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Steffen Schmitz-Valckenberg, Martina Braun, Sarah Thiele, Simon S. Gao, Hao Chen, Verena Steffen, Jian Dai, Lee Honigberg, Daniela Ferrara, Frank G Holz, Marlene Sassmannshausen; Development of geographic atrophy assessed by multimodal imaging in intermediate age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2353.
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To identify and characterize precursors for development of geographic atrophy (GA) in eyes with intermediate age-related macular degeneration (iAMD).
Retrospective analysis of imaging data from patients included in a natural history study of disease progression in patients with GA, Proxima B (NCT02399072). Longitudinal multimodal imaging data, including confocal scanning laser ophthalmoscopy, fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT), of 30 patients with iAMD in one eye and GA in the fellow eye were obtained every 6 months. Features preceding progression and conversion to advanced AMD, either GA (defined as FAF minimal lesion size ≥0.15 mm2) or choroidal neovascularization (CNV), were assessed. These included drusen, reticular pseudodrusen/subretinal drusenoid deposits (SDD), and incomplete or complete retinal pigment epithelium and outer retinal atrophy (iRORA/cRORA).
During the observation period (median 17 months, range 9.2–28.0 months), out of the 30 fellow eyes with iAMD, 12 eyes converted to GA by FAF, and 2 eyes converted to CNV. Features of iRORA and cRORA were identified in all eyes that progressed to GA, demonstrating a median time interval from iRORA to cRORA of 7 months and a median time interval from cRORA to GA of 7 months. Eyes with reticular pseudodrusen (n=6) at baseline showed faster GA enlargement (mean 1.70 mm2/year) as compared to eyes with sub-RPE-drusen-associated GA and without reticular pseudo-drusen (n=5) enlargement (0.51 mm2/year). Use of the progression tool for registration of baseline to follow-up OCT scans was particularly helpful to identify features of GA development and progression.
In this GA cohort with unilateral iAMD, two patterns of GA development and progression were observed by multimodal imaging, either reticular pseudodrusen or drusen associated. Identification of precursor lesions and characteristics of GA occurrence and enlargement will be important for the development of future therapeutic strategies in iAMD.
This is a 2020 ARVO Annual Meeting abstract.
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