Quantitative analysis of macular holes with scanning laser tomography

Objective: The purpose of the study is to establish objective, quantitative, and reproducible three-dimensional analysis for macular holes with scanning laser tomography and to correlate measurements with visual acuity. Design: The authors performed a cross-sectional, nonrandomized study. Participants: The authors examined 28 full-thickness macular holes of 23 patients aged 61 to 84 years. Intervention: Confocal infrared imaging with scanning laser tomography using the TopSS (790 nm, 10 degrees field) three-dimensional measurements and macular hole analysis were performed. Main Outcome Measures: Area, depth, and volume parameters for both macular holes and rims were obtained in two ways: (I) reference plane for analysis equal to height of the retina (offset surface distance [OSD] 0) or (2) equal to height-of the surrounding edematous rim of the hole (OSD user). Correlation of measurements with visual acuity and groups of macular holes was performed. Reproducibility from three image series per subject and intraobserver variability from ten measurements in four subjects were computed. Results: Scanning laser tomography could detect macular hole and rim features in all subjects. Infrared images provided clinically useful information that may help explain macular hole pathophysiology, Based on quantitative, three-dimensional measurements, holes were assigned to four groups: large, small, shallow, and average, Groups varied significantly (P < 0.05) for the majority of measurements. Visual acuity correlated significantly (P < 0.05) with macular hole volume, depth, slope, and rim height with OSD user only, but not with hole area. Holes computed with OSD user were deeper and of greater volume. Reproducibility was excellent for hole area, slope, and rim area; good for hole volume and depth; variable for rim volume; and improved with OSD user. Intraobserver variability was low in each group. Conclusions: Scanning laser tomography is a reproducible three-dimensional imaging technique providing objective and quantitative clinical information in assessing, grouping, and managing macular holes. By setting the OSD to rim height, additional information of rim height and hole volume was provided and correlated with visual acuity. In addition, more reliable differences among macular hole groups were found. Axial measurements such as macular hole depth, volume, and rim height may be more important for visual acuity than hole area indicating their possible predictive value for outcome measures.