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Purpose <p>Off-axis retroillumination (known as “Retro mode”) has been shown to enhance the detection of drusen, particularly smaller lesions. Images are obtained by shifting the aperture left (DL) or right (DR), each revealing complementary aspects of drusen. This study evaluated whether combining DL and DR images could enhance drusen boundary depiction.</p> Methods <p>Multimodal images from 11 patients (mean age 74.5 ± 12.1 years; 8 females) with early or intermediate age-related macular degeneration (AMD) were retrospectively analyzed. Imaging included pseudocolor photographs, Retro mode (Mirante, NIDEK), and optical coherence tomography (OCT; Cirrus 5000, Zeiss). DL and DR Retro mode images were manually aligned using vascular landmarks, and differential images (DIF) were generated with FIJI (ImageJ).</p> Results <p>DIF images appeared to facilitate lesion boundary depiction compared with individual DL or DR images. Hard drusen were barely visible on pseudocolor photographs and en face OCT but were identifiable with Retro mode; on DIF images, they appeared larger than on DL or DR images. Intermediate drusen were visible across all modalities, and Bland–Altman analysis showed a small positive bias toward larger areas on DIF compared with en face OCT (mean difference: +2.2%). Soft drusen also appeared larger on DIF, with a systematic positive bias of 14.5% relative to pseudocolor imaging. DIF images further supported the qualitative characterization of cuticular drusen and subretinal drusenoid deposits (SDD).</p> Conclusion <p>This pilot study suggests that Retro mode imaging of drusen can be refined through alignment and differential analysis of DL and DR images, providing a more complete visual depiction of drusen surface features and offering complementary information for the characterization of AMD stages.</p>

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Bidirectional Retro mode differential imaging improves drusen boundary depiction in early and intermediate AMD: a pilot study

  • 期刊论文

  • 发表日期：

    2026年4月25日

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  • Thomas Desmettre,
  • Gerardo Ledesma-Gil,
  • Michel Paques

摘要

Purpose

Off-axis retroillumination (known as “Retro mode”) has been shown to enhance the detection of drusen, particularly smaller lesions. Images are obtained by shifting the aperture left (DL) or right (DR), each revealing complementary aspects of drusen. This study evaluated whether combining DL and DR images could enhance drusen boundary depiction.

Methods

Multimodal images from 11 patients (mean age 74.5 ± 12.1 years; 8 females) with early or intermediate age-related macular degeneration (AMD) were retrospectively analyzed. Imaging included pseudocolor photographs, Retro mode (Mirante, NIDEK), and optical coherence tomography (OCT; Cirrus 5000, Zeiss). DL and DR Retro mode images were manually aligned using vascular landmarks, and differential images (DIF) were generated with FIJI (ImageJ).

Results

DIF images appeared to facilitate lesion boundary depiction compared with individual DL or DR images. Hard drusen were barely visible on pseudocolor photographs and en face OCT but were identifiable with Retro mode; on DIF images, they appeared larger than on DL or DR images. Intermediate drusen were visible across all modalities, and Bland–Altman analysis showed a small positive bias toward larger areas on DIF compared with en face OCT (mean difference: +2.2%). Soft drusen also appeared larger on DIF, with a systematic positive bias of 14.5% relative to pseudocolor imaging. DIF images further supported the qualitative characterization of cuticular drusen and subretinal drusenoid deposits (SDD).

Conclusion

This pilot study suggests that Retro mode imaging of drusen can be refined through alignment and differential analysis of DL and DR images, providing a more complete visual depiction of drusen surface features and offering complementary information for the characterization of AMD stages.