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Photoreceptor Integrity in MEWDS: Longitudinal Structure-Function Correlations

Cicinelli, M. V., Montesano, G. ORCID: 0000-0002-9148-2804, Berni, A. , Scandale, P., Ometto, G. ORCID: 0000-0002-0900-4847, Introini, U., Battaglia Parodi, M., Bandello, F., Miserocchi, E. & Marchese, A. (2024). Photoreceptor Integrity in MEWDS: Longitudinal Structure-Function Correlations. Investigative Opthalmology & Visual Science, 65(4), article number 28. doi: 10.1167/iovs.65.4.28


PURPOSE. The purpose of this study was to investigate structure-function correlations in multiple evanescent white dot syndrome (MEWDS) using microperimetry (MP) and spectral-domain optical coherence tomography (SD-OCT).

METHODS. Single-center prospective observational study including 14 eyes from 13 patients with MEWDS monitored over a median of 49.5 days (interquartile range = 29–92 days). Investigations focused on best-corrected visual acuity (BCVA), foveal granularity, and the Photoreceptor Reflectivity Ratio (PRR) as a measure of photoreceptor integrity. MP assessed average retinal threshold sensitivity (RTS) and bivariate contour ellipse area (BCEA) for fixation stability. A linear mixed model was used to test associations and interactions among RTS, time, and clinical variables. A hierarchical linear mixed model was used to analyze structure-function relationships, addressing both individual and location-specific variations.

RESULTS. Overall, 2340 MP locations were tested. PRR revealed a transient decrease within 30 days post-presentation, indicative of early photoreceptor disruption, followed by a progressive increase, signaling recovery. Significantly lower foveal sensitivity (RTS = 14.8 ± 7.4 vs. 22.5 ± 4.4 decibel [dB], P = 0.04) and increased fixation spread (63% BCEA = 1.26 ± 0.97 vs. 0.48 ± 0.35 deg2, P = 0.06) were noted in eyes with foveal granularity compared to those without. A significant increase in RTS was demonstrated over time (0.066 dB/day, P < 0.001), with a central-to-peripheral gradient of improvement. The interaction between follow-up time and baseline BCVA (P < 0.001) indicated more rapid improvement in eyes with worse initial vision. There was a robust, nonlinear association between PRR and RTS across all tested locations (P < 0.001), becoming asymptotic for sensitivity losses exceeding 20 dB.

CONCLUSIONS. Photoreceptor reflectivity accurately aligned with visual function in MEWDS on longitudinal examinations. The central-to-peripheral gradient of improvement may suggest specific vulnerabilities underlying the area around the disc.

Publication Type: Article
Additional Information: This work is licensed under a Creative Commons Attribution 4.0 International License.
Publisher Keywords: multiple evanescent white dot syndrome (MEWDS), microperimetry, spectral-domain optical coherence tomography (SD-OCT), photoreceptor reflectivity ratio (PRR), retinal threshold sensitivity (RTS), foveal granularity
Subjects: R Medicine > RE Ophthalmology
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:
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Available under License Creative Commons: Attribution International Public License 4.0.

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