatment Diabetic Retinopathy Study letters was used as the outcome variable in univariate and multivariate analysis testing the measured SD OCT variables as predictors.

Results: A statistically significant correlation between percentage disruption of the IS/OS junction and visual acuity was found (P = .0312). Additionally, there was a strong trend suggesting a relationship between macular volume and visual acuity, although borderline significance was found (P = .07).

Conclusions: Disruption of the photoreceptor IS/OS junction is an important predictor of visual acuity among diabetic macular edema patients.

Figures

Figure 1
Figure 1. Normal Retinal Layers Imaged by SD-OCT
Spectral domain OCT imaged with Heidelberg Spectralis. Note the improved delineation of each layer of the retina and the clearly distinguishable IS/OS junction. ILM=internal limiting membrane, RNFL: retinal nerve fiber layer, GCL: ganglion cell layer, IPL: inner plexiform layer, INL: inner nuclear layer, OPL: outer plexiform layer, ONL: outer nuclear layer, ELM: external limited membrane, IS/OS inner segment/outer segment junction, RPE: retinal pigment epithelium.
Figure 2
Figure 2. Examples of Photoreceptor IS/OS Layer Disruption on SD-OCT in Patients with Diabetic Macular Edema
Six SD-OCT Heidelberg Spectralis images through the fovea. The photoreceptor IS/OS layer was evaluated 500 microns in either direction of the fovea. The IS/OS disruption was graded from 0–2. Grade 0 was given when an intact IS/OS layer was found, Grade 1 scored focal disruption of the IS/OS junction of 200 microns or less, and Grade 2 scored greater than 200 microns of disruption. The percentage of disruption along the IS/OS layer, again measured 500 microns in either direction from the foveal center, was recorded. The percentage disruption was averaged to generate a number between 0% (no IS/OS disruption) and 100% (total loss of the IS/OS layer in both horizontal and vertical scans). The arrow head corresponds to the IS/OS junction: top right and left shows an intact IS/OS junction with Grade 0 disruption, the middle right and left shows a disrupted IS/OS junction with Grade 1 disruption, and the bottom right and left show a disrupted IS/OS junction with Grade 2 disruption
Figure 3
Figure 3. Relationship between Visual Acuity and Increasing IS/OS Disruption on SD-OCT in Patients with Diabetic Macular Edema
The scatter plot of patient visual acuity, expressed as the ETDRS letters read, over percentage of inner and outer segment disruption, judged from the spectral OCT, with a regression line. The graph demonstrates the decline of visual acuity with the increasing disturbance of the IS/OS layer of the photoreceptors. The regression coefficient was −0.30 after adjusting for volume effect, indicating that for each percent increase of IS/OS disruption vision decreases by 0.3 ETDRS letters.

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