Predictive model for incomplete and complete retinal pigment epithelium and outer retinal atrophy in non-exudative age related macular degeneration

Abstract

Purpose : Non-exudative age related macular degeneration (NEAMD) is a significant cause of visual impairment and reduced quality of life worldwide. Prior studies examined associations between individual biomarkers on optical coherence tomography (OCT) and progression of disease. However, no comprehensive study has been undertaken to study the natural history of OCT biomarkers in NEAMD and to model their likelihood in predicting development of end-stage disease; namely incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) and complete retinal pigment epithelium and outer retinal atrophy (cRORA).

Methods : Retrospective chart review at two academic practices. Patients diagnosed with NEAMD for whom yearly OCT scans were obtained for at least 4 consecutive years were included. Baseline demographic, visual acuity, Age-Related Eye Disease Study (AREDS) staging, and OCT data was collected. OCTs were assessed for presence or absence of 11 features individually associated with progression of NEAMD, both at baseline, and on all subsequent follow up scans. Likewise, charts were reviewed to assess visual acuity and staging of NEAMD at all follow up visits.

Results : 107 eyes of 88 patients met inclusion criteria. Patients had yearly OCTs for a median duration of 62 months (range: 48 months-132 months). During this time, of 107 eyes, 14 eyes (14%) progressed to exudative AMD, 17 eyes (16%) progressed to iRORA, 26 eyes (25%) progressed to cRORA, and 49 eyes (44%) did not progress to atrophy or exudative disease. Baseline OCT features associated with progression to iRORA and cRORA included hyporeflective intra-retinal spaces (p<0.05), drusen ooze (p<0.01) and drusen collapse (p<0.05). Features found in serial OCTs associated with progression to iRORA and cRORA included hyporeflect dots (p<0.05), hyporeflective foci (p<0.01), hyporeflective intra-retinal spaces (p<0.01), drusen ooze (p<0.01) and drusen collapse(p<0.01). In 72% of patients with bilateral involvement, OCT biomarkers of progression in one eye was predictive of progression to a similar extent of disease (exudative, iRORA, cRORA, or no atrophy) in the fellow eye.

Conclusions : This comprehensive study examines OCT biomarkers of NEAMD progression to iRORA and cRORA. These biomarkers can be used to predict progression of NEAMD disease, both in the affected eye, and in the fellow eye.

This is a 2021 ARVO Annual Meeting abstract.