title: High-resolution imaging with adaptive optics in patients with inherited retinal degeneration.
abstract: OBJECTIVE
  To investigate macular photoreceptor structure in patients with inherited retinal degeneration using high-resolution images and to correlate the findings with clinical phenotypes and genetic mutations.
  
  
  METHODS
  Adaptive optics scanning laser ophthalmoscopy (AOSLO) images of photoreceptors were obtained in 16 eyes: five with retinitis pigmentosa (RP), three with cone-rod dystrophy (CRD), and eight without retinal disease. A quadratic model was used to illustrate cone spacing as a function of retinal eccentricity. Cone spacing at 1 degrees eccentricity was compared with standard measures of central visual function, including best-corrected visual acuity (BCVA), foveal threshold, and multifocal electroretinogram (mfERG) amplitude and timing. Intervisit variations were studied in one patient with RP and one patient with CRD. Screening of candidate disease genes identified mutations in two patients, one with RP (a rhodopsin mutation) and the other with CRD (a novel RPGR-ORF15 mutation).
  
  
  RESULTS
  Cone spacing values were significantly different from normal for patients with RP (P = 0.01) and CRD (P < 0.0001) and demonstrated a statistically significant correlation with foveal threshold (P = 0.0003), BCVA (P = 0.01), and mfERG amplitude (P = 0.008). Although many RP patients showed normal cone spacing within 1 degrees of fixation, cones could not be unambiguously identified in several retinal regions. Cone spacing increased in all CRD patients, even those with early disease. Little variation was observed in cone spacing measured during two sessions fewer than 8 days apart.
  
  
  CONCLUSIONS
  AOSLO images can be used to study macular cones with high resolution in patients with retinal degeneration. The authors present the first report of cone structure in vivo in patients with mutations in rhodopsin and RPGR-ORF15 and show that macular cones display distinct characteristics, depending on the underlying disease. AOSLO imaging, therefore, can provide new insight into possible mechanisms of cone vision loss in patients with retinal degeneration.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California 94143-0730, USA. duncanj@vision.ucsf.edu
authors.forename: Jacque L
authors.initials: JL
authors.lastname: Duncan
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jarel
authors.initials: J
authors.lastname: Gandhi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakanishi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Othman
authors.forename: Kari E H
authors.initials: KE
authors.lastname: Branham
authors.forename: Anand
authors.initials: A
authors.lastname: Swaroop
authors.forename: Austin
authors.initials: A
authors.lastname: Roorda
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging / Q000379:methods*; D004596:Electroretinography; D005136:Eye Proteins / Q000235:genetics; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D008869:Microtubule-Associated Proteins; D008875:Middle Aged; D009154:Mutation; D009887:Ophthalmoscopy / Q000379:methods*; D055095:Optics and Photonics; D015203:Reproducibility of Results; D017949:Retinal Cone Photoreceptor Cells / Q000473:pathology*; D012174:Retinitis Pigmentosa / Q000175:diagnosis* / Q000235:genetics; D012243:Rhodopsin / Q000235:genetics; D014792:Visual Acuity
chemical_list: D005136:Eye Proteins; D008869:Microtubule-Associated Proteins; C120042:RP1 protein, human; C099929:RPGR protein, human; D012243:Rhodopsin