EXPLORING NOVEL APPLICATIONS OF RETROMODE IMAGING IN ANGIOID STREAKS

PURPOSE: To evaluate retromode scanning laser ophthalmoscopy (RM-SLO) for detecting and characterizing angioid streaks (AS). METHODS: Retrospective case series of five patients (10 eyes) imaged with color fundus, fundus autofluorescence, spectral-domain optical coherence tomography (OCT), and RM-SLO using right-deviated, left-deviated (DL), and ring/central apertures. Two graders assessed images; disagreements were adjudicated by a third expert. RESULTS: Retromode scanning laser ophthalmoscopy depicted AS as hyporeflective bands. Right-deviated and DL produced polarity-dependent, relief-like pseudo-3D cues attributable to lateral aperture deviation and collection of multiply scattered infrared light at the retinal pigment epithelium (RPE)/Bruch membrane interface. Ring/central maximized border sharpness and preserved apparent streak width, closely matching color images. Fundus autofluorescence confirmed hypoautofluorescent bands but provided less edge detail. Spectral-domain optical coherence tomography (SD-OCT) corroborated RPE/Bruch complex abnormalities with focal discontinuities and localized hypertransmission. In this cohort, no choroidal neovascularization was present at imaging or during documented follow-up. CONCLUSION: Retromode scanning laser ophthalmoscopy complements conventional en-face modalities by enhancing border delineation and rapid mapping of AS and can guide targeted OCT/optical coherence tomography angiography. Given the small sample and retrospective design, this series was not powered for head-to-head detection-rate comparisons; prospective studies are warranted.