June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Consensus Grading of Persistent Hyper-Transmission Defects on En Face OCT Imaging of Age-Related Macular Degeneration
Author Affiliations & Notes
  • Jeremy Liu
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Rita Laiginhas
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Federico Corvi
    Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
  • Frederick L Ferris
    Ophthalmic Research Consultants, Waxhaw, North Carolina, United States
  • Tock H Lim
    National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
  • Srinivas R Sadda
    Doheny Eye Institute, David Geffen, School of Medicine, University of California Los Angeles, Los Angeles, California, United States
  • Nadia K Waheed
    New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Prashanth G Iyer
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Mengxi Shen
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Yingying Shi
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Omer Trivizki
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Liang Wang
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Elizabeth Vanner
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • William J Feuer
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Giovanni Gregori
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Philip J Rosenfeld
    University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, United States
  • Footnotes
    Commercial Relationships   Jeremy Liu None; Rita Laiginhas None; Federico Corvi None; Frederick Ferris None; Tock Lim Novartis, Code C (Consultant/Contractor), Heidelberg Engineering, Code R (Recipient); Srinivas Sadda Amgen, Apellis, Abbvie/Allergan, Iveric, Roche/Genentech, Novartis, Regeneron, 4DMT, Oxurion, Gyroscope, Nanoscope, Heidelberg, Optos, Centervue, Code C (Consultant/Contractor), Carl Zeiss Meditec, Nidek, Heidelberg, Optos, Topcon, Centervue, Code F (Financial Support), Carl Zeiss Meditec, Nidek, Novartis, Heidelberg, Optos, Topcon, Code R (Recipient); Nadia Waheed Carl Zeiss Meditec, Nidek, Heidelberg Engineering, Topcon, Code F (Financial Support), Gyroscope Therapeutics, Ocudyne, Code S (non-remunerative); Prashanth Iyer None; Mengxi Shen None; Yingying Shi None; Omer Trivizki None; Liang Wang None; Elizabeth Vanner None; William Feuer None; Giovanni Gregori Carl Zeiss Meditec, Code F (Financial Support); Philip Rosenfeld Carl Zeiss Meditec, Code C (Consultant/Contractor), Carl Zeiss Meditec, Code F (Financial Support)
  • Footnotes
    Support  Carl Zeiss Meditec, Inc. (Dublin, CA), Salah Foundation (Ft. Lauderdale, FL), National Eye Institute Center Core Grant (P30EY014801), Research to Prevent Blindness (unrestricted Grant) to the Department of Ophthalmology, University of Miami Miller School of Medicine
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1029 – F0276. doi:
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    • Get Citation

      Jeremy Liu, Rita Laiginhas, Federico Corvi, Frederick L Ferris, Tock H Lim, Srinivas R Sadda, Nadia K Waheed, Prashanth G Iyer, Mengxi Shen, Yingying Shi, Omer Trivizki, Liang Wang, Elizabeth Vanner, William J Feuer, Giovanni Gregori, Philip J Rosenfeld; Consensus Grading of Persistent Hyper-Transmission Defects on En Face OCT Imaging of Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1029 – F0276.

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

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Abstract

Purpose : A training exercise was performed using en face optical coherence tomography (OCT) images to study the ability of graders to reliably identify persistent choroidal hyper-transmission defects (hyperTDs), also known as complete retinal pigment epithelium and outer retinal atrophy (cRORA).

Methods : Formal training on how to identify persistent hyperTDs on en face OCT images was provided to 11 graders. Persistent hyperTDs were defined as bright, well-delineated lesions having a greatest linear dimension (GLD) of at least 250 μm. Training consisted of a tutorial session followed by the grading of three pretest exercises, each consisting of three cases. After all the graders scored 100% on the pretest exercises, they evaluated a final test set consisting of 30 en face OCT images from 29 eyes with non-exudative age-related macular degeneration (AMD). These images contained 107 hyperTDs, as determined by a senior author (P.J.R.) and represented a variety of AMD-related atrophic lesions.

Results : A total of 1177 hyperTDs from 30 en face OCT images were reviewed by the graders. The mean sensitivity, PPV, and modified accuracy for all the graders were 99.0%, 99.2%, and 98.2%, respectively. There was a 97% agreement observed between all the graders (AC1 = 0.97). Internal graders from the Bascom Palmer Eye Institute had a slightly higher agreement compared with the external graders (AC1 = 0.98 vs. 0.96). The hyperTDs most often incorrectly identified included the following features: (1) hyperTDs containing a hypo-transmission defect (hypoTD) core, (2) single hyperTDs that were incorrectly graded as two separate lesions, and (3) hyperTDs with a borderline GLD close to 250 μm.

Conclusions : The accurate detection of persistent hyperTDs on en face OCT images by graders demonstrates the feasibility of using this OCT biomarker to identify disease progression in eyes with non-exudative AMD. Thus, hyperTDs can represent a clinical trial endpoint in studies designed to test new therapies that may slow disease progression from intermediate AMD to cRORA.

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

 

Figure 1. A case from the pretest exercise showing persistent choroidal hyper-transmission defects (hyperTDs). En face swept-source OCT (SS-OCT) sub-RPE structural images (A-C) and corresponding color-coded B-scans (D-I). Red circles represent the lesions that met the criteria for a persistent hyperTD and needed to be identified by the graders.

Figure 1. A case from the pretest exercise showing persistent choroidal hyper-transmission defects (hyperTDs). En face swept-source OCT (SS-OCT) sub-RPE structural images (A-C) and corresponding color-coded B-scans (D-I). Red circles represent the lesions that met the criteria for a persistent hyperTD and needed to be identified by the graders.

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