Geographic Atrophy and Foveal-Sparing Changes Related to Visual Acuity in Patients With Dry Age-Related Macular Degeneration Over Time

Sayegh, Ramzi; Sacu, Stefan; Dunavoelgyi, Roman; Kroh, Maria Elisabeth; Roberts, Philipp; Mitsch, Christoph; Montuoro, Alessio; Ehrenmüller, Margit; Schmidt‐Erfurth, Ursula

doi:10.1016/j.ajo.2017.03.031

Cited by 61 publications

(48 citation statements)

References 40 publications

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“…The fovea was graded as spared in presence of foveal depression with preserved inner and outer retinal layers. 32 In case of foveal sparing, if the greater extension of cRORA was located between central subfield and the 3-mm (outer) diameter ring it was graded as parafoveal; and between 3-mm and the 6-mm (outer) diameter ring, as perifoveal.…”

Section: Refractile Drusen and Macular Complicationsmentioning

confidence: 99%

The Fate and Prognostic Implications of Hyperreflective Crystalline Deposits in Nonneovascular Age-Related Macular Degeneration

Fragiotta

Fernández-Avellaneda

Breazzano

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To explore patterns of disease progression in nonneovascular age-related macular degeneration (AMD) associated with hyperreflective crystalline deposits (HCDs) in the subretinal pigment epithelium-basal laminar space. METHODS. Retrospective review of medical records, multimodal imaging, and longitudinal eyetracked near-infrared reflectance (NIR) and optical coherence tomography (OCT) spanning ‡2 years. NIR/OCT images were analyzed with ImageJ software to identify HCD morphology and location. Associated macular complications were reviewed from the time of HCD detection to the most recent follow-up, using NIR/OCT. RESULTS. Thirty-three eyes with HCDs from 33 patients (mean age: 72 6 7.5 years) had 46.7 months (95% confidence limits: 33.7, 59.6) of serial eye-tracked NIR/OCT follow-up. Baseline best-corrected visual acuity (BCVA) was 0.44 logMAR (Snellen equivalent 20/55). At a mean of 11.3 months (3.1, 19.6) after HCD detection, 31/33 (93.9%) eyes had developed macular complications including de novo areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in 21/33 (64%) eyes, enlargement of preexisting cRORA in 4/33 (12%) eyes, and incident macular neovascularization in 3/33 (9%) eyes. Movement and clearance of HCDs in 9/33 (27%) eyes was associated with enlargement of preexisting cRORA (r ¼ 0.44, P ¼ 0.02). BCVA at the last follow-up visit had decreased to 0.72 logMAR (20/105). CONCLUSIONS. Eyes with nonneovascular AMD demonstrating HCDs are at risk for vision loss due to macular complications, particularly when movement and clearance of these structures appear on multimodal imaging. HCD reflectivity and dynamism may be amenable to automated recognition and analysis to assess cellular activity related to drusen end-stages.

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Section: Refractile Drusen and Macular Complicationsmentioning

confidence: 99%

The Fate and Prognostic Implications of Hyperreflective Crystalline Deposits in Nonneovascular Age-Related Macular Degeneration

Fragiotta

Fernández-Avellaneda

Breazzano

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…Geographic atrophy (GA) presents as localized atrophy of the retinal pigment epithelium (RPE), the outer retina and the choriocapillaris in advanced AMD, causing central scotomas and permanent loss of visual acuity (Sayegh et al. ; Fleckenstein et al. ).…”

Section: Introductionmentioning

confidence: 99%

Semi‐automated quantification of geographic atrophy with blue‐light autofluorescence and spectral‐domain optical coherence tomography: a comparison between the region finder and the advanced retinal pigment epithelium tool in the clinical setting

Reumueller

Sacu

Karantonis

et al. 2019

Acta Ophthalmologica

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Purpose To compare inter‐ and intraobserver reliability and intermodality agreement on quantification of geographic atrophy, using two routinely available quantification tools, based on blue‐light fundus autofluorescence (BAF) and spectral‐domain optical coherence tomography (SD‐OCT). Methods Quantifications of atrophic lesions within the central 5 mm of 30 eyes from 30 patients (mean age: 76.1 years) were independently performed by two clinicians on BAF images using the region finder (RF; Heidelberg Engineering) and on SD‐OCT using the advanced retinal pigment epithelium tool (ARPET; Carl Zeiss Meditec) at baseline and follow‐up (mean interval: 336 days). Inter‐ and intraobserver reliability was determined by intraclass correlation coefficients (ICC) and Bland–Altmann plots. Additionally, graders rated the experienced difficulty of each measurement. Results Intraclass correlation coefficients (ICC) showed excellent inter‐ and intraobserver reliability with values between 0.994 and 0.998 for RF and slightly higher values for ARPET of 0.997 and 0.999. Bland–Altman plots showed smaller variability for ARPET. Mean interobserver differences (95% CI) for size measurements were −0.11 (−0.27; 0.05) (baseline) and −0.05 mm² (−0.18; 0.08) (follow‐up) for RF and −0.04 (−0.14; 0.06) and −0.06 mm² (−0.14; 0.02) for ARPET. Measurements of lesions were on average 0.57 mm² (0.35; 0.79) or 7.6% larger in ARPET. Lesion size between graders did not differ significantly. There was no statistically significant difference in relative enlargement rates between methods. There was poor to moderate agreement between graders when rating the experienced difficulty of each measurement. Conclusion Semi‐automated analysis of geographic atrophy with RF and ARPET is equally reliable and reproducible in clinical settings, despite both algorithms require frequent adjustment by users. The ARPET restricts size measurements to the central 5 mm, which limits its ability to fully track GA progression. Results of both tools are not interchangeable as measurements with ARPET result in larger lesion sizes.

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“…The loss of RPE and depletion of intact overlying photoreceptors in the fovea lead to an irreversible vision loss. 33 Current studies focus on the lesion growth as a structural endpoint of GA, which is measurable on FAF imaging. 10 SD-OCT is now widely available and the three-dimensional data acquired provides information about the course of disease additional to that from conventional two-dimensional FAF imaging.…”

Section: Discussionmentioning

confidence: 99%

Subretinal Drusenoid Deposits and Photoreceptor Loss Detecting Global and Local Progression of Geographic Atrophy by SD-OCT Imaging

Reiter

Told

Schranz

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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To investigate the impact of subretinal drusenoid deposits (SDD) and photoreceptor integrity on global and local geographic atrophy (GA) progression. METHODS. Eighty-three eyes of 49 patients, aged 50 years and older with GA secondary to age-related macular degeneration (AMD), were prospectively included in this study. Participants underwent spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) imaging at baseline and after 12 months. The junctional zone and presence of SDD were delineated on SD-OCT and FAF images. Linear mixed models were calculated to investigate the association between GA progression and the junctional zone area, baseline GA area, age, global and local presence of SDD and unifocal versus multifocal lesions. RESULTS. The area of the junctional zone was significantly associated with the progression of GA, both globally and locally (all P < 0.001). SDD were associated with faster growth in the overall model (P = 0.039), as well as in the superior-temporal (P = 0.005) and temporal (P = 0.002) sections. Faster progression was associated with GA baseline area (P < 0.001). No difference was found between unifocal and multifocal lesions (P > 0.05). Age did not have an effect on GA progression (P > 0.05). CONCLUSIONS. Photoreceptor integrity and SDD are useful for predicting global and local growth in GA. Investigation of the junctional zone is merited because this area is destined to become atrophic. Photoreceptor loss visible on SD-OCT might lead to new structural outcome measurements visible before irreversible loss of retinal pigment epithelium occurs.

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Geographic Atrophy and Foveal-Sparing Changes Related to Visual Acuity in Patients With Dry Age-Related Macular Degeneration Over Time

Abstract: GA and FS changed inversely over time. In general, FS highly correlated with BCVA, while GA progression correlated with the central 3-mm FS regression, but not with BCVA. A threshold in GA and FS area could be determined for BCVA necessary for daily activity.

Cited by 61 publications

References 40 publications

The Fate and Prognostic Implications of Hyperreflective Crystalline Deposits in Nonneovascular Age-Related Macular Degeneration

The Fate and Prognostic Implications of Hyperreflective Crystalline Deposits in Nonneovascular Age-Related Macular Degeneration

Semi‐automated quantification of geographic atrophy with blue‐light autofluorescence and spectral‐domain optical coherence tomography: a comparison between the region finder and the advanced retinal pigment epithelium tool in the clinical setting

Subretinal Drusenoid Deposits and Photoreceptor Loss Detecting Global and Local Progression of Geographic Atrophy by SD-OCT Imaging

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