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Giliann K Collins, Rachel E Silver, Ricardo Louzada, Eduardo Amorim Novais, Jay S Duker, Daniela Ferrara, Johanna M Seddon; Optical coherence tomography features preceding the onset of geographic atrophy and neovascular disease. Invest. Ophthalmol. Vis. Sci. 2017;58(8):51.
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© ARVO (1962-2015); The Authors (2016-present)
Age-related macular degeneration (AMD) is a progressive disease with multifactorial etiology. There is a need to identify robust clinical features or other biomarkers that predict advanced disease prior to irreversible visual loss. We previously assessed morphological features of the retina on spectral domain optical coherence tomography (SD-OCT) in a comparison of geographic atrophy (GA) and normal eyes (Novais EA et al. IOVS 2016;57:ARVO E-Abstract 1610). This study evaluated specific SD-OCT features to determine if they predict progression from early or intermediate disease to advanced AMD, GA, and neovascular disease (NV).
Participants were enrolled in our prospective epidemiologic studies of AMD. Those who transitioned to advanced disease were classified as progressors (n=40 eyes), and were matched on baseline AMD grade and follow up interval to participants who did not develop advanced AMD (nonprogressors; n=40 eyes). Mean follow up time was 5.4 years. Morphological SD-OCT features of the neurosensory retina, photoreceptors, and retinal pigment epithelium (RPE) were systematically evaluated by two independent graders. Logistic regression was used to evaluate the association between these SD-OCT features and progression to advanced AMD.
Retinal thickness abnormalities were significantly associated with higher odds of progression to advanced AMD, GA, and NV (odds ratios [ORs]: 19.2 to 72.6; P<0.001). Disruption of the ellipsoid zone was also associated with progression to advanced AMD and NV (ORs: 17.9 and 30.6; P<0.001), with similar trends for GA. Disruption of the photoreceptor outer segments and interdigitation zone trended in the same direction for each endpoint. Drusenoid pigment epithelial detachment and RPE thickening were also associated with higher odds of progression to advanced AMD (ORs: 5.6 and 5.0; P<0.001) and NV (ORs: 17.2 and 10.8; P<0.001, P=0.003). Presence of pigmentary hyperreflective material was associated with progression to each outcome (ORs: 7.5 to 12.8; P<0.01).
Systematic assessment of OCT features in early or intermediate AMD showed that abnormalities at the level of photoreceptors and RPE are associated with progression to both GA and NV. These findings provide relevant insights into mechanisms of AMD progression, suggesting these two forms of advanced disease have similar etiology.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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