title: IMAGING WITH MULTIMODAL ADAPTIVE-OPTICS OPTICAL COHERENCE TOMOGRAPHY IN MULTIPLE EVANESCENT WHITE DOT SYNDROME: THE STRUCTURE AND FUNCTIONAL RELATIONSHIP.
abstract: OBJECTIVE
  To elucidate the location of pathological changes in multiple evanescent white dot syndrome (MEWDS) with the use of multimodal adaptive optics (AO) imaging.
  
  
  METHODS
  A 5-year observational case study of a 24-year-old female with recurrent MEWDS. Full examination included history, Snellen chart visual acuity, pupil assessment, intraocular pressures, slit lamp evaluation, dilated fundoscopic exam, imaging with Fourier-domain optical coherence tomography (FD-OCT), blue-light fundus autofluorescence (FAF), fundus photography, fluorescein angiography, and adaptive-optics optical coherence tomography.
  
  
  RESULTS
  Three distinct acute episodes of MEWDS occurred during the period of follow-up. Fourier-domain optical coherence tomography and adaptive-optics imaging showed disturbance in the photoreceptor outer segments (PR OS) in the posterior pole with each flare. The degree of disturbance at the photoreceptor level corresponded to size and extent of the visual field changes. All findings were transient with delineation of the photoreceptor recovery from the outer edges of the lesion inward. Hyperautofluorescence was seen during acute flares. Increase in choroidal thickness did occur with each active flare but resolved.
  
  
  CONCLUSIONS
  Although changes in the choroid and RPE can be observed in MEWDS, Fourier-domain optical coherence tomography, and multimodal adaptive optics imaging localized the visually significant changes seen in this disease at the level of the photoreceptors. These transient retinal changes specifically occur at the level of the inner segment ellipsoid and OS/RPE line. En face optical coherence tomography imaging provides a detailed, yet noninvasive method for following the convalescence of MEWDS and provides insight into the structural and functional relationship of this transient inflammatory retinal disease.
authors.affiliation: *Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; †Department of Ophthalmology, Carle Foundation Hospital, and College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois; ‡Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, FDA, Silver Spring, Maryland; §Physical Sciences Inc, Andover, Massachusetts; and ¶Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Leanne T
authors.initials: LT
authors.lastname: Labriola
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Legarreta
authors.forename: John E
authors.initials: JE
authors.lastname: Legarreta
authors.forename: Zach
authors.initials: Z
authors.lastname: Nadler
authors.forename: Denise
authors.initials: D
authors.lastname: Gallagher
authors.forename: Daniel X
authors.initials: DX
authors.lastname: Hammer
authors.forename: R Daniel
authors.initials: RD
authors.lastname: Ferguson
authors.forename: Nicusor
authors.initials: N
authors.lastname: Iftimia
authors.forename: Gadi
authors.initials: G
authors.lastname: Wollstein
authors.forename: Joel S
authors.initials: JS
authors.lastname: Schuman
mesh_terms: D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D018613:Microscopy, Confocal; D064847:Multimodal Imaging / Q000379:methods; D055095:Optics and Photonics / Q000379:methods*; D012164:Retinal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D041623:Tomography, Optical Coherence / Q000379:methods*; D055815:Young Adult