The Evolution of the Plateau, an Optical Coherence Tomography Signature Seen in Geographic Atrophy

We read with interest the article by Tan et al.¹ entitled “The Evolution of the Plateau, an Optical Coherence Tomography Signature Seen in Geographic Atrophy.” 

We congratulate the authors for the excellent description of the origins and long-term evolution of an optical coherence tomography (OCT) feature named “plateau” in nascent geographic atrophy and for proposing its histologic correlate. Querques et al.² first reported this tomographic signature in geographic atrophy with the name of “wedge-shaped subretinal hyporeflectivity.” However, the authors renamed this finding for the following reasons. 

First, they raise concerns for having two “hyporeflective wedge'' descriptors in the same setting of geographic atrophy.^2,3 However, this concern has already been addressed in previous correspondence, as these two entities involve different structures and are unlikely to be confused.^4,5 

Second, they state that “wedge-shaped hyporeflectivity” is not an accurate descriptor because it does not reflect the appearance of most of these signatures. However, many figures of their article illustrate signatures that remind us of wedge-shaped or triangular compositions, as pointed out in extracts of their original images that here we report in the Figure. 

Figure

 

Spectral domain optical coherence tomography of wedge-shaped subretinal hyporeflectivity (adapted from Tan et al. The evolution of the plateau, an optical coherence tomography signature seen in geographic atrophy. Invest Ophthalmol Vis Sci. 2017;58:2349–2358). Wedge-shaped subretinal hyporeflectivity (magnified white squares) is delimited by the outer plexiform and the Bruch's membrane. Note the imaging features of these hyporeflective lesions, which resemble triangular structures.

Besides these considerations, we have further concerns about the novel descriptor called “plateau.” This signature is not a new finding, but it has already received full interest in the past and renaming may generate confusion. Furthermore, the original descriptor “wedge-shaped subretinal hyporeflectivity” gives insight on the morphology and the position of these abnormalities, while the novel term “plateau” indicates just their morphology, which seems to be still controversial. 

Taking together all these observations, we feel that no substantial reasons exist to change the original name of this OCT signature and we currently suggest to keep the first descriptor “wedge-shaped subretinal hyporeflectivity,” as originally reported.² 

Acknowledgments

Disclosure: A. Marchese, None; G. Querques, Allergan (C, S), Bayer (C, S), Novartis (C, S), Zeiss (C, S), Alimera (C), Bausch & Lomb (C), Heidelberg (C)