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Interpretation of Outer Retina Appearance in High-resolution Optical Coherence Tomography

      Lim and associates are to be congratulated for their efforts describing the in vivo histopathology of retinal dystrophy that high-resolution optical coherence tomography (HR-OCT) now permits.
      • Lim J.I.
      • Tan O.
      • Fawzi A.A.
      • Hopkins J.J.
      • Gil-Flamer J.H.
      • Huang D.
      A pilot study of Fourier-domain optical coherence tomography of retinal dystrophy patients.
      They proposed that the macular outer retinal layer thickness is a promising and reliable indicator in evaluating such patients. Taking into consideration the knowledge learned from studies utilizing other HR-OCT, the definition of the retinal pigment epithelium (RPE) layer used in their study is confusing and seems inappropriate.
      • Witkin A.J.
      • Ko T.H.
      • Fujimoto J.G.
      • et al.
      Ultra-high resolution optical coherence tomography assessment of photoreceptors in retinitis pigmentosa and related diseases.
      • Marmor M.F.
      • Choi S.S.
      • Zawadzki R.J.
      • Werner J.S.
      Visual insignificance of the foveal pit: reassessment of foveal hypoplasia as fovea plana.
      • Srinivasan V.J.
      • Monson B.K.
      • Wojtkowski M.
      • et al.
      Characterization of outer retinal morphology with high-speed, ultra-high-resolution optical coherence tomography.
      We feel that a more definite and reliable definition for the RPE layer is needed for evaluating retinal thickness as a clinically reliable indicator.
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      References

        • Lim J.I.
        • Tan O.
        • Fawzi A.A.
        • Hopkins J.J.
        • Gil-Flamer J.H.
        • Huang D.
        A pilot study of Fourier-domain optical coherence tomography of retinal dystrophy patients.
        Am J Ophthalmol. 2008; 146: 417-426
        • Witkin A.J.
        • Ko T.H.
        • Fujimoto J.G.
        • et al.
        Ultra-high resolution optical coherence tomography assessment of photoreceptors in retinitis pigmentosa and related diseases.
        Am J Ophthalmol. 2006; 142: 945-952
        • Marmor M.F.
        • Choi S.S.
        • Zawadzki R.J.
        • Werner J.S.
        Visual insignificance of the foveal pit: reassessment of foveal hypoplasia as fovea plana.
        Arch Ophthalmol. 2008; 126: 907-913
        • Srinivasan V.J.
        • Monson B.K.
        • Wojtkowski M.
        • et al.
        Characterization of outer retinal morphology with high-speed, ultra-high-resolution optical coherence tomography.
        Invest Ophthalmol Vis Sci. 2008; 49: 1571-1579
        • Sharma R.K.
        • Ehinger B.E.J.
        Development and structure of the retina.
        in: Kaufman P.L. Alm A. Adler's Physiology of the Eye. 10th ed. Mosby, St Louis, Missouri2003: 319-347

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        American Journal of OphthalmologyVol. 147Issue 1
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          We appreciate the interest of Drs Byeon and Kang in our article.1 Their representative optical coherence tomography (OCT) figure shows two lines beneath the inner segment (IS)/outer segment (OS) junction. They cite the article by Srinivasan that attributes the first line to the cone outer segment tips (COST).2 They attribute the second line to the retinal pigment epithelium (RPE)/Bruch membrane (BM) boundary. Indeed, in our normal patients, the RTVue also shows two highly reflective lines associated with the RPE.
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