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Jianqing Li, Jeremy Liu, Rita Laiginhas, Mengxi Shen, Yingying Shi, Omer Trivizki, Nadia K Waheed, Giovanni Gregori, Philip J Rosenfeld; Multimodal Imaging and En Face OCT Detection of Calcified Drusen in Eyes with Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1039 – F0286.
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En face optical coherence tomography (OCT) imaging was investigated as a method for the detection and monitoring of calcified drusen in eyes with non-exudative age-related macular degeneration (AMD).
A retrospective review of a prospective study was performed of same-day color fundus (CF), near infrared (NIR), fundus autofluorescence (FAF), and en face swept-source OCT (SS-OCT) images to identify eyes with non-exudative AMD and calcified drusen. The appearance and subsequent progression of these lesions were compared using the different imaging modalities.
Two hundred twenty eyes from 139 patients with non-exudative AMD were studied with 42.7% of the eyes containing calcified drusen either at baseline or during their follow-up visits. On the en face sub-RPE SS-OCT slabs, calcified drusen appeared as dark focal lesions referred to as choroidal hypo-transmission defects (hypoTDs). The corresponding B-scans showed drusen with heterogenous internal reflectivity and a hyper-reflective cap. In the majority of the calcified drusen, choroidal hyper-transmission defects (hyperTDs) were observed to develop over time around the periphery of the hypoTDs giving them the appearance of a donut lesion on the en face SS-OCT images. These donut lesions were associated with significant attenuation of the overlying retina, and the corresponding FAF images showed hypo-autofluorescence at the location of these lesions. The donut lesions fulfilled the requirement for a persistent hyperTD and is synonymous with complete retinal pigment epithelium and outer retinal atrophy (cRORA). Six eyes displayed regression of their calcified drusen without developing cRORA. B-scans at the location of the regressed calcified drusen showed deposits along the RPE with outer retinal thinning in the regions where the calcified lesions previously existed.
En face rendering of OCT images is a useful method for the detection and monitoring of calcified drusen and future studies will document the evolution of these drusen as they form donut lesions and foci of cRORA.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
Figure 1. Multimodal imaging of the right eye from a 73-year-old woman showing calcified drusen (white arrows). (A) CF. (B) NIR. (C) FAF. (D) Drusen volume map. (E,F) SS-OCT en face sub-RPE slab. (G-I) Color-coded B-scans. The yellow arrow identifies a hyperTD representing atrophy.
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