June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Complexities in interpreting subretinal fluid on spectral-domain optical coherence tomography in intermediate age-related macular degeneration
Author Affiliations & Notes
  • Jia Jia Lek
    Centre of Eye Research Australia, Royal Victorian Eye and Ear Hospital , Melbourne, Victoria, Australia
    Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
  • Elizabeth Baglin
    Centre of Eye Research Australia, Royal Victorian Eye and Ear Hospital , Melbourne, Victoria, Australia
    Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
  • Pyrawy Sivarajah
    Centre of Eye Research Australia, Royal Victorian Eye and Ear Hospital , Melbourne, Victoria, Australia
    Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
  • Emily Caruso
    Centre of Eye Research Australia, Royal Victorian Eye and Ear Hospital , Melbourne, Victoria, Australia
    Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
  • Richard Smallwood
    Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  • Matthew Ayres
    Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  • Lauren Hodgson
    Centre of Eye Research Australia, Royal Victorian Eye and Ear Hospital , Melbourne, Victoria, Australia
    Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
  • Chi D Luu
    Centre of Eye Research Australia, Royal Victorian Eye and Ear Hospital , Melbourne, Victoria, Australia
    Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
  • Robyn H Guymer
    Centre of Eye Research Australia, Royal Victorian Eye and Ear Hospital , Melbourne, Victoria, Australia
    Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia
  • Footnotes
    Commercial Relationships   Jia Jia Lek, None; Elizabeth Baglin, None; Pyrawy Sivarajah, None; Emily Caruso, None; Richard Smallwood, None; Matthew Ayres, None; Lauren Hodgson, None; Chi Luu, None; Robyn Guymer, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3211. doi:
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      Jia Jia Lek, Elizabeth Baglin, Pyrawy Sivarajah, Emily Caruso, Richard Smallwood, Matthew Ayres, Lauren Hodgson, Chi D Luu, Robyn H Guymer; Complexities in interpreting subretinal fluid on spectral-domain optical coherence tomography in intermediate age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3211.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The incidental finding of subretinal fluid (SRF) on spectral-domain optical coherence tomography (SD-OCT) in intermediate age-related macular degeneration (iAMD) is a sign suggestive of exudative choroidal neovascularization (CNV). We describe the complexities of interpreting SRF and report the natural history and phenomenon of asymptomatic iAMD eyes with SRF in the absence of exudation.

Methods : Participants with bilateral iAMD (drusen > 125µm) were followed at 6 monthly intervals as part of a natural history study. Participants underwent clinical examinations and multi-modal imaging including SD-OCT. Eyes that developed SRF were graded as a ‘slither’ if SRF ≤ 30µm (height), and were monitored without further investigation. Eyes with SRF of > 30µm (height) underwent fluorescein angiography (FA) and indocyanine green angiography (ICGA) to identify exudative CNV. Cases without exudative CNV on FA were defined as non-exudative detachment of the neurosensory retina (NEDNR). Untreated occult CNV, slither and NEDNR cases were followed up prospectively to investigate the natural history.

Results : In addition to identifying exudative CNV cases, which received subsequent treatment, 16 eyes of 14 patients with SRF were identified and did not receive active intervention. Untreated SRF cases included 4 eyes with occult CNV, 6 eyes with a slither, and 6 eyes with NEDNR. Two eyes with NEDNR demonstrated plaques on ICGA. Follow up assessments of these 16 eyes with SRF were for a period of 6 to 30 months. One eye with NEDNR progressed to exudative CNV and received treatment. All other 15 eyes with occult CNV, slither or NEDNR did not progress to require active intervention. All 12 eyes with either slither or NEDNR demonstrated signs of fluid resolution, with resolution in 11 out of 12 eyes being associated with the development of subretinal hyperreflective material.

Conclusions : Interpretation of SRF found incidentally on SD-OCT in iAMD eyes is complex and often requires information from other modalities. SRF can be asymptomatic, remain stable without treatment and does not always exhibit abnormalities on FA or ICGA. Advances in retinal imaging such as OCT angiography provides a non-invasive option for monitoring these cases and may further elucidate the presence of vascular abnormalities.

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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