Recent studies demonstrate the crucial role of mitochondria in retinal disease pathogenesis. Recently, a device was developed to non-invasively study retinal metabolic stress and measure retinal mitochondrial activity. Previous studies indicate that oxidized flavoproteins increase during metabolic stress and are a marker of mitochondrial dysfunction. This device measures oxidized flavoprotein fluorescence, which absorbs blue light and emits green autofluorescence. This review summarizes the biological rationale, technology advances, research findings, and future perspectives of mitochondrial retinal imaging.

Objective: Geographic atrophy (GA) is a progressive, irreversible advanced form of age-related macular degeneration. There is limited information on the burden of illness of GA from patient, caregiver, and eye care professional perspectives. This study identifies key factors that should be included for assessment in future studies of patients with GA. Methods: In this cross-sectional qualitative study, patients with symptomatic GA (n = 8), their caregivers (n = 6), and eye care professionals who treat patients with GA (n = 5) were interviewed at US sites. Interview guides were designed to evaluate the understanding of the disease, costs and burden of illness, use of vision aids or services, and impact on emotional or psychological well-being and on daily activities. Results: Half of the patients mentioned social, psychological, or helplessness issues. Patients reported the impact of GA on sports and outdoor hobbies, meals or food preparation, religious activities, and long-distance travel. Patients reported having stopped driving or changing driving patterns as a major concern. 38% of all patients reported previously modifying their work schedules due to vision impairment. All patients reported the use of at least one vision aid, with 88% of patients purchasing the aids out of pocket. Caregivers reported modifying their schedules to provide assistance as needed and expressed frustration over their inability to improve patients’ health. Eye care professionals noted the emotional impact of vision loss, accidents, and injuries, and identified mental health as a key topic for patients with GA. Conclusions: Although limited by size, this study indicates that GA has a major negative impact on patients’ and caregivers’ social functioning and health-related quality of life. This study has identified indirect resource use, including caregiving needs, and direct patient outof-pocket costs as factors relevant to patients with GA. Future larger studies are needed to further characterize the burden of illness of GA for patients and caregivers.

Diabetic retinopathy (DR) is a common complication of diabetes mellitus. Imaging techniques such as the gold standard of fluorescein angiography (FA) and the recent advent of optical coherence tomography angiography (OCTA) have allowed for detailed visualization of the microvasculature to assess and quantify macular perfusion. The development of ultra-widefield FA (UWFA) has allowed clinicians to examine ischemia within the periphery. As our imaging and diagnostic methods continue to be refined, it is important to understand how to best utilize these technologies to characterize disease severity and determine how it can guide treatment and prognosis. With the increasing use of anti-vascular endothelial growth factor (VEGF) agents for the treatment of DR, we can characterize the changes in perfusion on the microvascular level. The focus of this review is to summarize and identify the changes in both macular and peripheral perfusion with anti-VEGF treatment for patients with DR utilizing FA, UWFA, and OCTA. There remains a need for more prospective, long-term clinical trials with controls to better understand the characterization of the retinal microvasculature using these imaging techniques. In clinical practice, physicians likely will need to utilize a multimodal imaging approach to appropriately characterize the degree and progression of ischemia in DR.

In clinical practice, visual acuity (VA) outcomes after treatment may be associated with multiple optical coherence tomography (OCT) variables including central subfield thickness (CST), ellipsoid zone (EZ) disruption , epiretinal membrane, vitreoretinal interface abnormalities, and disorganization of retinal inner layers (DRIL). Since CST has shown only a modest correlation with VA, additional OCT-based prognostic factors can be useful. DRIL is an OCT derived variable that may be a prognostic factor. Ischemia and inflammation may explain the pathogenesis of DRIL but are not well understood. Visual transmission pathways may be interrupted and affect VA. This review highlights the various studies on DRIL and VA, specifically within diabetic macular edema (DME), diabetic retinopathy, retinal vein occlusion, and Uvetic macular edema (ME). Based on the current literature review, DRIL’s prognostic value in predicting VA is not well elucidated but shows potential to be utilized in clinical practice.

A wide variety of lesions from the benign to aggressively malignant can present in the orbital region. Imaging is especially important in this highly specialized region. Computed tomography can provide data regarding bony involvement, and anatomical localization relative to the bony orbit, which is useful for surgical planning. Magnetic resonance imaging is superior in soft tissue resolution, lesion morphology, intensity, contrast enhancement, and for allowing localization in relation to vital orbital structures such as the optic nerve and extraocular muscles. Due to these structures and the closed orbital space, an orbital biopsy is not always easily performed and not without risk. Careful imaging with continual histopathological correlation can allow both the radiologist and surgeon to narrow the differential diagnosis of characteristic orbital tumors, which can ultimately guide management and potentially avoid risky surgery. We present the imaging characteristics of histopathologically proven neoplastic and inflammatory lesions of the orbit.

The majority of Coats’ disease cases are diagnosed in the first decade of life, though cases with symptom onset and first diagnosis in adulthood are well documented. While the cases diagnosed in childhood and adulthood share many of the characteristic features that define Coats’ disease, adult cases have been shown to present with less severe disease manifestations and an increased incidence of macroaneurysms with perianeurysmal hemorrhage. We present two cases of Coats’ disease diagnosed in adulthood that demonstrate prominent arteriolar macroaneurysms with perianeurysmal hemorrhages and contribute to an understanding of the adult Coats’ phenotype.