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Normal and abnormal foveal development

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journal contribution
posted on 23.11.2020, 11:53 by Mervyn G Thomas, Eleni Papageorgiou, Helen J Kuht, Irene Gottlob
Normal foveal development begins in utero at midgestation with centrifugal displacement of inner retinal layers (IRLs) from the location of the incipient fovea. The outer retinal changes such as increase in cone cell bodies, cone elongation and packing mainly occur after birth and continue until 13 years of age. The maturity of the fovea can be assessed invivo using optical coherence tomography, which in normal development would show a well-developed foveal pit, extrusion of IRLs, thickened outer nuclear layer and long outer segments. Developmental abnormalities of various degrees can result in foveal hypoplasia (FH). This is a characteristic feature for example in albinism, aniridia, prematurity, foveal hypoplasia with optic nerve decussation defects with or without anterior segment dysgenesis without albinism (FHONDA) and optic nerve hypoplasia. In achromatopsia, there is disruption of the outer retinal layers with atypical FH. Similarly, in retinal dystrophies, there is abnormal lamination of the IRLs sometimes with persistent IRLs. Morphology of FH provides clues to diagnoses, and grading correlates to visual acuity. The outer segment thickness is a surrogate marker for cone density and in foveal hypoplasia this correlates strongly with visual acuity. In preverbal children grading FH can help predict future visual acuity.

History

Citation

British Journal of Ophthalmology Published Online First: 04 November 2020. doi: 10.1136/bjophthalmol-2020-316348

Author affiliation

Department of Neuroscience, Psychology and Behaviour, College of Life Sciences

Version

AM (Accepted Manuscript)

Published in

British Journal of Ophthalmology

Publisher

BMJ

issn

0007-1161

eissn

1468-2079

Acceptance date

17/10/2020

Copyright date

2020

Available date

04/11/2020

Language

en

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