Optic Disc Appearance in Advanced Age-Related Macular Degeneration

Abstract

Abstract: : Purpose:To describe and categorize the appearance of the optic disc in patients with advanced age-related macular degeneration (ARMD) quantitatively by confocal scanning laser image analysis and qualitatively by stereoscopic photographic evaluation. Methods: Patients with ARMD and had macular photos and optic disc photos were retrospectively reviewed. Patients who had advanced stages of ARMD such as geographic atrophy or disciform scar in at least one eye were enrolled. The probability of glaucomatous structural damage of the optic disc was scored in a masked fashion according to a predefined evaluation scale. The macular involvement was measured in unit of disc area. The optic disc evaluation scores and Heidelberg retinal tomographic (HRT) measurements of the group of eyes with larger extent of macular involvement of ARMD was compared to the group of opposite eyes with lesser extent of macular involvement. The correlations between the extent of macular involvement and the optic disc evaluation scores and HRT measurements were analyzed for the pool of all eyes. Results: 757 charts were reviewed. 41 subjects who had advanced stages of ARMD such as geographic atrophy or disciform scar in at least one eye were enrolled. The eyes with larger extent of advanced stages of ARMD had an optic disc that more likely to be classified by clinical evaluation as glaucomatous (3.47 +/- 0.24 vs. 3.09 +/- 0.18, p=0.028) and HRT imaging analysis (-1.173 +/- 0.465 vs. -0.503 +/- 0.241, p=0.0355) than the opposite eyes with less extent of macular involvement. For eyes with more than or equal to 6 disc areas of advanced stages of ARMD, larger extent of macular involvement was associated with a higher cup-to-disc ratio (p=0.0223), lower rim area (p=0.0219), and glaucomatous classification (p=0.040) of HRT analysis. Conclusions: In eyes with large area of advanced stages of ARMD such as geographic atrophy or disciform scar, the optic disc may associate with a structural alteration that resembles glaucomatous optic neuropathy.

Keywords: optic disc • imaging/image analysis: clinical • age-related macular degeneration