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Clinical Sciences |

Outer Retinal Morphology and Visual Function in Patients With Idiopathic Epiretinal Membrane

Ken Watanabe, MD; Kazushige Tsunoda, MD, PhD; Yoshinobu Mizuno, MD; Kunihiko Akiyama, MD; Toru Noda, MD
JAMA Ophthalmol. 2013;131(2):172-177. doi:10.1001/jamaophthalmol.2013.686.
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Objective  To determine the relationship between the morphology of the fovea and visual acuity in patients with an untreated idiopathic epiretinal membrane (ERM).

Methods  We examined 52 eyes of 45 patients diagnosed with an ERM. The morphology of the foveal area was determined by spectral-domain optical coherence tomography. The relationships between the best-corrected visual acuity (BCVA) and 8 optical coherence tomography features, central retinal thickness, cone outer segment tip (COST) line, photoreceptor inner/outer segment (IS/OS) junction line, foveal bulge of the IS/OS line, external limiting membrane, inner limiting membrane, foveal pit, and ERM over the foveal center, were evaluated.

Results  Multiple regression analysis showed that intact COST line, IS/OS junction line, and external limiting membrane independently and significantly contributed to the BCVA. The standardized partial regression coefficient β was 0.415 for the COST line, 0.287 for the IS/OS junction line, and 0.247 for the external limiting membrane. However, the other features, eg, foveal bulge, inner limiting membrane, foveal pit, and ERM, were not significantly associated with the BCVA. The central retinal thickness was significantly correlated with the BCVA (r2 = 0.274; P < .01).

Conclusions  At an early stage of an ERM, only the photoreceptor structures are significantly associated with the BCVA, and the appearance of the COST line was most highly associated. Detailed examinations of the photoreceptor structures using optical coherence tomography may help find photoreceptor dysfunction in cases of idiopathic ERM.

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Figures

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Grahic Jump Location

Figure 1. Optical coherence tomography images. A, Horizontal optical coherence tomography image of the retina of a normal eye with a magnified image showing the locations of the external limiting membrane (ELM), photoreceptor inner segment/outer segment junction line (IS/OS), cone outer segment tip line (COST), retinal pigment epithelium (RPE), foveal bulge (asterisk), and central retinal thickness (CRT) (arrow). Scale bar = 500 μm. B and C, Classification of 7 features in spectral-domain optical coherence tomography image in patients with an epiretinal membrane (ERM). A indicates abnormal; ILM, internal limiting membrane; and N, normal.

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Grahic Jump Location

Figure 2. Comparisons between normal (N) and abnormal (A) eyes for 7 optical coherence tomography features. A, Best-corrected visual acuity (BCVA). B, Central retinal thickness (CRT). Mann-Whitney test, * P < .05 and † P < .01. COST indicates cone outer segment tip line; ELM, external limiting membrane; ERM, epiretinal membrane; ILM, internal limiting membrane; and IS/OS, inner segment/outer segment junction line.

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Grahic Jump Location

Figure 3. Significant correlation between central retinal thickness (CRT) and best-corrected visual acuity (BCVA) in 52 eyes. Pearson correlation coefficient r2 was 0.274 (P < .01).

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