NOVEL METHOD OF DETECTION OF BIREFRINGENT OCULAR AMYLOIDOSIS DEPOSITS USING MONOCHROMATIC WAVELENGTHS OF SCANNING LASER OPHTHALMOSCOPY.

Abstract

To describe a noninvasive imaging technique for the detection of ocular amyloidosis using ultra-widefield images. This was a retrospective, case-control study of patients with familial transthyretin amyloidosis seen at the Wills Eye Hospital and Moorfields Eye Hospital, United Kingdom. Pseudocolor, 100% red, and 100% green ultra-widefield fundus images of patients with familial transthyretin were reviewed, and s ensitivity, specificity, and area under the curve for the pattern abnormalities noted on fundus images for amyloidosis were calculated. A total of 19 eyes of 10 patients with transthyretin amyloidosis were included. Vitreous floaters were the most common posterior segment manifestation present in 57.9% (N = 11/19) eyes. The sensitivity and specificity for a hypointense or isointense pattern on 100% red and a hyperintense pattern on 100% green being amyloidosis were 57.9% (95% CI: 33.5%‒79.7%) and 100% (95% CI: 54.1%‒100%), respectively. The area under the curve was 0.79 (95% CI: 0.68-0.90). Excluding the hypomorphic V122I mutation, the sensitivity and specificity for a hypointense or isointense pattern on 100% red and a hyperintense pattern on 100% green being amyloidosis were 64.7% (95% CI: 38.3%‒85.8%) and 100% (54.1%‒100%), respectively. The area under the curve was 0.82 (95% CI: 0.71-0.94). Histopathological analysis showed that amyloid deposits were visible under green and blue filters but not under red filters. The appearance of amyloid deposits can vary based on the type of scanning laser used. The methodology described in this study represents a novel and noninvasive approach to detect ocular amyloidosis with relatively high specificity.