Color Code of the Retina - Lecture III

What determines the color appearance of the fundus?

reflection and absorption of different wavelengths of light

Does light penetrate or be absorbed by sensory retina?

penetrates

Does light penetrate or be absorbed by melanin within the RPE?

absorbed

What determines the degree of absorption of pigment?

density & uniformity

Where is light absorbed by melanin?

choroid

What part of the choroid is some light reflected?

vasculature

What light is the nerve fiber layer best seen in?

blue-green light (red-free)

What light are the retinal vessels accentuated most by?

green light

What light can penetrate the RPE?

red light

What light are choroidal pigmented lesions impossible to see under?

green light

What are the 6 findings of the color code?

1. Shape

2. Borders

3. Location

4. Uniformity

5. Distribution

6. Associated Findings

What are the layers of the fundus (inside-out)?

1. Internal Limiting Membrane

2. Nerve Fiber Layer

3. Ganglion Cell Layer

4. Inner Plexiform Layer

5. Inner Nuclear Layer

6. Outer Plexiform Layer

7. Outer Nuclear Layer

8. External Limiting Membrane

9. Rods/Cones

10. RPE

11. Bruch’s

12. Choroid

13. Sclera

What are the 2 aspects of the vascular retina?

1. Superficial Vessels - NFL

2. Inner Capillary Plexus - Inner Nuclear Layer

Where is the avascular retina?

outer plexiform to Bruch’s membrane

What color are the inner 9 layers of the retina?

colorless

What layers are responsible for the color of the fundus?

pigment in RPE/choroid, choriocapillaris

What are the 7 types of White Color in the Retina?

1. Myelinated - medulated NFL

2. Cotton Wool Spots

3. Superficial glial cells

4. Deep glial cells

5. Sclera

6. Lattice - vitreous condensation

7. WBCs

What is the shape of myelinated?

linear

What are the borders of myelinated?

feathery

What is the retinal plane of myelinated?

retinal blood vessels

What is the retinal layer of myelinated?

NFL

What is the uniformity of myelinated?

uniform

What is the distribution pattern of myelinated?

peri, parapapillary, mid-periphery

What are the associated factors of myelinated?

none

What is the significance of myelinated?

congenital lesion, stable

What is the shape of cotton wool spots?

cloud-like

What are the borders of cotton wool spots?

fluffy

What is the retinal plane of cotton wool spots?

retinal blood vessels

What is the retinal layer of cotton wool spots?

NFL

What is the uniformity of cotton wool spots?

uniform

What is the distribution pattern of cotton wool spots?

posterior pole

What are the associated factors of cotton wool spots?

hemorrhage, exudate, ischemia

What is the significance of cotton wool spots?

vascular disorders, infection, inflammation

T/F: Can cotton wool spots change over time

True

T/F: Cotton wool spots are parallel to retinal vessels

False; perpendicular

What is the shape of superficial glial cells?

linear, membrane-like

What are the borders of superficial glial cells?

distinct

What is the retinal plane of superficial glial cells?

above retinal blood vessels

What is the retinal layer of the superficial glial cells?

internal limiting membrane

What is the uniformity of the superficial glial cells?

uniform, striae (stretch marks)

What is the distribution pattern of superficial glial cells?

posterior pole

What are the associated factors of superficial glial cells?

vessel tortuosity, pseudomacular hole

What is the significance of superficial glial cells?

idiopathic, trauma, PVD

What are the shape of deep glial cells?

disciform, linear

What are the borders of deep glial cells?

distinct

What is the retinal plane of deep glial cells?

below retinal blood vessels

What is the retinal layer of the deep glial cells?

retinal pigment epithelium

What is the uniformity of deep glial cells?

varied

What is the distribution pattern of deep glial cells?

posterior pole, periphery

What are the associated factors of deep glial cells?

RPE hyperplasia, sclera visible

What is the significance of deep glial cells?

trauma (blunt) , infection, inflammation

What is the retinal plane of lattice?

above retinal blood vessels

What is the retinal layer of lattice?

superficial retina - vitreous

What is the distribution pattern of lattice?

mid-far periphery, circumferential, cigar-shape

What are the associated factors of lattice?

partial & full thickness retinal holes, pigment

What is the significance of lattice?

retinal thinning, retinal detachment

What is the shape of WBCs?

cloud-like

What are the borders of WBCs?

indistinct, fluffy, hazy

What is the retinal plane of WBCs?

intraretinal, vitreous

What is the retinal layer of WBCs?

retina - vitreous

What is the uniformity of WBCs?

nonuniform

What is the distribution pattern of WBCs?

posterior pole, mid-far periphery

What are the associated factors with WBCs?

chorioretinal scars, RPE hyperplasia

What is the significance of WBCs?

inflammation, infection

What are the 6 types of yellow coloring in the fundus?

1. Drusen

2. Lipid Exudation

3. RPE-choriocapillaris atrophy

4. Flecked Retina (Stargardt disease)

5. Best Vitelliform

6. Resolving Hemorrhage

Drusen

by product of photo metabolism (lipoprotein)

What is the shape of drusen?

round

What are the borders of drusen?

relatively distinct, reddish-brown halo

What is the retinal plane of drusen?

below retinal blood vessels

What is the retinal layer of drusen?

RPE, Bruch’s membrane

What is the distribution pattern of drusen?

posterior pole, mid-periphery

What are the associated factors of drusen?

chorioretinal atrophy, RPE hyperplasia

What is the significance of drusen?

macular degeneration

What is the shape of lipid exudation?

angular

What are the borders of lipid exudation?

distinct, sharp

What is the retinal plane of lipid exudation?

slightly below blood vessels (intraretinal)

What is the retinal layer of lipid exudation?

outer plexiform

What is the distribution pattern of lipid exudation?

isolated, circinate, star-shape, posterior pole, periphery

What are the associated factors of lipid exudation?

serous fluid, hemorrhage, CWS

What is the significance of lipid exudation?

vascular disorders (systemic, ocular)