Adaptive optics fundus camera to examine localized changes in the photoreceptor layer of the fovea.

PURPOSE To examine highly localized photoreceptor disruptions in the fovea by a high-resolution adaptive optics (AO) fundus camera combined with Fourier-domain optical coherence tomography (FD OCT). DESIGN Observational case series. PARTICIPANTS Three eyes of 3 patients who showed dark foveal spots by slit-lamp biomicroscopy. METHODS Three patients who reported metamorphopsia but showed no changes in the retina in conventional fundus photographs were examined. High-resolution retinal images were obtained with the AO fundus camera and by FD OCT. The images were compared with the findings obtained by standard clinical tests, including Amsler charts and fluorescein angiography (FA). MAIN OUTCOME MEASURES Quantitative measurements of the area of photoreceptor disruption. RESULTS Slit-lamp biomicroscopy revealed an irregularly shaped dark spot in the fovea centralis but no changes in FA in the 3 cases. The photoreceptor mosaic was absent in a highly localized area of the fovea in the images obtained by the AO fundus camera, and the photoreceptor outer segment was absent or disturbed at the corresponding area by FD OCT in all 3 cases. The horizontal and vertical sizes of the area of disturbance of the photoreceptor mosaic in the AO images in the 3 eyes were 400x200 microm, 300x120 microm, and 300x200 microm. These sizes were comparable to the photoreceptor outer segment disturbances in the OCT images which were 330x150 microm, 280x100 microm, 200x150 microm, respectively. CONCLUSIONS Localized OS disturbances were able to be detected in eyes with a dark foveal spot by AO fundus camera 2-dimensionally and by FD OCT axially. The good correspondence of the sizes of the area of photoreceptor disturbances obtained by AO images to those by FD OCT images indicate that the AO images can be used to evaluate and follow the 2-dimensional area of focal changes of the photoreceptors in the fovea quantitatively.