title: Disruption of the photoreceptor inner segment/outer segment layer on spectral domain-optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the predictive value of spectral domain-optical coherence tomography-determined integrity of the photoreceptor inner segment/outer segment (IS/OS) junction on visual acuity in patients with epiretinal membranes (ERMs).
  
  
  METHODS
  This is a retrospective consecutive case series of 54 eyes from 48 patients with primary ERMs who underwent spectral domain-optical coherence tomography scans. Regression analysis was used to calculate the relative contribution of several variables, including photoreceptor IS/OS disruption, grade of IS/OS disruption, macular thickness, and ERM grade on fundus imaging to visual acuity.
  
  
  RESULTS
  The strongest individual predictor of visual acuity among patients with ERM was central retinal thickness on spectral domain-optical coherence tomography (r(2) = 0.16, P = 0.0024), but the most efficient model was the combination of macular thickness and presence or absence of photoreceptor IS/OS disruption (r(2) = 0.24, P = 0.0008). Additional measured variables did not significantly contribute to visual acuity prediction. Inner segment/outer segment layer integrity was also an independent predictor of visual acuity, and patients with IS/OS disruption were 6.88 times as likely to have 20/50 or worse vision than patients with intact photoreceptor layers (odds ratio: 6.88, confidence interval: 1.56-30.43, P = 0.01).
  
  
  CONCLUSIONS
  Disruption of the photoreceptor IS/OS junction is a statistically significant predictor of poor visual acuity among patients with ERM and is most useful when combined with central retinal thickness measurement.
authors.affiliation: Jacobs Retina Center, Department of Opthalmology, University of California, San Diego, La Jolla, California 92103, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Oster
authors.forename: Francesca
authors.initials: F
authors.lastname: Mojana
authors.forename: Manpreet
authors.initials: M
authors.lastname: Brar
authors.forename: Ritchie M S
authors.initials: RM
authors.lastname: Yuson
authors.forename: Lingyun
authors.initials: L
authors.lastname: Cheng
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D000368:Aged; D019773:Epiretinal Membrane / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D055211:Retinal Photoreceptor Cell Inner Segment / Q000473:pathology*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*