Local Progression Kinetics of Geographic Atrophy in Age-Related Macular Degeneration Are Associated With Atrophy Border Morphology

Abstract

PURPOSE.To assess the impact of distinct atrophy border characteristics based on spectraldomain optical coherence tomography (SD-OCT) imaging on local atrophy progression. METHODS.Patients with geographic atrophy (GA) secondary to AMD were recruited in the context of the Longitudinal Fundus Autofluorescence in Age-related Macular Degeneration and Directional Spread in Geographic Atrophy studies (NCT00393692, NCT02051998). Horizontal and vertical SD-OCT scans were acquired at sequential visits using a device allowing for anatomically accurate registration of follow-up to baseline scans. For quantification of local atrophy progression, the lateral spread of GA (LSGA) was measured. Further, border types were independently graded. Comparison of LSGA between the different border types was performed using linear mixed-effects models. RESULTS. Seventy-two eyes of 49 patients (27 female) aged 74.0 years (Inter quartile range[IQR], 68.1-79.0) were included into this analysis. A total of 258 border sections were analyzed longitudinally over a median period of 1.2 years (IQR, 0.9-1.6). At baseline, 17.1% borders were classified as 'regular', 47.7% as 'irregular', and 35.3% as 'splitting'. Sixty-two percent of the eyes exhibited more than one border type. LSGA was slowest in 'regular' borders (62.85 6 25.29 lm/y), followed by 'irregular' borders (91.15 6 15.05 lm/y) and fastest in 'splitting' borders (183.15 6 18.17 lm/y). Differences between the 'splitting' and each other border type were statistically significant (P < 0.001). CONCLUSIONS.The results indicate that SD-OCT-based assessment of local GA border morphology can serve as a predictor for local atrophy progression. These observations help to better understand the natural history and potential pathogenetic factors of GA development and progression.

Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration

“…Our proposed metrics of photoreceptor degeneration may be helpful in future clinical trials in patients with GA as an additional biomarker for patient selection/stratification or even as a structural, objective clinical end point. Previously, imaging features related to lesion shape (lesion size, lobularity, and focality), RPE-associated characteristics (FAF patterns), junctional-zone configuration in SD-OCT, and optical coherence tomography angiography (OCTA)–based choriocapillaris flow-signal voids were shown to be prognostic for atrophy progression. Moreover, a qualitative study by Nunes et al, based on a en face projection centered to the EZ, suggested an association of photoreceptor degeneration with future atrophy progression.…”

Deep learning in ophthalmology: The technical and clinical considerations

“…In addition, a severity classification based on fundus photography was developed 16 . Again, OCT angiography was not included in classification systems as yet, although a wide variety of studies indicate that choroidal perfusion abnormalities are associated with the risk of disease progression [225][226][227][228][229] .…”

Multimodal imaging and deep learning in geographic atrophy secondary to age‐related macular degeneration

“…Conceptually related to the FAF phenotype, it was shown that patients with severe junctional zone abnormalities at the GA boundary in SD‐OCT, photoreceptor thinning outside of GA and reticular pseudodrusen, or hyperreflective foci exhibit a faster atrophy progression rate (Lindner et al., 2018; Pfau, Möller, Künzel, et al., 2020; Pfau, von der Emde, de Sisternes, et al., 2020; Pfau, von der Emde, Dysli, et al., 2020; Reiter et al., 2020; Schmidt‐Erfurth et al., 2020).…”