Swept Source Optical Coherence Tomography Angiography of Asymptomatic Neovascularization in Intermediate Age-Related Macular Degeneration

Abstract

Purpose : Purpose: To identify subclinical type 1 neovascularization in asymptomatic eyes with intermediate age-related macular degeneration (iAMD) using swept source optical coherence tomography angiography (SS-OCTA)

Methods : Methods: Consecutive patients with asymptomatic iAMD in one eye and neovascular AMD in their fellow eye were enrolled in a prospective OCT study at the Bascom Palmer Eye Institute. They underwent SS-OCTA, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Images from these three angiographic techniques were then compared. Additional patients with intermediate age-related macular degeneration (iAMD) were imaged as well.

Results : Results: Eleven consecutive patients with iAMD in one eye and neovascular AMD in their fellow eye were imaged with FA, ICGA, and SS-OCTA between August 2014 and September 2015. Clinical examination of the 11 eyes revealed drusen and pigmentary abnormalities in the central macula and no evidence of macular fluid on routine OCT imaging. Ten of the 11 eyes had no evidence of leakage on FA and one eye had questionable fluorescein leakage. ICGA revealed the presence of central macular plaques in three of the 11 asymptomatic eyes with iAMD, and SS-OCTA was able to unambiguously identify type 1 neovascularization corresponding to the plaques in all three eyes. No additional foci of neovascularization were identified in the remaining eight asymptomatic eyes with iAMD. To determine the true prevalence of type 1 CNV in asymptomatic eyes with iAMD, we have imaged 103 patients with non-exudative AMD in one eye and exudative AMD in their fellow eye. Additional examples of type 1 neovascularization in these asymptomatic eyes with iAMD will be shown.

Conclusions : Conclusions: SS-OMAG identified type 1 neovascularization corresponding to ICGA plaques in asymptomatic eyes with iAMD. The ability of OCTA to provide non-invasive, fast, detailed, depth-resolved identification of non-exudative neovascular lesions in eyes with iAMD suggests the need for a new classification system that distinguishes between neovascular and non-neovascular iAMD.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.