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Inner Retinal Changes in Primary Open-Angle Glaucoma Revealed Through Adaptive Optics-Optical Coherence Tomography

Wells-Gray, Elaine M., PhD*; Choi, Stacey S., PhD*,†; Slabaugh, Mark, MD; Weber, Paul, MD; Doble, Nathan, PhD*,†

doi: 10.1097/IJG.0000000000001039
Case Report/Small Case Series

Purpose: To examine the microstructural changes in the inner nuclear layer (INL) and ganglion cell layer (GCL) in a primary open-angle glaucoma (POAG) subject at 2 timepoints, 4 months apart.

Patients and Methods: This case-control study (1 POAG subject and 1 normal control) used the single cell, 3-dimensional volumetric imaging capability of an adaptive optics-optical coherence tomography-scanning laser ophthalmoscopy system to examine the inner retina.

Results: At the area of greatest glaucomatous change in the POAG subject [3-degrees temporal (T), 3-degrees inferior (I), right eye], the GCL was greatly thinned at both timepoints, yet retinal ganglion cell soma remained visible amid a meshwork of capillaries. Microcystic lesions in the INL were visible at both timepoints, ranging in diameter from 8 to 43 μm on day 1 to 11 to 64 μm at 4 months, with an average diameter increase of ∼124%. Small hyperreflective features (not seen in the contralateral eye or control subject) at a depth midway through the INL seemed correlated to the development of microcysts.

Conclusions: We demonstrate the ability to image microcystic lesions early in their development and have quantified longitudinal changes. The presence of small hyperreflective structures at a layer midway through the INL seems to be a precursor to their formation and is a potential biomarker for assessing POAG severity and progression. The adaptive optics imaging system is also able to visualize retinal ganglion cells in this subject, despite severe thinning of the GCL.

*The Ohio State University College of Optometry

Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University, Columbus, OH

Supported by Ann Ellis Fund of the Columbus Foundation, Columbus, Ohio (grant no.; TFB17-2182 AEF).

Disclosure: The authors declare no conflict of interest.

Reprints: Elaine M. Wells-Gray, PhD, The Ohio State University College of Optometry, 338 W 10th Ave., Columbus 43210, OH (e-mail:

Received July 17, 2018

Accepted July 18, 2018

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