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. 2020 Apr;127(4):492–500. doi: 10.1016/j.ophtha.2019.10.037

Figure 1.

Figure 1

Schematic demonstrating the Leicester Grading System for Foveal Hypoplasia, showing features of a normal fovea detectable using OCT, followed by the features of typical and atypical grades of foveal hypoplasia. The normal fovea features outward displacement, termed extrusion, of the plexiform layers. All grades of foveal hypoplasia feature continuation of the plexiform layers. Grade 1a foveal hypoplasia is associated with a nearly normal pit resembling a “V” shape and outer segment (OS) lengthening, and outer nuclear layer (ONL) widening relative to the parafoveal OS and ONL lengths, respectively. Grade 1b foveal hypoplasia is associated with a shallow indent and OS lengthening and ONL widening relative to the parafoveal OS and ONL lengths, respectively. In grade 2 foveal hypoplasia, all features of grade 1 are present except that no pit is present. Grade 3 foveal hypoplasia represents all features of grade 2, except no lengthening of the OS segment is present. Grade 4 foveal hypoplasia represents grade 3, except no ONL widening at the fovea (termed fovea plana) is present. Atypical foveal hypoplasia is characterized by a shallow foveal pit and disruption of the inner segment ellipsoid (ISe) band forming a hyporeflective zone. ELM = external limiting membrane; GCL = ganglion cell layer; ILM = internal limiting membrane; INL = inner nuclear layer; IPL = inner plexiform layer; OPL = outer plexiform layer; RNFL = retinal nerve fiber layer; RPE = retinal pigment epithelium. Reprinted and adapted with permission from Thomas MG, Kumar A, Mohammad S, et al. Structural grading of foveal hypoplasia. Ophthalmology. 2011;118(8):1653–1660. Copyright © 2011 Elsevier.