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.
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Drexler W, Fujimoto JG (2008) State-of-the-art retinal optical coherence tomography. Prog Retin Eye Res 27:45–88
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
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
O'Brien KMB (2008) Development of the foveal specialization. Visual Transduction and Non-Visual Light Perception Humana Press, pp 17–33
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
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
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
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
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
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
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
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
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
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
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
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
Yuodelis C, Hendrickson A (1986) A qualitative and quantitative analysis of the human fovea during development. Vis Res 26:847–855
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
Rodieck RW, Rodieck RW (1998) The first steps in seeing. Sinauer Associates, Sunderland
Williams DR (1986) Seeing through the photoreceptor mosaic. Trends Neurosci 9:193–198
Curcio CA, Sloan KR, Kalina RE, Hendrickson AE (1990) Human photoreceptor topography. Comp Neurol 292:497–523
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
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
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
Pilz KS, Miller L, Agnew HC (2017) Motion coherence and direction discrimination in healthy aging. J Vis 17:31–31
Pilz KS, Papadaki D (2019) An advantage for horizontal motion direction discrimination. Vis Res 158:164–172
Ke SR, Lam J, Pai DK, Spering M (2013) Directional asymmetries in human smooth pursuit eye movements. Invest Ophthalmol Vis Sci 54:4409–4421
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
Littmann H (1982) Determination of the real size of an object on the fundus of the living eye. Klin Monatsbl Augenheilkd 180:286–289
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).
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.
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.
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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
- Ultrahigh-resolution optical coherence tomography
- Spectral domain optical coherence tomography
- Foveal bulge
- Foveal pit