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Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 866-867

Commentary: Multicolor imaging: A new imaging tool in central serous chorioretinopathy

Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India

Date of Web Publication20-Apr-2020

Correspondence Address:
Ramesh Venkatesh
Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2190_19

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How to cite this article:
Venkatesh R, Pereira A, Sangai S, Singh V, Sridharan A. Commentary: Multicolor imaging: A new imaging tool in central serous chorioretinopathy. Indian J Ophthalmol 2020;68:866-7

How to cite this URL:
Venkatesh R, Pereira A, Sangai S, Singh V, Sridharan A. Commentary: Multicolor imaging: A new imaging tool in central serous chorioretinopathy. Indian J Ophthalmol [serial online] 2020 [cited 2020 Jun 4];68:866-7. Available from: http://www.ijo.in/text.asp?2020/68/5/866/282959

Central serous chorioretinopathy (CSCR) is a hyperpermeable choroidal vascular disease characterized by the serous detachment of the retina and/or retinal pigment epithelium (RPE), usually confined to the macula.[1] In CSCR, the accumulation of the subretinal fluid (SRF) is mainly attributed to the imbalance between the increased choroidal vascular permeability and reduced SRF absorption by the RPE. A combination of imaging features from color fundus photography (CFP), fundus autofluorescence (FAF), fluorescein and indocyanine green angiography, and optical coherence tomography (OCT) are routinely required to detect the mechanism at fault. Both fluorescein and indocyanine green angiography are invasive techniques and can have dye-related complications. Thus, an ideal imaging modality in the diagnosis and treatment of CSCR would be a noninvasive tool, which could identify all the clinical features of CSCR like the presence of leaks, fibrin, pigment epithelium detachment, diffuse retinal pigment epithelial atrophy, and the extent of SRF, simultaneously. Multicolor (MI) scanning laser imaging is a new imaging technique developed by the Spectralis, Heidelberg Engineering, where en face images are generated based on the tissue's reflectance spectrum to the light of different wavelengths. The images are captured by simultaneously scanning the tissue with light of three individual wavelengths—blue (488 nm), green (518 nm), and infrared (815 nm). The different wavelengths penetrate the tissue at varying depths and, thereby, provide structural information from different depths within the retina and choroid.[2] We published our study comparing the utility of MI to the gold standard imaging modalities in identifying the various clinical features in CSCR.[3] In comparison with fluorescein angiography (FA), we found MI to be more effective in identifying the extent of SRF (78% vs 13%). In addition, MI was equally capable of identifying pigment epithelium detachment (100% vs 100%) and retinal pigment epithelial changes (100% vs 100%). Focal leaks were identified in 84% and 97% eyes on MI and FA imaging respectively. The sensitivity of MI in identifying focal retinal pigment epithelial leaks was higher compared to near-infrared autofluorescence (84% vs 34%) and blue wavelength autofluorescence (84% vs 18%) imaging. Govindahari et al. compared various clinical findings in CSCR (SRF, subretinal deposits, RPE atrophy, retinal pigment epithelial detachment [PED], and pachy vessels) on FAF, both qualitatively and quantitatively.[4] They concluded that MI demonstrated better-defined lesions (neurosensory retinal detachment [NSD], PED, RPE atrophy) and a greater number of eyes with PED and pachy vessels in comparison with FAF. Both investigations had a 100% sensitivity in detecting SRF and 100% specificity for subretinal deposits. The study demonstrated the ability of MI to quantitatively and qualitatively define various clinical features in CSCR and the advantages it holds over FAF. Saurabh et al.,[5] in their study, compared the MI imaging signatures vis-à-vis CFP in CSCR to identify SRF, PED, fibrin and RPE atrophy. They concluded that both MI and CFP were inferior to the gold standard in identifying the SRF, PED, and RPE atrophy. However, MI was better than CFP in comparison with the gold standard for these clinical findings in CSCR.

Thus, from the various studies available in the literature, it can be concluded that MI is a useful, non-invasive imaging modality in documenting and monitoring various structural changes in eyes with CSCR.

MI has some additional advantages as well: 1) It is non-invasive; 2) nondye-based imaging; 3) less photophobic to the patient; 4) can be used in undilated pupil; 5) 55° images gives a larger view of the retinal periphery; 6) can be combined along with OCT to allow simultaneous fundus and cross-sectional imaging, and 7) provides high-contrast images, thus, allowing to image through hazy media-like cataract.

In the future, MI has the potential to substitute FA and CFP as the imaging modality of choice in CSCR.

  References Top

Wang M, Munch IC, Hasler PW, Prünte C, Larsen M. Central serous chorioretinopathy. Acta Ophthalmol (Copenh) 2008;86:126-45.  Back to cited text no. 1
Tan ACS, Fleckenstein M, Schmitz-Valckenberg S, Holz FG. Clinical application of multicolor imaging technology. Ophthalmol J Int Ophtalmol Int J Ophthalmol Z Augenheilkd 2016;236:8-18.  Back to cited text no. 2
Venkatesh R, Agarwal SK, Bavaharan B, Sangai S, Jain K, Gadde SG, et al. Multicolour imaging in central serous chorioretinopathy. Clin Exp Optom 2019. doi: 10.1111/cxo. 12965. [Epub ahead of print]  Back to cited text no. 3
Govindahari V, Singh SR, Rajesh B, Gallego-Pinazo R, Marco RD, Nair DV, et al. Multicolor imaging in central serous chorioretinopathy - a quantitative and qualitative comparison with fundus autofluorescence. Sci Rep 2019;9:11728.  Back to cited text no. 4
Saurabh K, Roy R, Goel S, Garg B, Mishra S. Validation of multicolor imaging signatures of central serous chorioretinopathy lesions vis-a-vis conventional color fundus photographs. Indian J Ophthalmol 2020;68:861-6.  Back to cited text no. 5
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