Cone photoreceptor density in metric and angular units at 2° and 5° to the fovea.

<p>It was firstly automatically counted and then manually edited.</p

Multiple linear regression coefficients analyzing effects of demographic valuables on cone photoreceptor distribution at 2°.

<p>Coefficients that were not statistically significant are not shown.</p

Quantitative Analysis of Cone Photoreceptor Distribution and Its Relationship with Axial Length, Age, and Early Age-Related Macular Degeneration

<div><p>Purpose</p><p>It has not been clarified whether early age-related macular degeneration (AMD) is associated with cone photoreceptor distribution. We used adaptive optics fundus camera to examine cone photoreceptors in the macular area of aged patients and quantitatively analyzed its relationship between the presence of early AMD and cone distribution.</p><p>Methods</p><p>Sixty cases aged 50 or older were studied. The eyes were examined with funduscopy and spectral-domain optical coherence tomography to exclude the eyes with any abnormalities at two sites of measurement, 2° superior and 5° temporal to the fovea. High-resolution retinal images with cone photoreceptor mosaic were obtained with adaptive optics fundus camera (rtx1, Imagine Eyes, France). After adjusting for axial length, cone packing density was calculated and the relationship with age, axial length, or severity of early AMD based on the age-related eye disease study (AREDS) classification was analyzed.</p><p>Results</p><p>Patient’s age ranged from 50 to 77, and axial length from 21.7 to 27.5 mm. Mean density in metric units and that in angular units were 24,900 cells/mm², 2,170 cells/deg² at 2° superior, and 18,500 cells/mm², 1,570 cels/deg² at 5° temporal, respectively. Axial length was significantly correlated with the density calculated in metric units, but not with that in angular units. Age was significantly correlated with the density both in metric and angular units at 2° superior. There was no significant difference in the density in metric and angular units between the eyes with AREDS category one and those with categories two or three.</p><p>Conclusion</p><p>Axial length and age were significantly correlated with parafoveal cone photoreceptor distribution. The results do not support that early AMD might influence cone photoreceptor density in the area without drusen or pigment abnormalities.</p></div

Cone mosaic images of the case with AREDS category 1 (no drusen).

<p>The right eye of 69-year-old male (the same eye as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091873#pone-0091873-g001" target="_blank">Figure 1</a>) as a representative case with AREDS category 1 (no drusen). The fundus photo (<b>a</b>) did not show any sign of drusen or pigmentary abnormalities. The fundus autofluorescence (FAF) (<b>b</b>) was also unremarkable. After AO image was taken, the 60 pixel by 60 pixel square image was cropped at 2° superior (<b>c</b>) and 5° temporal (<b>d</b>) to the fovea (also shown as yellow squares in <b>a</b>). Cone mosaic was identified automatically at first (red dots in <b>c</b> and <b>d</b>), then added (yellow dots) in manual modification. Cone density were 25,500 cells/mm² (2,340 cells/deg²) at 2° and 14,030 cells/mm² (1,290 cells/deg²) at 5°.</p

Cone mosaic images of the case with AREDS category 3 (large drusen).

<p>The right eye of 68-year-old female with AREDS category 3. The fundus photo (<b>a</b>) showed large drusen superior and temporal to the fovea. FAF (<b>b</b>) revealed hyper- and hypopigmentation corresponding to the drusen. After AO image was taken, the 60 pixel by 60 pixel square image was cropped at 2° superior (<b>c</b>) and 5° temporal (<b>d</b>) to the fovea (also shown as yellow squares in <b>a</b>). Cone mosaic was identified automatically at first (red dots in <b>c</b> and <b>d</b>), then added (yellow dots) in manual modification. Cone density were 25,700 cells/mm² (1,990 cells/deg²) at 2° and 14,900 cells/mm² (1,450 cells/deg²) at 5°.</p

Identification of the sites for measurement in the images taken by adaptive optics fundus camera.

<p>Identification and measurement of cone distribution at 2° superior and 5° temporal to the fovea. Figures of a representative case are shown. Horizontal and vertical SD-OCT scan images centered on the fovea were obtained simultaneously with IR images using Spectralis (a). After the site corresponding to the fovea was identified on the IR image (orange cross in a) by referring to the OCT images, the sites at 2° superior and 5° temporal to the fovea on the IR image were located (yellow squares in a). Processed images from the adaptive optics (AO) fundus camera were overlaid with IR images by referring to retinal vessels in order to identify the sites of interest on AO images. A 60 pixel by 60 pixel square was placed at these sites (yellow square in b and c). Cone mosaic within the square was identified (red dots in the insets of 1b and 1c) and its distribution was assessed.</p

Choroidal structure as a biomarker for visual acuity in intravitreal aflibercept therapy for polypoidal choroidal vasculopathy

<div><p>Purpose</p><p>To investigate the relationship between choroidal structure and visual acuity after intravitreal aflibercept therapy for polypoidal choroidal vasculopathy (PCV).</p><p>Methods</p><p>We conducted a retrospective, single-centre and observational study including 18 eyes of 18 patients with PCV (73.8 ± 10.2 years of age) who were treated with three monthly intravitreal aflibercept injections followed by additional treatments in a treat-and-extend protocol. The cross-sectional images of the macula were obtained with enhanced depth imaging optical coherence tomography at baseline, at 3 months, and at 12 months. The choroidal layer was divided into luminal or stromal segments by applying binarization processing to calculate these areas. The relationships between age, spherical equivalent, best-corrected visual acuity (BCVA), baseline value, or changes in the luminal or the stromal areas, and the BCVA change at 12 months were analysed using multiple regression analyses and model selection procedures.</p><p>Results</p><p>Both stromal and luminal areas were decreased at 3 and 12 months compared to baseline areas (5% and 9% at 3 months, 6% and 12% at 12 months, p < 0.0001, p < 0.0001, p < 0.0001 and p < 0.0001, respectively). Greater improvement of visual acuity (VA) at 12 months was significantly associated with younger age, greater spherical equivalent, worse baseline BCVA, greater baseline luminal area, and smaller baseline stromal area.</p><p>Conclusions</p><p>Choroidal structure might be useful as a new biomarker for potential Visual outcomes after intravitreal aflibercept therapy for PCV.</p></div

Multivariate analyses between ΔBCVA12 and variables using binarization of the choroid at baseline, 3 and 12 months in polypoidal choroidal vasculopathy (PCV) with intravitreal aflibercept injections.

<p>Multivariate analyses between ΔBCVA12 and variables using binarization of the choroid at baseline, 3 and 12 months in polypoidal choroidal vasculopathy (PCV) with intravitreal aflibercept injections.</p

Baseline characteristics and number of injections of the patients.

<p>Baseline characteristics and number of injections of the patients.</p

Segmentation and binarization of EDI-OCT images.

<p>(Top) From the enhanced depth imaging optical coherence tomography images, subfoveal choroidal layers under the Bruch’s membrane were divided into three sectors with each width of 1,000 μm (yellow boxes). (Buttom) The Niblack auto local threshold was applied to binarize the images to subdivide them into the stromal and luminal choroid. Then, areas were calculated using the built-in measurement tool in ImageJ.</p