title: The significance of external limiting membrane status for visual acuity in age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate status of the external limiting membrane (ELM) as a contributor of visual acuity (VA) in age-related macular degeneration (AMD).
  
  
  METHODS
  Hospital-based, cross-sectional study.
  
  
  METHODS
  We retrospectively reviewed spectral-domain optical coherence tomography images of 158 patients with AMD who had undergone photodynamic therapy and classified them based on the status of the ELM: absent, discontinuous, or complete. We simultaneously assessed foveal thickness, presence or absence of subretinal fluid/mass, presence or absence of subretinal pigment epithelium fluid/mass, status of the inner segment/outer segment (IS/OS) junction, and status of the intermediate line between the IS/OS junction and retinal pigment epithelium. Correlation coefficients between each parameter and VA were analyzed.
  
  
  RESULTS
  There was a strong correlation between ELM status and VA (r = -0.75, P < .001), and that was higher than that of the IS/OS (r = -0.69, P < .001). Multivariate analysis showed that ELM status is the most important factor for VA. Other parameters that correlated with VA included age, status of the intermediate line, and presence of subretinal or subretinal pigment epithelium fibrosis. Foveal thickness showed V-shaped correlation, with the dividing line around 200 mum.
  
  
  CONCLUSIONS
  ELM status may be more useful than is IS/OS status in evaluation of retinal morphology and function in patients with AMD.
authors.affiliation: Department of Ophthalmology, Kobe City Medical Center General Hospital, Japan. aquio@kuhp.kyoto-u.ac.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Oishi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hata
authors.forename: Masataka
authors.initials: M
authors.lastname: Shimozono
authors.forename: Michiko
authors.initials: M
authors.lastname: Mandai
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishida
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kurimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology*; D001826:Body Fluids; D003430:Cross-Sectional Studies; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D011379:Prognosis; D012160:Retina / Q000473:pathology; D055213:Retinal Pigment Epithelium / Q000473:pathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*