title: In vivo optical imaging of amblyopia: Digital subtraction autofluorescence and split-spectrum amplitude-decorrelation angiography.
abstract: Amblyopia is a visual impairment that is attributed to either abnormal binocular interactions or visual deprivation. The retina and choroids have been shown to be involved in the development of amblyopia. The purpose of this study was to investigate the retinal and choroidal microstructural abnormalities of amblyopia using digital subtraction autofluorescence and split-spectrum amplitude-decorrelation angiography (SSADA) approaches.
  
  
  
  This prospective study included 44 eyes of 22 patients with unilateral amblyopia. All patients who received indirect ophthalmoscopy, combined depth imaging spectral domain optical coherence tomography (OCT), SSADA-OCT, and macular blue light (BL-) and near-infrared (NIR-) autofluorescences underwent pupil dilation. The subfoveal choroidal thickness (SFCT) was measured. BL- and NIR-autofluorescences were determined for all patients and used to generate subtraction images with ImageJ software. The superficial, deep layers of the retina, and inner choroid layer were required for SSADA-OCT.
  
  
  
  For the normal eyes, a regularly increasing signal was observed in the central macula based on the subtraction images. In contrast, a decreased signal for the central patch or a reduced peak was detected in 16 of 22 amblyopic eyes (72.7%). The mean SFCT of the amblyopic eyes was greater than that of the fellow normal eyes (399.25 ± 4.944 µm vs. 280.58 ± 6.491 µm, respectively, P < 0.05). SSADA-OCT revealed a normal choroidal capillary network in all fellow normal eyes. However, 18 of 22 amblyopic eyes (86.4%) exhibited a blurry choroidal capillary network, and 15 of 22 amblyopic eyes (68.2%) displayed a dark atrophic patch.
  
  
  
  This is the first report of amblyopia using SSADA-OCT and digital subtraction images of autofluorescence. The mechanistic relationship of a thicker choroid and choroidal capillary atrophy with amblyopia remains to be described. The digital subtraction image confirmed the changes in the microstructure of the amblyopic retina as a supplementary approach to detect the progression of amblyopia. Lasers Surg. Med. 48:660-667, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Ophthalmology and Optometry Center, First Hospital of China Medical University, Shenyang, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Ophthalmology, The Fourth Hospital of People, Shenyang, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tao
authors.affiliation: Department of Ophthalmology, The Fourth Hospital of People, Shenyang, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Xia
authors.affiliation: Department of Ophthalmology, The Fourth Hospital of People, Shenyang, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Ophthalmology, First Hospital of China Medical University, No.155, Nanjingbei Street, Heping District, Shenyang, Liaoning Province, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Ophthalmology, First Hospital of China Medical University, No.155, Nanjingbei Street, Heping District, Shenyang, Liaoning Province, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Hua
mesh_terms: D000550:Amblyopia / Q000000981:diagnostic imaging* / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002829:Choroid / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D061848:Optical Imaging / Q000379:methods*; D012160:Retina / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies
keywords: amblyopia; autofluorescence; combined depth imaging; split-spectrum amplitude-decorrelation angiography; subtraction images