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Purpose: To describe retinal pigment epithelium (RPE) aperture preceding the collapse of RPE detachments (RPEDs) in eyes with neovascular and nonneovascular age-related macular degeneration (AMD). Methods: Medical records from five patients with RPE aperture associated with vascular and avascular RPEDs were reviewed between 2010 and 2021 at the New England Eye Center at Tufts Medical Center. Main outcome measures were analysis of RPE aperture characteristics and temporal course of RPED collapse. Results: Retinal pigment epithelium apertures were identified in six eyes from five women (mean age of 72.6 years). Two eyes had neovasacular AMD and four eyes had nonneovascular AMD. The RPE aperture initially appeared as a discontinuity at the apex of the RPED without rippling or retraction. Each aperture was associated with hypertransmission of optical coherence tomography signal into the choroid as well as hyperreflective foci. The mean time between the appearance of the RPE aperture and near-complete collapse of the RPED was 9 months. After RPED collapse, one eye developed choroidal neovascularization, three eyes progressed to geographic atrophy, one eye had recurrence of the RPED, and one eye remained unchanged. Conclusion: Retinal pigment epithelium aperture is a characteristic optical coherence tomography finding that can be observed in avascular or vascularized RPED secondary to AMD. Retinal pigment epithelium apertures precede RPED collapse, which are most likely to occur within 9 months of RPE aperture detection. [ABSTRACT FROM AUTHOR]

Optical coherence tomography angiography (OCTA) can visualize vasculature structures, but provides limited information about blood flow speed. Here, we present a second generation variable interscan time analysis (VISTA) OCTA, which evaluates a quantitative surrogate marker for blood flow speed in vasculature. At the capillary level, spatially compiled OCTA and a simple temporal autocorrelation model, ρ ( τ ) = exp(- ατ ), were used to evaluate a temporal autocorrelation decay constant, α , as the blood flow speed marker. A 600 kHz A-scan rate swept-source OCT prototype instrument provides short interscan time OCTA and fine A-scan spacing acquisition, while maintaining multi mm 2 field of views for human retinal imaging. We demonstrate the cardiac pulsatility and assess repeatability of α measured with VISTA. We show different α for different retinal capillary plexuses in healthy eyes and present representative VISTA OCTA in eyes with diabetic retinopathy., Competing Interests: EMM: IP related to VISTA-OCTA (P). SBP: IP related to VISTA-OCTA (P). NKW: Topcon (C, F), Complement Therapeutics (C), Olix Pharma (C), Iolyx Pharmaceuticals (C), Hubble (C), Saliogen (C), Syncona (C), AGTC (E), Ocudyne (I), Gyroscope (I), Nidek (F, R), Zeiss (F). JGF: Optovue (I, P), Topcon (F), IP related to VISTA-OCTA (P)., (© 2023 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement.)