Documentation of Intraretinal Retinal Pigment Epithelium Migration via High-Speed Ultrahigh-Resolution Optical Coherence Tomography Citation

PURPOSE—To describe the features of intraretinal retinal pigment epithelium (RPE) migration documented on a prototype spectral domain high speed, ultrahigh resolution optical coherence tomography (OCT) device in a group of patients with early to intermediate dry age-related macular degeneration (AMD). To correlate intraretinal RPE migration on OCT to RPE pigment clumping on fundus photographs. DESIGN—Retrospective, non-comparative, non-interventional case series. PARTICIPANTS—Fifty-five eyes of 44 patients seen at the New England Eye Center between December 2007 and June 2008 with early to intermediate dry AMD. METHODS—3D OCT scan sets from all patients were analyzed for presence of intraretinal RPE migration, defined as small discreet hyper-reflective and highly-backscattering lesions within the neurosensory retina. Fundus photographs were also analyzed to determine the presence of RPE pigment clumping, defined as black-colored, often spiculated areas of pigment clumping within the macula. OCT en face images were correlated with fundus photographs to demonstrate correspondence of intraretinal RPE migration on OCT and RPE clumping on fundus photo. MAIN OUTCOME MEASURES—Drusen, Dry AMD, intraretinal RPE migration, RPE pigment clumping. © 2010 American Academy of Ophthalmology, Inc. Published by Elsevier Inc. All rights reserved. Corresponding Author/ Reprints: Jay S. Duker, MD, Department of Ophthalmology, Chairman, Tufts Medical Center, 800 Washington St., Box #450, Boston, MA, 02111, Tel: 617-636-4677; Fax: 617-636-4866, [email protected]. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disclosures The sponsors had no role in the design or conduct of this research. Authors with financial/conflicting interests are listed after references. NIH Public Access Author Manuscript Ophthalmology. Author manuscript; available in PMC 2012 April 1. Published in final edited form as: Ophthalmology. 2011 April ; 118(4): 687–693. doi:10.1016/j.ophtha.2010.08.010. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript RESULTS—54.5% of eyes (61.4% of patients) demonstrated intraretinal RPE migration on OCT scans. 56.4% of the fundus photographs demonstrated RPE pigment clumping. All eyes with intraretinal RPE migration on OCT had corresponding RPE pigment clumping on fundus photographs. RPE pigment migrated most frequently into the outer nuclear layer (66.7% of eyes) and less frequently into more anterior retinal layers. Intraretinal RPE migration mainly occurred above areas of drusen (73.3% of eyes). CONCLUSIONS—The appearance of intraretinal RPE migration on OCT is a common occurrence in early to intermediate dry AMD, occurring in 54.5% of eyes or 61.4% of patients. The area of intraretinal RPE migration on OCT always correlated to areas of pigment clumping on fundus photography. Conversely, all but one eye with RPE pigment clumping on fundus photography also had areas of intraretinal RPE migration on OCT. The high incidence of intraretinal RPE migration observed above areas of drusen suggests that drusen may play physical and catalytic roles in facilitating intraretinal RPE migration in dry AMD patients.