Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO) in Patients with Choroideremia

Purpose: To provide a detailed characterization of choroideremia (CHM) using fluorescence lifetime imaging ophthalmoscopy (FLIO) and to provide a deeper understanding of disease-related changes and progression. Methods: Twenty-eight eyes of 14 patients with genetically confirmed CHM (mean age, 28 +/- 14 years) and 14 age-matched healthy subjects were investigated in this study. FLIO images of a 30 degrees retinal field were collected at the Moran Eye Center using a Heidelberg Engineering FLIO device. FLIO lifetimes were recorded in short spectral channels (SSC; 498-560 nm) and long spectral channels (LSC; 560-720 nm), and mean autofluorescence lifetimes (tau(m)) were calculated. Optical coherence tomography (OCT) scans were recorded for each patient. Three patients were re-imaged after a year. Results: Patients with CHM exhibit specific FLIO lifetime patterns. Prolonged FLIO lifetimes (around 600-700 ps) were found in the peripheral macula corresponding to atrophy in OCT imaging. In the central macula, tau(m), was unrelated to autofluorescence intensity. Some areas of persistent retinal pigment epithelial islands had prolonged FLIO lifetimes, whereas other areas of hypofluorescence had short FLIO lifetimes. At 1-year follow-up, FLIO lifetimes were significantly prolonged within atrophic areas (P < 0.05). Conclusions: FLIO shows distinct patterns in patients with CHM, indicating lesions of atrophy and areas of preserved function in the presence or absence of findings in fundus autofluorescence intensity images. FLIO may provide differentiated knowledge about pathophysiology and atrophy progression in CHM compared to conventional imaging modalities. Translational Relevance: FLIO shows distinctive lifetime patterns that potentially identify areas of function, atrophy, and disease progression in patients with CHM.