Multimodal Imaging Patterns for Development of Central Atrophy Secondary to Age-Related Macular Degeneration

Abstract

PURPOSE. To evaluate the development of central atrophy in eyes with age-related macular degeneration (AMD).METHODS. Six-year longitudinal multimodal retinal imaging data (MODIAMD study) from 98 eyes of 98 subjects with non-late-stage AMD in the study eye at baseline were analyzed for the presence of central atrophy at each annual follow-up visit. Development, manifestation, and further progression of complete retinal pigment epithelium and outer retinal atrophy (cRORA) by multimodal imaging data were compared with atrophy detection based on color fundus photography only.RESULTS. Seventeen study eyes with development of central cRORA within 6 years (cumulative rate: 17.4%) were identified based on multimodal imaging. In 10 (60%) of these eyes, presence of central manifest atrophy was initially not detectable by color fundus photography. In six (35%) eyes, central cRORA occurred by the spread of existing paracentral atrophy toward the fovea. Drusen-associated atrophy development was noted in eight eyes. In two eyes, atrophy development was associated with refractile deposits, while only pigmentary changes in absence of large drusen or refractile deposits were detectable before atrophy occurrence in one eye.CONCLUSIONS. The earlier and more precise detection of central cRORA by multimodal imaging as compared to atrophy detection solely based on color fundus photography allows for more accurate detection and identification of different pathways for atrophy development. In accordance with previous clinical and histopathologic reports, the results confirm that different precursor lesions may independently proceed to central cRORA in AMD.

Prognostic value of intermediate age-related macular degeneration phenotypes for geographic atrophy progression

“…The inclusion and exclusion criteria for these studies have been described in detail elsewhere. [15][16][17] Briefly, for inclusion into the DSGA study, patients could exhibit unifocal or multifocal atrophy, but must have had clear ocular media that allowed for good-quality FAF imaging. Exclusion criteria included any signs of macular neovascularisations, history of retinal surgery, laser photocoagulation or other retinal diseases in the study eye.…”

“…13 14 Previously, we were able to elaborate different structural patterns leading to atrophy by multimodal imaging. 15 While they were shown to be of prognostic relevance for GA development, it is still unclear if these local precursors may also impact the further disease course following conversion into late-stage AMD.…”

“…The position of the SD-OCT line scan in the en face images is represented as a green line. Please note, figure modified to a previous work 15.…”

Use of Composite End Points in Early and Intermediate Age-Related Macular Degeneration Clinical Trials: State-of-the-Art and Future Directions

“…Similarly to composite end points, a variety of single outcomes have been associated with progression to late-stage disease [3,36,[51][52][53][54][55][56][57][58][59][60][61][62][63][64]. Schaal et al [65] have published a comprehensive review of anatomical end points in nonexudative AMD.…”

Validation of an Automated Quantification of Relative Ellipsoid Zone Reflectivity on Spectral Domain-Optical Coherence Tomography Images

“…With the introduction of spectral-domain optical coherence tomography (SD-OCT), a high-resolution retinal ultrastructure can be imaged in vivo, allowing a more detailed study of the pathologic changes in the macular area offering a more refined diagnosis, classification, risk assessment, and monitoring of AMD. 4 – 6 In AMD, features of interest on SD-OCT scans are the four hyperreflective zones in the outer retina and retinal pigment epithelium (RPE). 7 Of the four hyperreflective outer retinal zones, the signal of the second hyperreflective band, termed the ellipsoid zone (EZ), is thought to derive from light scattering mitochondria, which are tightly packed in the photoreceptor inner segments and that have a crucial role for photoreceptor metabolic function, structural integrity and health.…”