Linking optical coherence tomographic, angiographic and photographic lesion components in neovascular age-related macular degeneration in the Comparison of Age-related Macular Degeneration Treatments Trials

Abstract

Purpose : To develop methods for highly precise comparisons of specific retinal features between and within images from spectral domain optical coherence tomography (SDOCT), color photographs (CP), and fluorescein angiograms (FA) in eyes treated with anti-VEGF agents for neovascular age-related macular degeneration (nAMD).

Methods : CP/FA graders reviewed quality study-eye images at the 104 weeks visit in the Comparison of AMD Treatments Trials and delineated areas of fibrotic scar (FS) or non-FS and geographic atrophy (GA) or non-GA. OCT graders reviewed SDOCT images and delineated retinal and subretinal morphologic characteristics and segmented the scans to measure subretinal lesion + retinal pigment epithelium thickness. Using newly-developed custom software and graphic user interfaces the distribution of SDOCT components and CP/FA components were compared in regional overlays. From this dataset, presence and thickness of each feature at each pixel on the en face retinal view was determined.

Results : The distribution of SDOCT features within areas designated as FS, non-FS, GA and non-GA by CP/FA, as well as the thickness of the SDOCT features, could be determined precisely and displayed in multiple formats, e.g. the precise relationship between OCT-determined sites of (a) photoreceptor loss, and/or (b) subretinal lesion, (c) thickness of photoreceptor layer and/or subretinal material + retinal pigment epithelium could also be determined relative to (d) CP/FA regions of scar or atrophy. Output files of the pixel-specific data allowed for statistical analysis of results within eyes and across eyes of different patients (Figure).

Conclusions : This novel method to integrate OCT assessments of retinal and subretinal microanatomy with CP/FA designations of the coincident nAMD lesion areas and sequelae is integral for accurate descriptions of post-treatment retinal morphology. Combining the information from these different modalities with high accuracy and precision allows for analyses to test hypotheses regarding the development and progression of neovascularization, atrophy, and scarring. Future studies using this methodology will inform assessment of the evolution of both the neovascular complex and the overlying retina during anti-VEGF treatment of nAMD.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Images from an eye with geographic atrophy