July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
How reliable is the clinical diagnosis of subretinal fibrosis in neovascular age-related macular degeneration?
Author Affiliations & Notes
  • Markus Schranz
    Department for Ophthalmology, Medical University of Vienna, Vienna, Austria
    Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
  • Philipp Ken Roberts
    Department for Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Stefan Sacu
    Department for Ophthalmology, Medical University of Vienna, Vienna, Austria
    Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
  • Wolf Buehl
    Department for Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Sylvia Desissaire
    Center F Med Physics & Biomed Eng, Medical University of Vienna, Austria
  • Michael Pircher
    Center F Med Physics & Biomed Eng, Medical University of Vienna, Austria
  • Magdalena Baratsits
    Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
  • Georgios Mylonas
    Department for Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Christoph K Hitzenberger
    Center F Med Physics & Biomed Eng, Medical University of Vienna, Austria
  • Ursula Schmidt-Erfurth
    Department for Ophthalmology, Medical University of Vienna, Vienna, Austria
  • Footnotes
    Commercial Relationships   Markus Schranz, None; Philipp Roberts, None; Stefan Sacu, None; Wolf Buehl, None; Sylvia Desissaire, None; Michael Pircher, None; Magdalena Baratsits, None; Georgios Mylonas, None; Christoph Hitzenberger, Canon (F); Ursula Schmidt-Erfurth, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4224. doi:
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    • Get Citation

      Markus Schranz, Philipp Ken Roberts, Stefan Sacu, Wolf Buehl, Sylvia Desissaire, Michael Pircher, Magdalena Baratsits, Georgios Mylonas, Christoph K Hitzenberger, Ursula Schmidt-Erfurth; How reliable is the clinical diagnosis of subretinal fibrosis in neovascular age-related macular degeneration?. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4224.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To compare different current imaging modalities with respect to their ability to assess subretinal fibrosis in neovascular age-related macular degeneration (AMD).

Methods : In this cross-sectional study 30 eyes of 30 patients with neovascular AMD with a minimum history of 1 year of anti-vascular endothelial growth factor (anti-VEGF) therapy were included.
Each patient underwent microperimetry (MP) testing with color fundus photography (CFP) and eye-tracking assisted polarization-sensitive optical coherence tomography (PS-OCT).
PS-OCT is capable of automatically detecting the presence of fibrosis based on tissue birefringence. Retinal morphology in CFP and PS-OCT was evaluated independently for the presence of fibrosis at the corresponding microperimetry sensitivity spots.
Microperimetry results and morphologic findings in CFP and PS-OCT were analyzed.

Results : Mean patient age was 74,5 ± 14.2 years. In total 1350 MP spots were evaluated in CFP and PS-OCT for impact of fibrosis according to a standardized protocol.
Intact retinal morphology diagnosed in CFP and PS-OCT was associated with a median retinal sensitivity of 26 dB (quartiles: 22 dB; 28 dB) and 26 dB (24 dB; 28 dB), respectively.
In CFP 318 (23.6 %) spots were graded as fibrosis and showed a median retinal sensitivity 0 dB (0 dB; 12 dB).In PS-OCT 174 spots (12.9 percent) of all tested MP spots were classified as fibrosis and showed a median retinal sensitivity of 0 dB (0 dB; 7.5 dB).
The difference in retinal sensitivity between spots showing signs of fibrosis and spots not showing signs of fibrosis was statistically significant in CFP (p<0.001) and PS-OCT (p<0.001), respectively. Most importantly, retinal sensitivity was significantly lower(p<0.05) in areas showing fibrosis in PS-OCT with a median of 0 dB (0 dB; 7.5 dB) than in spots showing fibrosis in CFP with a median of 0 dB (0 dB; 12 dB).

Conclusions : PS-OCT shows a very high capability of detecting the fibrotic alterations in neovascular AMD.
Areas of subretinal fibrosis identified by PS-OCT demonstrate more severe loss of retinal sensitivity than areas detected solely by CFP confirming advanced damage to the neurosensory retina. CFP is not a reliable tool for differentiating between clinically relevant fibrosis and intact retina . Selective imaging of collagen components by PS-OCT may be used for clinical classification of fibrosis in advanced AMD.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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