Article Text

Download PDFPDF
Original article
Evidence of outer retinal changes in glaucoma patients as revealed by ultrahigh-resolution in vivo retinal imaging
  1. Stacey S Choi1,
  2. Robert J Zawadzki1,
  3. Michele C Lim1,
  4. James D Brandt1,
  5. John L Keltner1,2,3,
  6. Nathan Doble4,
  7. John S Werner1,5
  1. 1Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, California, USA
  2. 2Department of Neurology, University of California Davis, Sacramento, California, USA
  3. 3Neurological Surgery, University of California Davis, Sacramento, California, USA
  4. 4Iris AO, Berkeley, California, USA
  5. 5Section of Neurobiology and Physiology & Behavior, University of California Davis, Davis, California, USA
  1. Correspondence to Dr Stacey S Choi, New England College of Optometry, 424 Beacon Street, Boston, MA 02115, USA; chois{at}


Aims It is well established that glaucoma results in a thinning of the inner retina. To investigate whether the outer retina is also involved, ultrahigh-resolution retinal imaging techniques were utilised.

Methods Eyes from 10 glaucoma patients (25–78 years old), were imaged using three research-grade instruments: (1) ultrahigh-resolution Fourier-domain optical coherence tomography (UHR-FD-OCT), (2) adaptive optics (AO) UHR-FD-OCT and (3) AO-flood illuminated fundus camera (AO-FC). UHR-FD-OCT and AO-UHR-FD-OCT B-scans were examined for any abnormalities in the retinal layers. On some patients, cone density measurements were made from the AO-FC en face images. Correlations between retinal structure and visual sensitivity were measured by Humphrey visual-field (VF) testing made at the corresponding retinal locations.

Results All three in vivo imaging modalities revealed evidence of outer retinal changes along with the expected thinning of the inner retina in glaucomatous eyes with VF loss. AO-UHR-FD-OCT images identified the exact location of structural changes within the cone photoreceptor layer with the AO-FC en face images showing dark areas in the cone mosaic at the same retinal locations with reduced visual sensitivity.

Conclusion Losses in cone density along with expected inner retinal changes were demonstrated in well-characterised glaucoma patients with VF loss.

  • Outer retina
  • glaucoma
  • adaptive optics
  • ultrahigh resolution in vivo retinal imaging
  • cone photoreceptors
  • retina
  • pathology
  • degeneration
  • imaging

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This research was supported by the National Eye Institute (EY014743) and an RPB Senior Scientist Award.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the School of Medicine, University of California, Davis, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.