Abstract
Purpose :
Avascular pigment epithelium detachments (aPED) in age-related macular degeneration frequently progress to geographic atrophy or choroidal neovascularization with reduction of best-corrected visual acuity (BCVA). The purpose of this study was to identify predictors of disease progression. To this end, we performed a prospective observational clinical study of aPED morphology and BCVA during a 12 months observation period.
Methods :
Patients ≥50 years with BCVA ≥20/400 and treatment-naïve aPED, ≥ 1000 μm in diameter, were included from 2016 to 2017. BCVA, optical coherence tomography (OCT) and OCT-angiography were obtained every six months. Fluorescein- and indocyanine green angiography were obtained at baseline and 12 months. Primary outcome: change of BCVA from baseline to 12 months in association to aPED-volume. Secondary outcomes: change of BCVA from baseline to 12 months in association to intraretinal hyperreflective foci volume (HRF-volume), subretinal hyperreflective material, subretinal fluid, age and the number of patients with progression of geographic atrophy or development of choroidal neovascularization (CNV). Data analyses: Descriptive statistics and linear mixed models. REVAnalyzer was used for volume measurements.
Results :
The study included 45 patients (68 eyes). In the linear mixed model, BCVA decreased with increasing aPED-volume over time (p=0.005), increasing HRF-volume (p<0.001), age (p=0.001) and subretinal hyperreflective material (p<0.001). Younger patients with higher HRF-volume had lower BCVA (p<0.001). Subretinal fluid was not a significant predictor (p=0.120). Three patients developed CNV and three had progression of geographic atrophy to complete outer retinal atrophy.
Conclusions :
Our findings indicate that aPED-volume, HRF-volume, and presence of subretinal hyperreflective material could be important OCT predictors of disease progression as measured by BCVA.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.