Disorganization of Retinal Inner Layers Serves as a Biomarker for Poorer Contrast Sensitivity

Ophthalmology office.
Ophthalmology office. Masked patient and doctor – Covid 19. Scan of the retina, an examination that allows you to precisely visualize the different parts of the eye. This imaging makes it possible to observe the retina in order to detect, for example, a retinal uplift with edema or a diabetic retinopathy. It is used to monitor wet AMD about every two months and complements the fundus to see if an injection of treatment is needed. OCT is also used to examine the optic nerve, and therefore screen for or monitor glaucoma. (Photo by: Pascal Bachelet/BSIP/Universal Images Group via Getty Images)
DRIL is an important imaging biomarker to consider when evaluating a patient’s visual functioning, a study suggests.

Disorganization of retinal inner layers (DRIL) may be associated with decreased contrast sensitivity (CS) in eyes with macular edema secondary to retinal vein occlusion, according to a study published in the British Journal of Ophthalmology.

Researchers conducted a prospective, observational study of patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) (N=31, mean age 63.9±10.5 years, 45% women). They performed ophthalmic assessments including spectral domain optical coherence tomography and contrast sensitivity testing with a quick contrast sensitivity function method.

Investigators observed DRIL in 69% of optical images with an average extent of 381±271 μm. DRIL associated with poorer visual acuity, external limiting membrane disruption, hyperreflective foci, ellipsoid zone disruption, greater central macular thickness, and greater central foveal thickness compared with images without DRIL (mean logMAR 0.28±0.18 vs 0.093±0.91, P <.001; 67.5% vs 11.1%, P =.001; 97.5% vs 50%, P =.048; 70% vs 16.7%, P =.013; 389±150 vs 294±42 µm, P =.009; and 322±182 vs 219±47 µm, P =.015, respectively).

Multivariate regression analysis revealed that visual acuity was significantly associated with moderate cataract (coefficient, 0.19; 95% CI, 0.08 -0.31; P =.001), central foveal thickness (coefficient, 0.0004; 95% CI, 0.0002-0.0007; P =.002), and DRIL extent (coefficient, 0.0002; 95% CI, 0.0001-0.0004; P =.004). It also revealed an association between a worse area under the curve of log contrast sensitivity (AULCSF) and DRIL extent (coefficient, -0.00072; 95% CI, -0.001 to -0.0004; P <.001), moderate cataract (coefficient, -0.32; 95% CI, -0.52 to -0.12; P =.001), central macular thickness (coefficient, -0.002; 95% CI, -0.003 to -0.0005; P =.007), and central foveal thickness (coefficient, 0.0013; 95% CI, 0.0002-0.0025; P =.024).

“DRIL is associated with not only worse visual acuity in patients with ME secondary to RVO, but also worse CS.” according to the investigators. “This study underscores DRIL as an important imaging biomarker to consider when assessing visual function of the patient.”

This study was limited by a small sample size, single center design, and a failure to assess fluorescein angiography and OCT-A findings.


Wang J, Cui Y, Vingopoulos F, et al. Disorganisation of retinal inner layers is associated with reduced contrast sensitivity in retinal vein occlusion. Br J Ophthalmol. 2022;106(2):241-245. doi:10.1136/bjophthalmol-2020-317615