Misalignment of foveal pit and foveal bulge determined by ultrahigh-resolution SD-OCT in normal eyes



The foveal bulge (FB) results from a lengthening of the outer segments of the photoreceptors which then makes the central fovea arcuate in shape. The purpose of this study was to evaluate the morphological features and locations of the FB relative to the foveal pit (FP) in a single B-scan image.


One hundred and forty-seven eyes of 147 healthy volunteers were studied. Horizontal and vertical B-scan optical coherence tomographic (OCT) images through the fovea were recorded by an ultrahigh-resolution spectral domain OCT (UHR-SD-OCT) instrument (Bi-μ, KOWA, Japan). The vertex of the FB and the center of the FP were identified with the ImageJ software. The distance between the FB and FP and the height of the FB were measured.


In the horizontal images, the vertex of the FB was on the nasal side of the center of the FP in 97 eyes (66%), on the temporal side in 42 eyes (29%), and the same position in 8 eyes (5%). In the vertical images, the vertex of the FB was superior to the center of the FP in 82 eyes (55%), inferior to the center of the FP in 45 eyes (31%), and the same position in 20 eyes (14%). The mean distance (± SD) between the FB and the FP was + 16.8 ± 30.1 μm in the horizontal images and + 8.27 ± 28.0 μm in the vertical images. The mean height (± SD) of the FB was 77.0 ± 4.78 μm in the horizontal images and 77.9 ± 5.05 μm in the vertical images. The height of the FB in the horizontal images was significantly correlated with refractive error in the multiple regression analysis (P = 0.041).


These results indicate that the vertex of the FB was not aligned with the center of the FP in the majority of the eyes of normal Japanese individuals in a single B-scan image. Analysis showed that eyes with less severe myopia had the higher height of the FB. This must be considered when interpreting the location of the vertex of the FB and the center of the FP in clinical situations.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Drexler W, Fujimoto JG (2008) State-of-the-art retinal optical coherence tomography. Prog Retin Eye Res 27:45–88

    Article  Google Scholar 

  2. 2.

    Tick S, Rossant F, Ghrbel I, Gaudric A, Sahel JA, Chaument-Riffaud P et al (2011) Foveal shape and structure in a normal population. Invest Ophthalmol Vis Sci 52:5105–5110

    Article  Google Scholar 

  3. 3.

    Hammer DX, Iftimia NV, Ferguson RD, Bigelow CE, Ustun TE, Barnaby AM et al (2008) Foveal fine structure in retinopathy of prematurity: an adaptive optics Fourier domain optical coherence tomography study. Invest Ophthalmol Vis Sci 49:2061–2070

    Article  Google Scholar 

  4. 4.

    O'Brien KMB (2008) Development of the foveal specialization. Visual Transduction and Non-Visual Light Perception Humana Press, pp 17–33

  5. 5.

    Maldonado RS, O’Connell RV, Sarin N, Freedman SF, Wallace DK, Cotton CM et al (2011) Dynamics of human foveal development after premature birth. Ophthalmology 118:2315–2325

    Article  Google Scholar 

  6. 6.

    Bringmann A, Syrbe S, Görner K, Kacza J, Francke M, Wiedemann P et al (2018) The primate fovea: structure, function and development. Prog Retin Eye Res 66:49–84

    Article  Google Scholar 

  7. 7.

    Hasegawa T, Ueda T, Okamoto M, Ogata N (2004) Relationship between presence of foveal bulge in optical coherence tomographic images and visual acuity after rhegmatogenous retinal detachment repair. Retina 34:1848–1853

    Article  Google Scholar 

  8. 8.

    Hasegawa T, Ueda T, Okamoto M, Ogata N (2014) Presence of foveal bulge in optical coherence tomographic images in eyes with macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 157:390–396

    Article  Google Scholar 

  9. 9.

    Chen CJ, Scholl HP, Birch DG, Iwata T, Miller NR, Goldberg MF (2012) Characterizing the phenotype and genotype of a family with occult macular dystrophy. Arch Ophthalmol 130:1554–1559

    Article  Google Scholar 

  10. 10.

    Al-Haddad CE, El Mollayess GM, Mahfoud ZR, Jaafar DF, Bashshur ZF (2013) Macular ultrastructural features in amblyopia using high-definition optical coherence tomography. Br J Ophthalmol 97:318–322

    Article  Google Scholar 

  11. 11.

    Thomas MG, Kumar A, Mohammad S, Proudlock FA, Engle EC, Andrews C et al (2011) Structural grading of foveal hypoplasia using spectral-domain optical coherence tomography a predictor of visual acuity? Ophthalmology 118:1653–1660

    Article  Google Scholar 

  12. 12.

    Mohammad S, Gottlob I, Kumar A, Thomas M, Degg C, Sheth V et al (2011) The functional significance of foveal abnormalities in albinism measured using spectral-domain optical tomography. Ophthalmology 118:1645–1652

    Article  Google Scholar 

  13. 13.

    Parthasarathy MK, Bhende M (2018) Deviation in the position of foveal bulge from foveal center in normal subjects measured using spectral-domain OCT. Ophthalmol Retina 2:337–342

    Article  Google Scholar 

  14. 14.

    Matsui Y, Kondo M, Uchiyama E, Miyata R, Matsubara H (2019) New clinical ultrahigh-resolution SD-OCT using A-scan matching algorithm. Graefes Arch Clin Exp Ophthalmol 257:255–263

    Article  Google Scholar 

  15. 15.

    Nishida Y, Fujiwara T, Imamura Y, Lima LH, Kurosaka D, Spaide RF (2012) Choroidal thickness and visual acuity in highly myopic eyes. Retina 32:1229–1236

    Article  Google Scholar 

  16. 16.

    Liu B, Wang Y, Li T, Ma W, Chen X (2018) Correlation of subfoveal choridal thickness with axial length, refractive error, and age in adult highly myopic eyes. BMC Ophthalmol 18:127

    Article  Google Scholar 

  17. 17.

    Yuodelis C, Hendrickson A (1986) A qualitative and quantitative analysis of the human fovea during development. Vis Res 26:847–855

    CAS  Article  Google Scholar 

  18. 18.

    Hendrickson A, Possin D, Vajzovic L, Toth CA (2012) Histologic development of the human fovea from midgestation to maturity. Am J Ophthalmol 154:767–778

    Article  Google Scholar 

  19. 19.

    Rodieck RW, Rodieck RW (1998) The first steps in seeing. Sinauer Associates, Sunderland

    Google Scholar 

  20. 20.

    Williams DR (1986) Seeing through the photoreceptor mosaic. Trends Neurosci 9:193–198

    Article  Google Scholar 

  21. 21.

    Curcio CA, Sloan KR, Kalina RE, Hendrickson AE (1990) Human photoreceptor topography. Comp Neurol 292:497–523

    CAS  Article  Google Scholar 

  22. 22.

    Wilk MA, McAllister JT, Cooper RF, Dubis AM, Patitucci TN, Summerfelt P et al (2014) Relationship between foveal cone specialization and pit morphology in albinism. Invest Ophthalmol Vis Sci 55:4186–4198

    Article  Google Scholar 

  23. 23.

    Wilk MA, Dubis AM, Cooper RF, Summerfelt P, Dubra A, Carroll J (2017) Assessing the spatial relationship between fixation and foveal specializations. Vis Res 132:53–61

    Article  Google Scholar 

  24. 24.

    Putnam NM, Hofer HJ, Doble N, Chen L, Carroll J, Williams DR (2005) The locus of fixation and the foveal cone mosaic. J Vis 5:632–639

    Article  Google Scholar 

  25. 25.

    Pilz KS, Miller L, Agnew HC (2017) Motion coherence and direction discrimination in healthy aging. J Vis 17:31–31

    Article  Google Scholar 

  26. 26.

    Pilz KS, Papadaki D (2019) An advantage for horizontal motion direction discrimination. Vis Res 158:164–172

    Article  Google Scholar 

  27. 27.

    Ke SR, Lam J, Pai DK, Spering M (2013) Directional asymmetries in human smooth pursuit eye movements. Invest Ophthalmol Vis Sci 54:4409–4421

    Article  Google Scholar 

  28. 28.

    Saurabh K, Roy R, Sharma P, Chandrasekharan DP, Deshmukh K, Vyas C (2017) Age-related changes in the foveal bulge in healthy eyes. Middle East Afr J Ophthalmol 24:48

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Littmann H (1982) Determination of the real size of an object on the fundus of the living eye. Klin Monatsbl Augenheilkd 180:286–289

    CAS  Article  Google Scholar 

Download references


We thank Professor Duco Hamasaki of the Bascom Palmer Eye Institute of the University of Miami for critical discussion and final manuscript revisions.


We thank the Grant-in-Aid for Scientific Research (C) (MK, 17 K19721) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. (http://www.jsps.go.jp/). This study was funded by the Grant-in-Aid for Scientific Research B (#18H02954).

Author information



Corresponding author

Correspondence to Yoshitsugu Matsui.

Ethics declarations

Conflict of interest

YM received honoraria from Alcon, Bayer, Hoya, Kowa, Novartis, Santen, AMO Japan, and Senju. RM received honoraria from Alcon, Hoya, Kowa, Novartis, Santen, and AMO japan. HM received financial research support from Novartis and honoraria from Alcon, Bayer, Novartis, and Santen. MK is a consultant to Senju and Bayer and received financial research support from Alcon, AMO Japan, Hoya, Kowa, NIDEK, Novartis, Otsuka, Pfizer, Santen, and Senju and honoraria from Alcon, Bayer, Hoya, Kowa, NIDEK, Novartis, Otsuka, Pfizer, Sanofi, Santen, Sanwa, and Senju. Other author had no financial disclosures. But all authors had no non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(DOCX 18 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Matsui, Y., Miyata, R., Uchiyama, E. et al. Misalignment of foveal pit and foveal bulge determined by ultrahigh-resolution SD-OCT in normal eyes. Graefes Arch Clin Exp Ophthalmol (2020). https://doi.org/10.1007/s00417-020-04813-6

Download citation


  • Ultrahigh-resolution optical coherence tomography
  • Spectral domain optical coherence tomography
  • Fovea
  • Macular
  • Foveal bulge
  • Foveal pit