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. 2015 May;56(5):3226-34.
doi: 10.1167/iovs.14-16050.

Near-infrared autofluorescence: its relationship to short-wavelength autofluorescence and optical coherence tomography in recessive stargardt disease

Vivienne C Greenstein  1 , Ari D Schuman  2 , Winston Lee  1 , Tobias Duncker  3 , Jana Zernant  1 , Rando Allikmets  4 , Donald C Hood  1 , Janet R Sparrow  4
Affiliations

Near-infrared autofluorescence: its relationship to short-wavelength autofluorescence and optical coherence tomography in recessive stargardt disease

Vivienne C Greenstein et al. Invest Ophthalmol Vis Sci. 2015 May.

Abstract

Purpose: We compared hypoautofluorescent (hypoAF) areas detected with near-infrared (NIR-AF) and short-wavelength autofluorescence (SW-AF) in patients with recessive Stargardt disease (STGD1) to retinal structure using spectral domain optical coherence tomography (SD-OCT).

Methods: The SD-OCT volume scans, and SW-AF and NIR-AF images were obtained from 15 eyes of 15 patients with STGD1 and registered to each other. Thickness maps of the total retina, receptor-plus layer (R+, from distal border of the RPE to outer plexiform/inner nuclear layer boundary), and outer segment-plus layer (OS+, from distal border of the RPE to ellipsoid zone [EZ] band) were created from SD-OCT scans. These were compared qualitatively and quantitatively to the hypoAF areas in SW-AF and NIR-AF images.

Results: All eyes showed a hypoAF area in the central macula and loss of the EZ band in SD-OCT scans. The hypoAF area was larger in NIR than SW-AF images and it exceeded the area of EZ band loss for 12 eyes. The thickness maps showed progressive thinning towards the central macula, with the OS+ layer showing the most extensive and severe thinning. The central hypoAF areas on NIR corresponded to the OS+ thinned areas, while the hypoAF areas on SW-AF corresponded to the R+ thinned areas.

Conclusions: Since the larger hypoAF area on NIR-AF exceeded the region of EZ band loss, and corresponded to the OS+ thinned area, RPE cell loss occurred before photoreceptor cell loss. The NIR-AF imaging may be an effective tool for following progression and predicting loss of photoreceptors in STGD1.

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Figures

Figure 1
Figure 1
(A) Horizontal SD-OCT b-scan of a healthy subject through the fovea. Red, cyan, pink, and blue lines represent borders that have been segmented. Red vertical lines show the thicknesses that were mapped. (B) Horizontal SD-OCT scan of P15 through the fovea. Red, cyan, pink, and blue lines were segmented. White arrows show the region of EZ band loss.
Figure 2
Figure 2
The SW-AF and NIR-AF images from a normal subject, showing hypoAF in the central macula on SW-AF and hyperAF in the central macula on NIR-AF.
Figure 3
Figure 3
Examples of SW-AF and NIR-AF images from 3 patients. (A) A more intense hyperAF ring on NIR-AF than on SW-AF in P5. (B) A fleck that is hyperAF on SW-AF and hypoAF on NIR-AF in P11. (C) Foveal sparing, which is more apparent on NIR-AF than SW-AF in P10.
Figure 4
Figure 4
Bland-Altman plot showing differences in the size of the NIR- hypoAF and SW- hypoAF areas in the central macula. The dashed horizontal lines represent 95% CIs and the bold solid line represents the mean.
Figure 5
Figure 5
The SW-AF image for P14 is shown (upper), the SD-OCT horizontal scan through the fovea (center) panel, and the NIR-AF image (lower). (A) Horizontal extent of the NIR hypoAF defect. (B) Extent of EZ band loss. (C) Extent of the SW hypoAF defect.
Figure 6
Figure 6
The locations of the edges of the EZ band, represented by the white dots, overlaid onto the SW-AF and NIR-AF images for P5.
Figure 7
Figure 7
Normalized thickness maps for SD-OCT volume scans from a control and 3 representative patients (P3, P8, and P15) for TR, R+, and OS+ layers. The maps show normalized thickness, where dark blue is 0% of normal and dark red is 120% of normal. Thinning progressing from the periphery toward the center can be seen for all three layer measurements, with the most severe central thinning seen in the OS+ map.
Figure 8
Figure 8
Thickness maps of P9 overlaid on SW-AF and NIR-AF images. The white outline represents the measured hypoAF area on SW-AF and NIR-AF. The scale on the right shows relative thickness compared to normals, where dark red is above normal thickness and dark blue is 0% of normal thickness.
Figure 9
Figure 9
Comparison between the areas of central hypoAF on NIR-AF (red symbols) and SW-AF (blue symbols) and the thinned areas for the R+ (A) and OS+ (B) layers for all 15 eyes. The diagonal line represents equality.
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