Spatial agreement between Goldmann visual field defects and fundus autofluorescence in patients with birdshot chorioretinopathy

Abstract

BackgroundThe purpose of this paper is to study the spatial agreement between visual field defects and ultra-wide field (UWF) fundus autofluorescence (FAF) in patients with birdshot chorioretinopathy (BSCR). The study is a retrospective, cross-sectional analysis of a university uveitis practice. Eight (8) eyes of five (5) patients with BSCR were included. Inclusion criteria were ability to fixate reliably. Goldmann visual fields (GVF) and UWF FAF were obtained, digitalized, and standardized. Analysis was performed by measuring areas of overlap of hypo-autofluorescent FAF lesions and GVF scotomas within the central 60°. Overlap was calculated as a percentage of the total area of FAF and GVF, respectively. Average areas were also calculated.ResultsThe mean age of the subjects was 51 ± 12.28 years (range 38–69 years). 14 ± 23 % of the total lesion area identified as hypo-autofluorescent on FAF overlapped with scotoma. 28 ± 41 % of the GVF scotomas overlapped with hypo-autofluorescent FAF lesions. Average area of FAF hypo-autofluorescence was much larger (15.19 disc areas) than GVF (3.45 disc areas).ConclusionsThere appear to be larger total areas of hypo-autofluorescence on FAF than scotoma evidenced by GVF and only a small amount of overlap. The finding suggests that GVF is relatively insensitive to anatomic loss, which can be detected using FAF. Further studies are required to assess whether this finding holds true for automated white-on-white perimetry. In addition, more selective psychophysical stimuli may have higher sensitivity in detecting early functional loss that accompanies anatomic damage.

Fundus Autofluorescence Findings in Eyes With Birdshot Chorioretinitis

“…Overall, these observations are consistent with smaller and mostly retrospective studies of FAF in eyes with BSCR. [2][3][4]38,39 Peripapillary hypoautofluorescence was strongly related with age and disease duration. Global hypoautofluorescence (i.e., present in both the macula and extramacular region) was associated longer disease duration (OR ¼ 1.46, P < 0.001) and presence of macular edema (OR ¼ 5.26, P < 0.001), suggesting that hypoautofluorescence may be a marker for chronicity and severity of BSCR.…”

“…The relationship between macular hypoautofluorescence and reduced BCVA is consistent with findings in eight individuals with BSCR reported by Koizumi et al 2 Piffer et al 38 studied 39 individuals with BSCR and also found that macular hypoautofluorescence was linked to worse visual acuity, but in contrast to our study, it was not affected by disease duration. The agreement between Goldmann visual field (GVF) and autofluorescence was analyzed in five individuals with BSCR by Jack et al 4 they found a relatively small overlap, suggesting that GVF is insensitive to anatomic RPE loss. Our data in a larger cohort found several relationships between FAF findings and visual field, using the automated Humphrey Field Analyzer.…”

“…1 In other studies, fundus autofluorescence (FAF) imaging was also able to show abnormalities not identified by clinical examination or other modalities. [2][3][4] FAF identifies lipofuscin accumulation in the RPE and provides information about RPE structure and health. Unmasking of underlying RPE autofluorescence because of photoreceptor loss is an additional mechanism of hyperautofluorescence.…”

“…2,3 Previous studies of FAF imaging and BSCR involved small numbers of individuals, and they were primarily descriptive, without extensive comparison to other disease features or visual function. [2][3][4] To expand our understanding of FAF in eyes with BSCR, we performed a prospective study of FAF findings in the same cohort of 86 individuals whose choroids were studied by EDI-OCT. 1 As in that study, we compared imaging findings to demographic and medical factors, clinical examination findings, and multiple measures of visual function. Findings may provide a better understanding of the spectrum of abnormalities associated with BSCR, suggest disease mechanisms, and identify features of the disease that should be monitored in future clinical studies.…”

An Automatic ROI of The Fundus Photography

“…The following research is the use of ROI in fundus image processing to analyze various diseases. Many studies that define ROI based on processing needs by cropping [17][18][19][20][21][22][23][24]. Zahoor et al conducted a study of optical disc space ROI taking with Polar Transform method [25].…”