Prevalence and Persistence of Hypertransmission Defects of Various Sizes in Eyes with Intermediate Age-related Macular Degeneration

Abstract

Purpose: To determine the prevalence and rate of persistence over two years of various-sized hypertransmission defects (hyperTDs) in eyes with intermediate age-related macular degeneration (iAMD). Methods: Retrospective analysis of optical coherence tomography (OCT) data from consecutive iAMD patients. Choroidal en face OCT images were evaluated for the presence and number of hyperTDs of three different sizes based on greatest linear dimension (small, 63-124 µm; medium, 125-249 µm; large, ≥250 µm) at baseline and at 2-years follow-up. Interreader agreement was determined by Gwet’s agreement coefficient (AC). Disagreements between graders were resolved by the senior investigator to yield a single consensus for all cases. Results: From 273 iAMD eyes (247 patients), 72 and 76 hyperTD lesions were independently identified by two graders at baseline and overall AC was 0.89 (95% CI, 0.86-0.93). After adjudication by the senior grader, the final consensus yielded 78 hyperTD lesions from 46 eyes (16.8%) of 42 patients (17.0%) in this study cohort. Among eyes with follow-up OCT, 32 of 45 hyperTD lesions (71.1%) persisted. The rates of persistence were 100.0%, 72.7% and 53.3% in large, medium and small hyperTD sizes, respectively. Conclusion: HyperTDs were present in a significant proportion of iAMD eyes. Acceptable interreader agreement was demonstrated in identifying hyperTD. Larger hyperTD lesions were more likely to persist over two years.

Choroidal signal hypertransmission on optical coherence tomography imaging: Association with development of geographic atrophy in age‐related macular degeneration

“…The inter‐reader agreement for detecting eyes with LHyperT on SD‐OCT B‐scans (AC 1 = 0.65) was instead more comparable with those observed in another previous study where 12 readers across six reading centers evaluated SD‐OCT B‐scans in a cohort of 60 eyes (AC 1 = 0.71; 95% CI = 0.62–0.80 [ unpublished data ]; which was also comparable with the inter‐reader agreement of nGA [AC 1 = 0.75]) 31 . Another recent study by Nanegrungsunk and colleagues 32 reported near‐perfect inter‐reader agreement for the detection of any hypertransmission ≥63 μm at the lesion level (AC 1 = 0.89), but lower agreement when categorising the size of the hypertransmission (based on lesions that were 63–124, 125–249 and ≥ 250 μm; AC 1 = 0.57). Re‐analysis of the data presented in this study showed even higher levels of agreement for the presence of LHyperT at the lesion level (AC 1 = 0.97), although LHyperT were only present in 7% of all the readings due to the exclusion of eyes with cRORA 32 .…”

“…Re-analysis of the data presented in this study showed even higher levels of agreement for the presence of LHyperT at the lesion level (AC 1 = 0.97), although LHyperT were only present in 7% of all the readings due to the exclusion of eyes with cRORA. 32 In contrast, 'persistent hyperTDs' was present in 36% of the readings on SS-OCT scans and LHyperT was present in 44% of the readings on SD-OCT scans in the cross-sectional cohort in this study. Similar to the abovementioned limitation of the study by Liu and colleagues, 14 the inclusion of a cohort in the study by Nanegrungsunk and colleagues 32 of eyes without cRORA may also be subject to confirmation bias (of the absence of LHyperT) and thus also result in over-optimistic estimates of inter-reader agreement.…”

“…Previous studies have also reported that not all regions of hypertransmission ≥125 μm persist over time. 26,32 Whilst the specific patho-mechanisms for the non-persistence of choroidal signal hypertransmission is unclear, this mechanism could contribute to the lower specificity of LHy-perT for the subsequent development of GA observed in this study.…”

“…In contrast, ‘persistent hyperTDs’ was present in 36% of the readings on SS‐OCT scans and LHyperT was present in 44% of the readings on SD‐OCT scans in the cross‐sectional cohort in this study. Similar to the abovementioned limitation of the study by Liu and colleagues, 14 the inclusion of a cohort in the study by Nanegrungsunk and colleagues 32 of eyes without cRORA may also be subject to confirmation bias (of the absence of LHyperT) and thus also result in over‐optimistic estimates of inter‐reader agreement.…”

“…Another recent study by Nanegrungsunk and colleagues 32 reported near‐perfect inter‐reader agreement for the detection of any hypertransmission ≥63 μm at the lesion level (AC 1 = 0.89), but lower agreement when categorising the size of the hypertransmission (based on lesions that were 63–124, 125–249 and ≥ 250 μm; AC 1 = 0.57). Re‐analysis of the data presented in this study showed even higher levels of agreement for the presence of LHyperT at the lesion level (AC 1 = 0.97), although LHyperT were only present in 7% of all the readings due to the exclusion of eyes with cRORA 32 . In contrast, ‘persistent hyperTDs’ was present in 36% of the readings on SS‐OCT scans and LHyperT was present in 44% of the readings on SD‐OCT scans in the cross‐sectional cohort in this study.…”