June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Adaptive optics phenotypes of intermediate age-related macular degeneration
Author Affiliations & Notes
  • Ahmed M Hagag
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    Institute of Ophthalmology, University College London, United Kingdom
  • Sophie Riedl
    Medizinische Universitat Wien, Vienna, Austria
  • Toby Prevost
    King's College London, London, United Kingdom
  • Lars Fritsche
    University of Michigan, Ann Arbor, Michigan, United States
  • Daniel Rueckert
    Imperial College London, London, United Kingdom
  • Hendrik P Scholl
    Institute of Molecular and Clinical Ophthalmology Basel, Basel, Basel-Stadt, Switzerland
    Department of Ophthalmology, Universitat Basel, Basel, Basel-Stadt, Switzerland
  • Ursula Schmidt-Erfurth
    Medizinische Universitat Wien, Vienna, Austria
  • Sobha Sivaprasad
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
    Institute of Ophthalmology, University College London, United Kingdom
  • Andrew J Lotery
    University of Southampton Faculty of Medicine, Southampton, United Kingdom
  • Footnotes
    Commercial Relationships   Ahmed Hagag None; Sophie Riedl None; Toby Prevost None; Lars Fritsche None; Daniel Rueckert None; Hendrik Scholl None; Ursula Schmidt-Erfurth None; Sobha Sivaprasad None; Andrew Lotery None
  • Footnotes
    Support  Wellcome Trust grant [210572/Z/18/Z]
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2322. doi:
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      Ahmed M Hagag, Sophie Riedl, Toby Prevost, Lars Fritsche, Daniel Rueckert, Hendrik P Scholl, Ursula Schmidt-Erfurth, Sobha Sivaprasad, Andrew J Lotery; Adaptive optics phenotypes of intermediate age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2322.

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

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Abstract

Purpose : To describe the microscopic characteristics of known lesions associated with intermediate age-related macular degeneration (AMD) on adaptive optics ophthalmoscopy (AOO) imaging and their correlation to other multimodal imaging methods.

Methods : Patients with intermediate AMD were enrolled in an observational longitudinal multicenter cohort to decipher the natural history of the disease. Participants underwent spectral-domain optical coherence tomography (SD-OCT), infrared scanning laser ophthalmoscopy (IR-SLO), and fundus autofluorescence (FAF) imaging using the Spectralis device (Heidelberg Engineering, Germany). Flood-illumination AOO images were acquired using the commercially available rtx1 camera (Imagine Eyes, France). AO image mosaics were constructed using the montage function on the i2k Retina AO software (DualAlign LLC, USA). En face and/or cross-sectional images across modalities were manually aligned to perform intra- and inter-modality comparisons of retinal lesions.

Results : Heterogeneity of drusen characteristics was observed on AOO. Typical large drusen were characterized by a hyper-reflective rim with central iso-reflectivity. The visibility of the cone photoreceptor mosaic was largely obliterated around and on top of these drusen. On the contrary, cone photoreceptors were visualised in another group of patients with smaller drusen that manifested on AO images as a hyper-reflective rim with internal hypo-reflectivity. Cone visibility on AO correlated with the presence of interdigitation zone on OCT B-scans. Subretinal drusenoid deposits (SDD) typically displayed hypo-reflective circles surrounding areas of iso-reflectivity on AO images. Early stages of the SDD appeared as an ill-defined area of hypo-reflectivity. Several distinct phenotypes of retinal pigment epithelium and outer retinal atrophy were identified on AOO. Variability in the focusing depth can significantly alter the appearance and interpretation of AO images.

Conclusions : We describe various phenotypes of intermediate AMD on adaptive optics ophthalmoscopy, showing distinct patterns, which correlate with known morphologic presentations on multimodal imaging. The significance of the described changes is yet to be determined in large longitudinal cohort studies.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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