Spectral-Domain Optical Coherence Tomography Characteristics of Intermediate Age-related Macular Degeneration

Abstract

Purpose Describe qualitative spectral-domain optical coherence tomography (SD-OCT) characteristics of eyes classified as intermediate age-related macular degeneration (nonadvanced AMD) from Age-Related Eye Disease Study 2 (AREDS2) color fundus photography (CFP) grading. Design Prospective cross-sectional study. Participants We included 345 AREDS2 participants from 4 study centers and 122 control participants who lack CFP features of intermediate AMD. Methods Both eyes were imaged with SD-OCT and CFP. The SD-OCT macular volume scans were graded for the presence of 5 retinal, 5 subretinal, and 4 drusen characteristics. In all, 314 AREDS2 participants with ≥1 category-3 AMD eye and all controls each had 1 eye entered into SD-OCT analysis, with 63 eyes regraded to test reproducibility. Main Outcome Measures We assessed SD-OCT characteristics at baseline. Results In 98% of AMD eyes, SD-OCT grading of all characteristics was successful, detecting drusen in 99.7%, retinal pigment epithelium (RPE) atrophy/absence in 22.9%, subfoveal geographic atrophy in 2.5%, and fluid in or under the retina in 25.5%. Twenty-eight percent of AMD eyes had characteristics of possible advanced AMD on SD-OCT. Two percent of control eyes had drusen on SD-OCT. Vision loss was not correlated with foveal drusen alone, but with foveal drusen that were associated with other foveal pathology and with overlying focal hyperreflectivity. Focal hyperreflectivity over drusen, drusen cores, and hyper- or hyporeflectivity of drusen were also associated with RPE atrophy. Conclusions Macular pathologies in AMD can be qualitatively and reproducibly evaluated with SD-OCT, identifying pathologic features that are associated with vision loss, RPE atrophy, and even possibly the presence of advanced AMD not apparent on CFP. Qualitative and detailed SD-OCT analysis can contribute to the anatomic characterization of AMD in clinical studies of vision loss and disease progression.

Quantity of Intraretinal Hyperreflective Foci in Patients With Intermediate Age-Related Macular Degeneration Correlates With 1-Year Progression

“…5,8,20,21 This hypothesis was supported by some laboratory studies that demonstrated the potential ability of RPE cells to migrate when induced by cytokines and other inflammatory mediators in response to oxidative damage and complement activation. 22,23 Previous studies 7,24 showed that HRF in AMD were associated or colocalized with the drusen apex and showed an increased association with RPE atrophy at baseline, 24 or if atrophy was not already present, with an increased risk of developing atrophy at that location. 7 Christenbury et al 8 suggested that the association between HRF and drusen becomes more significant over time with an increasing number of HRF associated with increasing drusen and atrophy.…”

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

“…29 A better classification that becomes widely established would be also helpful for interpretation of other potential precursor lesions that have been recently described by SD-OCT, such as thinning of retinal layers in the presence of drusen regression, evolution of HRF, and disintegrated RPE dots. 23,[26][27][28][47][48][49][50][51] Various limitations of this study need to be considered. The number of included subjects is relatively small, and a substantial high number of subjects dropped out of this natural history study (a total of 32.7% at year 6).…”

Lateral and axial measurement differences between spectral-domain optical coherence tomography systems

“…[23][24][25] Furthermore, the largest ongoing randomized trial for age-related macular degeneration (AMD), the NEI-sponsored Age-Related Eye Disease Study 2, exclusively allows the Bioptigen SDOIS platform for its longitudinal, observational ancillary SDOCT study (AREDS2 Ancillary SDOCT Study). 6,26 The baseline dataset and measurements for both control and AMD eyes in this study has been made publicly available. 6 Several studies have concluded that comparing retinal thickness with instruments from different manufacturers is not advised for clinical studies.…”