involutional foveal thinning

[promethiusII]

hi - I can't seem to get my questions answered. I was basically told that there was no point asking my questions because the answers would worry me (!) and I should just follow my docs advice. Why bother having these forums if you don't want to provide the info that people are looking for?

I'll keep it simple: can someone please tell me what involutional foveal thinning is, what causes it, and what things in an OCT one looks for to indicate whether itis there?

thanks much

[Houman Vosoghi, MD]

The following quote is from: http://www.v2020la.org/pub/PUBLICATIONS_BY_TOPICS/Retina%20-%20various/Macular%20hole.pdf

"E. INVOLUTIONAL MACULAR THINNING
Morgan and Schatz proposed a mechanism that
they described as
involutional macular thinning
, incorporating
vitreous, vascular, and cystic degeneration
theories.
151
The macular lesion was described as
“thin, mildly atrophic fovea that has lost its normal
architecture and appearance.” The foveal lesion was
a subtle abnormal depression with variably associated
retinal cystic changes or a surrounding yellow
ring. Of 95 eyes with involutional macular thinning,
27% developed full-thickness macular holes during
a follow-up period ranging between 3 months and
10 years (mean: 4.5 years). In the first step of this
schema, choroidal vascular changes lead to altered
submacular choroidal vascular perfusion, leading to
focal foveal, retinal and pigment epithelial changes.
Alterations in the retinal pigment epithelium, as detected
by fluorescein angiography, were identified as
an independent risk factor for macular hole formation.
These vascular changes then lead to cystic degeneration
of the retina, which produces permanent
structural changes in the fovea or in the retinal pigment
epithelium, leading to involutional macular
thinning. The final step in the pathogenesis of a
macular hole in this theory is vitreous traction on
thinned foveal tissue.
151,152
These authors did not
specify the nature of the vitreous traction in their
theory, but presumably it was generated from attached
posterior vitreous, the other independent
risk factor for macular hole development in involutional
macular thinning. Interestingly, two eyes with
a complete posterior vitreous separation were observed
to develop a macular hole despite the lack of
an apparent vitreous attachment."

[promethiusII]

found something a little more recent. will keep looking. (same comment applies to my other post "back from retinal specialist..."

Ophthalmic Surg. 1992 Sep;23(9):594-7.

Fellow eyes in idiopathic macular hole cases.
Akiba J, Kakehashi A, Arzabe CW, Trempe CL.

[promethiusII]

that's perfect - thanks;i will look up the paper and see if there have been any folloups in the current era of hi-res OCT scanning.