Association between Foveal Photoreceptor Integrity and Visual Outcome in Neovascular Age-related Macular Degeneration HISAKO HAYASHI, KENJI YAMASHIRO, AKITAKA TSUJIKAWA, MASAFUMI OTA, ATSUSHI OTANI, AND NAGAHISA YOSHIMURA ● PURPOSE: To evaluate the correlation between visual outcome and foveal photoreceptor integrity after success- ful treatment of eyes with neovascular age-related mac- ular degeneration (AMD). ● DESIGN: Retrospective chart review. ● METHODS: We retrospectively studied the medical records of 51 eyes of 51 patients with neovascular AMD who were treated successfully with photodynamic ther- apy (PDT). All eyes were followed-up for more than 24 months after the initial treatment. Using spectral-domain optical coherence tomography, the status of the inner segment and outer segment (IS/OS) photoreceptor junc- tion was assessed as a hallmark of the integrity of the foveal photoreceptor layer. ● RESULTS: At the final visit, no eyes showed an exuda- tive change. A complete or discontinuous IS/OS line was detected beneath the fovea in 8 (15.7%) and 25 (29.4%) eyes, respectively, whereas 28 (54.9%) had no IS/OS line. Eyes with a continuous or discontinuous IS/OS line beneath the fovea had better final visual acuity (VA) than did eyes without an IS/OS line (P < .001, respec- tively). Of the 51 eyes, 36 showed polypoidal choroidal vasculopathy (PCV), whereas 15 were diagnosed as having typical AMD without PCV. Visual outcome was significantly better in eyes with PCV (P  .026). Most eyes (13/15; 86.7%) with typical AMD had no IS/OS line at the final visit, whereas only 13 (36.1%) of the 36 eyes with PCV had no IS/OS line beneath the fovea. ● CONCLUSIONS: Integrity of the photoreceptor layer beneath the fovea is associated with the final VA in neovascular AMD after successful PDT. (Am J Oph- thalmol 2009;148:83– 89. © 2009 by Elsevier Inc. All rights reserved.) A GE-RELATED MACULAR DEGENERATION (AMD) IS the leading cause of severe impairment of visual function in industrialized countries in people older than 50 years. To resolve the exudative changes resulting from choroidal neovascularization (CNV), various treatments have been performed on patients with neovascular AMD, such as photodynamic therapy (PDT), 1–3 use of anti–vascular endothelial growth factor agents, 4,5 and use of angiostatic steroids. 6 Some of these treatments also have been shown to be effective in treating polypoidal choroidal vasculopathy (PCV). 7–11 Treatment effects of resolving exudative changes can be evaluated with fluorescein angiography and optical coherence tomography (OCT). 4,5,12,13 However, some eyes with AMD have a poor visual outcome despite complete resolution of the exudative change— even after successful treatment. In support of this observation, a recent study showed that retinal thickness (RT) does not necessarily correlate with visual function in AMD. 14 We hypothesized that integrity of the foveal photoreceptor layer, especially its outer aspect, may be essential for the preservation of visual function after treatment for AMD. The recent introduction of spectral-domain OCT (SD- OCT) has provided improved delineation of retinal fea- tures. 15,16 The junction between inner segments and outer segments (IS/OS) of retinal photoreceptors now can be visualized clearly in various diseases, such as macular hole, 16 uveitis, 17 central serous chorioretinopathy, 18,19 myo- pic schisis, 20 and branch retinal vein occlusion. 21 Accord- ingly, the IS/OS line in OCT images has been attracting a great deal of attention as a hallmark of photoreceptor cell integrity in the outer retinal segment. Recently, Drexler and associates and Ko and associates each reported a case of an eye with AMD in which the IS/OS was affected. 22,23 How- ever, limited information is available on the association between the foveal IS/OS line and visual function in neovas- cular AMD. In the current study, we examined the relation- ship between visual acuity (VA) and integrity of the foveal photoreceptor layer in eyes with AMD by evaluation of the IS/OS line after successful treatment. In addition to the IS/OS line, we evaluated the RT and the retinal pigment epithelium (RPE) line in relation to the visual outcome in AMD after successful treatment. METHODS ● PATIENT POPULATION: We retrospectively reviewed the medical records of 51 eyes of 51 consecutive patients with subfoveal neovascular AMD who were treated suc- cessfully with PDT and who were followed-up for more Accepted for publication Jan 22, 2009. From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. Inquiries to Kenji Yamashiro, Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto 606-8507, Japan; e-mail: yamashro@ kuhp.kyoto-u.ac.jp © 2009 BY ELSEVIER INC.ALL RIGHTS RESERVED. 0002-9394/09/$36.00 83 doi:10.1016/j.ajo.2009.01.017