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To investigate the prognostic value of peripheral retinal nonperfusion in patients with diabetic retinopathy using ultra-widefield fluorescein angiography (UWFA).A cross-sectional study included 78 treatment-naïve eyes with nonproliferative and proliferative diabetic retinopathy (NPDR and PDR). Eyes were divided into three groups: mild/moderate NPDR (n = 31), severe NPDR (n = 31), and PDR (n = 16). Three nonperfusion variables were calculated reflecting the proportion of nonperfused to visible retina based on initial UWFA: central nonperfusion (CNP) index, peripheral nonperfusion (PNP) index, and PNP ratio. The relationships between these indices and central subfield thickness (CST) and spectacle-corrected visual acuity (SCVA) were evaluated.CNP and PNP indices were significantly higher in the PDR group vs. mild/moderate NPDR group (p = 0.007 and 0.008, respectively) but not in the PDR group vs. severe NPDR group (p = 0.149 and p = 0.535, respectively). A significant linear correlation was found between the CNP and PNP indices in both severe NPDR and PDR groups (RHigher amounts of retinal nonperfusion are seen in patients with more severe retinopathy. Increased CNP is associated with macular thickening and subsequent vision loss. Having predominantly PNP was independently associated with worse VA, regardless of macular thickness. Further studies are needed to investigate the role of PNP in vision loss in diabetic retinopathy.

Interest in fundus autofluorescence (FAF) imaging in the setting of geographic atrophy (GA) secondary to nonneovascular age-related macular degeneration (AMD) has recently increased. Attempts have been made to describe FAF phenotypes1–3 and to correlate these phenotypes with prognosis for disease progression.3–6 Several studies have also investigated the natural progression of GA and have primarily used either color fundus photographs (CFP)7–10 or FAF images.5,6,11,12 The Age-Related Eye Disease Study Research Group9,10 and the natural history studies of GA performed by Sunness et al7,8 used different techniques of measuring GA with color fundus photos. Both these groups used film instead of digital images and required special procedures to calculate GA area. Although these techniques were shown to be relatively reliable, they were arguably labor intensive and involved using either standardized grids over photographic slides9 or projections of film onto paper, repeated manual tracings, and corrections for multiple magnifications.7,8 More recently, the Age-Related Eye Disease Study Research Group reported growth rates of GA using digitized standard CFP.10 Furthermore, these methods required adjustments based on the Macular Photocoagulation Study standard disk size (1 disk area [DA] defined as 2.54 mm2)7 or other standard disk sizes (e.g., 2.66 mm2),10 and the resulting measurements were approximations. Other researchers have recently described the use of digital FAF images for measuring GA and predicting progression.5,6,11,12 The recent emergence of clinical trials to evaluate new therapies for nonneovascular AMD has increased the need for reliable, accurate, and simple means of monitoring GA size and progression. Whether CFP or FAF is superior for measuring GA area is not known. In this study, we compared digital CFP and FAF in the setting of GA secondary to nonneovascular AMD. We sought to determine whether CFP or FAF has less grader variability in the measurement of total GA area at a given time point.

Fundus autofluorescence imaging has been shown to be helpful in predicting progression of geographic atrophy (GA) secondary to age-related macular degeneration. We assess the ability of fundus autofluorescence imaging to predict rate of GA progression using a simple categorical scheme.Subjects with GA secondary to age-related macular degeneration with fundus autofluorescence imaging acquired at least 12 months apart were included. Rim area focal hyperautofluorescence was defined as percentage of the 500-μm-wide margin bordering the GA that contained increased autofluorescence. Rim area focal hyperautofluorescence on baseline fundus autofluorescence images was assessed and categorized depending on the extent of rim area focal hyperautofluorescence (Category 1: ≤33%; Category 2: between 33 and 67%; Category 3: ≥67%). Total GA areas at baseline and follow-up were measured to calculate change in GA progression.Forty-five eyes of 45 subjects were included; average duration of follow-up was 18.5 months. Median growth rates differed among categories of baseline rim area focal hyperautofluorescence (P = 0.01 among Categories 1, 2, and 3; P = 0.008 for Category 1 compared with Category 3, Jonckheere-Terpstra test).A simple categorical scheme that stratifies the amount of increased autofluorescence in the 500-μm margin bordering GA may be used to differentiate faster and slower progressors.

Purpose To evaluate macular volume in normal and glaucomatous eyes using optical coherence tomography (OCT). Design Case control study. Methods The authors assessed 272 eyes of 164 subjects as part of an institutional study at New England Eye Center in Boston, Massachusetts; 202 eyes were in the study group and 70 eyes in the control group. Eyes were categorized as normal (70 eyes of 43 subjects), glaucoma suspect (70 eyes of 44 subjects), early glaucoma (70 eyes of 47 subjects), or advanced glaucoma (62 eyes of 43 subjects). Subjects underwent analysis with the commercially available OCT1 unit. Optical coherence tomography macular neurosensory retinal thickness maps were used to calculate macular volume for comparison to Humphrey visual field testing, intraocular pressure measurement, and stereo biomicroscopy of the optic nerve head and nerve fiber layer. Results Using repeated measures regression, macular volume in normal (2.37 ± 0.11 mm 3 ) glaucoma suspect (2.33 ± 0.16 mm 3 ), and early glaucoma eyes (2.27 ± 0.13 mm 3 ) was significantly greater than in eyes with advanced glaucoma (2.12 ± 0.23 mm 3 , P = .0001, P = .0001, and P = .0008, respectively). Macular volume in normal eyes was significantly greater than in early glaucoma eyes ( P = .01). Conclusions Optical coherence tomography retinal macular volume correlates with known structural defects of glaucoma, providing a potential objective and quantitative parameter for evaluation. Our data show a significant difference in macular volume between normal, glaucoma suspect, and early glaucoma eyes, compared with advanced glaucomatous eyes as well as between normal and early glaucomatous eyes. This correlates with a trend of decreasing macular volume in eyes with more advanced disease.

To evaluate the hypothesis that macular thickness correlates with the diagnosis of glaucoma.Cross-sectional study.We studied 367 subjects (534 eyes), including 166 eyes of 109 normal subjects, 83 eyes of 58 glaucoma suspects, 196 eyes of 132 early glaucoma patients, and 89 eyes of 68 advanced glaucoma patients.We used optical coherence tomography (OCT) to measure macular and nerve fiber layer (NFL) thickness and to analyze their correlation with each other and with glaucoma status. We used both the commercial and prototype OCT units and evaluated correspondence between measurements performed on the same eyes on the same days.Macular and NFL thickness as measured by OCT.All NFL parameters both in prototype and commercial OCT units were statistically significantly different comparing normal subjects and either early or advanced glaucoma (P0.001). Inner ring, outer ring, and mean macular thickness both in prototype and commercial OCT devices were found to be significantly different between normal subjects and advanced glaucomatous eyes (P0.001). The outer ring was the only macular parameter that could significantly differentiate between normal and early glaucoma with either the prototype or commercial OCT unit (P = 0.003, P = 0.008, respectively). The area under the receiver operator characteristic (AROC) curves comparing mean NFL thickness between normal and advanced glaucomatous eyes was 1.00 for both the prototype and commercial OCT devices for eyes scanned on both machines on the same day. The AROC comparing mean macular thickness in normal and advanced glaucomatous eyes scanned on both machines on the same day was 0.88 for the prototype OCT device and 0.80 for the commercial OCT.Both macular and NFL thickness as measured by OCT showed statistically significant correlations with glaucoma, although NFL thickness showed a stronger association than macular thickness. There was good correspondence between findings using both the prototype and commercial OCT units. Macular and NFL thickness measurements made with OCT may have usefulness in the clinical assessment of glaucoma.

Choroidal melanoma represents a diagnostic challenge in ophthalmology owing to the varied presenting symptoms and signs coupled with a wide variety of masquerading lesions. In this article the authors review the clinical presentation and differential diagnosis of this malignant neoplasm.