Maturation of the Human Fovea: Correlation of Spectral-Domain Optical Coherence Tomography Findings With Histology

• Published in: American journal of ophthalmology Vol. 154; no. 5; pp. 779 - 789.e2
• Main Authors: Vajzovic, Lejla, Hendrickson, Anita E, O'Connell, Rachelle V, Clark, Laura A, Tran-Viet, Du, Possin, Daniel, Chiu, Stephanie J, Farsiu, Sina, Toth, Cynthia A
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2012; Elsevier; Elsevier Limited
• Subjects: Adolescent; Age; Aged; Biological and medical sciences; Biomedical research; Child; Child, Preschool; Dietary fiber; Female; Fovea Centralis - anatomy & histology; Fovea Centralis - growth & development; Gestational Age; Histology; Humans; Infant; Infant, Newborn; Infant, Premature - growth & development; Male; Medical sciences; Miscellaneous; Nerve Fibers; Ophthalmology; Pathology; Pediatrics; Photoreceptor Cells, Vertebrate - cytology; Premature Birth; Retinal Ganglion Cells - cytology; Retrospective Studies; Studies; Term Birth; Tomography, Optical Coherence; Human; Correlation; Histology; Ophthalmology; Optical coherence tomography
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2012.05.004

Purpose To correlate human foveal development visualized by spectral-domain optical coherence tomography (SDOCT) with histologic specimens. Design Retrospective, observational case series. Methods Morphology and layer thickness of retinal SDOCT images from 1 eye each of 22 premature infants, 30 term infants, 16 children, and 1 adult without macular disease were compared to light microscopic histology from comparable ages. Results SDOCT images correlate with major histologic findings at all time points. With both methods, preterm infants demonstrate a shallow foveal pit indenting inner retinal layers (IRL) and short, undeveloped foveal photoreceptors. At term, further IRL displacement forms the pit and peripheral photoreceptors lengthen; the elongation of inner and outer segments (IS and OS, histology) separates the IS band from retinal pigment epithelium. Foveal IS and OS are shorter than peripheral for weeks after birth (both methods). By 13 months, foveal cone cell bodies stack >6 deep, Henle fiber layer (HFL) thickens, and IS/OS length equals peripheral; on SDOCT, foveal outer nuclear layer (which includes HFL) and IS/OS thickens. At 13 to 16 years, the fovea is fully developed with a full complement of SDOCT bands; cone cell bodies >10 deep have thin, elongated, and tightly packed IS/OS. Conclusions We define anatomic correlates to SDOCT images from normal prenatal and postnatal human fovea. OCT bands typical of photoreceptors of the adult fovea are absent near birth because of the immaturity of foveal cones, develop by 24 months, and mature into childhood. This validates the source of SDOCT signal and provides a framework to assess foveal development and disease.