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The Anatomico-Functional Behaviour of Foveomacular Retinoschisis

Bloch, Edward D. S.; (2023) The Anatomico-Functional Behaviour of Foveomacular Retinoschisis. Doctoral thesis (M.D(Res)), UCL (University College London).

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Abstract

Foveomacular retinoschisis (FRS) describes a lamellar separation of the central neurosensory retina, as observed in acquired foveopathies, such as myopic foveoschisis (MFS), optic disc pit maculopathy (ODP-M) and idiopathic FRS (IFRS). The precise anatomico-functional behaviour and natural history of FRS remains largely unresolved and, while stability is exhibited in the majority of eyes, a subgroup is at risk of progression to foveal detachment (FD), with associated visual morbidity. Since the abovementioned disorders demonstrate similar behaviour, regardless of the underlying pathophysiology or disease duration, it is hypothesised that anatomical and functional decline in FRS is related instead to the degree of biomechanical retinal deformation. This thesis explores the characteristics of FRS, through observational investigation, to clarify its behaviour and identify biomarkers with which to inform clinical practice. A total of 201 eyes with FRS were identified. The overall incidence of progression to FD was 12% (17/140) in MFS, 58% (18/31) in ODP-M and 0% (0/30) in IFRS. OCTderived metrics, including average retinal thickness and central retinal thickness, demonstrated association with development of FD in MFS and ODP-M respectively. In those eyes that did not progress, visual acuity did not change significantly over a 4.5 years’ follow-up. Cross-sectional comparison found non-significant differences in microperimetric sensitivity and fixation indices between eyes with FRS and agematched controls. However, using a deep learning approach, it was possible to demonstrate correlation between the magnitude of the schisis cavity and worse retinal sensitivity, at a given locus, in eyes with FRS. This thesis serves to introduce several novel concepts, to inform on the clinical characteristics of FRS. The results support the hypothesis that anatomico-functional behavior of FRS is associated with the pattern and magnitude of retinal deformation, which in turn can be related to the distinct underlying pathomechanisms and their respective effects on the foveal ultrastructural arrangement.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: The Anatomico-Functional Behaviour of Foveomacular Retinoschisis
Language: English
Additional information: © The Author(s). This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/10173431
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