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Original article
Assessing photoreceptor structure in patients with traumatic head injury
  1. Matthew E Braza1,
  2. Jonathon Young2,
  3. Thomas A Hammeke3,
  4. Scott E Robison1,
  5. Dennis P Han1,
  6. Clinton C Warren1,
  7. Joseph Carroll1,2,4,
  8. Kimberly E Stepien5
  1. 1 Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  2. 2 Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  3. 3 Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  4. 4 Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  5. 5 Department of Ophthalmology and Visual Sciences, University of WI – Madison, Madison, Wisconsin, USA
  1. Correspondence to Dr Kimberly E Stepien; kstepien{at}wisc.edu

Abstract

Objective Previous work using adaptive optics scanning light ophthalmoscopy (AOSLO) imaging has shown photoreceptor disruption to be a common finding in head and ocular trauma patients. Here an expanded trauma population was examined using a novel imaging technique, split-detector AOSLO, to assess remnant cone structure in areas with significant disruption on confocal AOSLO imaging and to follow photoreceptor changes longitudinally.

Methods and Analysis Eight eyes from seven subjects with head and/or ocular trauma underwent imaging with spectral domain optical coherence tomography, confocal AOSLO and split-detector AOSLO to assess foveal and parafoveal photoreceptor structure.

Results Confocal AOSLO imaging revealed hyporeflective foveal regions in two of eight eyes. Split-detector imaging within the hyporeflective confocal areas showed both remnant and absent inner-segment structure. Both of these eyes were imaged longitudinally and showed variation of the photoreceptor mosaic over time. Four other eyes demonstrated subclinical regions of abnormal waveguiding photoreceptors on multimodal AOSLO imagery but were otherwise normal. Two eyes demonstrated normal foveal cone packing without disruption.

Conclusion Multimodal imaging can detect subtle photoreceptor abnormalities not necessarily detected by conventional clinical imaging. The addition of split-detector AOSLO revealed the variable condition of inner segments within confocal photoreceptor disruption, confirming the usefulness of dual-modality AOSLO imaging in assessing photoreceptor structure and integrity. Longitudinal imaging demonstrated the dynamic nature of the photoreceptor mosaic after trauma. Multimodal imaging with dual-modality AOSLO improves understanding of visual symptoms and photoreceptor structure changes in patients with head and ocular trauma.

  • imaging
  • trauma
  • retina
  • macula

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjophth-2017-000104

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    Footnotes

    • Contributors MEB, JY, JC and KES assisted in study design, data collection, analysis and manuscript drafting. TAH, SER, DPH, CCW, JC and KES assisted in the recruitment of patients. All authors had substantial contribution to the critical review of the manuscript and approval of the final version. JC and KES take responsibility for the overall content of the manuscript.

    • Funding This publication was supported by the National Center for Advancing Translational Sciences and the National Eye Institute (National Institutes of Health) through Grant Numbers UL1TR001436 and P30EY001931. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional support came from the Thomas M Aaberg, Sr Retina Research Fund, RD and Linda Peters Foundation, and an unrestricted grant from Research to Prevent Blindness (MCW, UW-Madison). This investigation was conducted in a facility constructed with support from the Research Facilities Improvement Program (Grant Number C06RR016511) from the National Center for Research Resources, National Institutes of Health.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This research project was approved by the Institutional Review Board at the Medical College of Wisconsin and followed the tenets of the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.