Relationship between foveal birefringence and visual acuity in neovascular age-related macular degeneration.

Purpose: To investigate the relationship between visual acuity and foveal birefringence in patients with neovascular age-related macular degeneration.

Methods: In total, 40 patients with choroidal neovascularization underwent macular imaging with scanning laser polarimetry. Bowtie patterns, typically seen in birefringence images of the macula, were evaluated and classified into three categories: (1) regular bowtie present; (2) bowtie present, but disrupted; and (3) no bowtie present. The relation of the bowtie appearance to the best-corrected logMAR visual acuities was tested (ANOVA).

Results: Mean visual acuity was best for the group that had regular bowties (mean logMAR=0.34) and differed statistically significantly from the disrupted bowtie group and no bowtie group (P=0.01 and 0.0007). Ages for the three groups did not differ (P=0.31).

Conclusions: Appearance of a regular bowtie indicates a substantially intact Henle fibre layer with the potential for good visual function, despite the presence of underlying pathology. Conversely, disruption or absence of a bowtie may indicate severe damage to the photoreceptors, consistent with the finding of poorer visual acuity.