June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Choriocapillaris flow impairment under the fovea is associated with delayed rod-mediated dark adaptation in the perifovea of eyes with early and intermediate age-related macular degeneration: ALSTAR2 baseline
Author Affiliations & Notes
  • Deepayan Kar
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
  • Giulia Corradetti
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Mohymina Amjad
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
  • Thomas A. Swain
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
    Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
  • Mark E. Clark
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
  • Gerald McGwin
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
    Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
  • Cynthia Owsley
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
  • Kenneth R Sloan
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
  • SriniVas R Sadda
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Christine A. Curcio
    Ophthalmology and Visual Sciences, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
  • Footnotes
    Commercial Relationships   Deepayan Kar None; Giulia Corradetti Nidek, Code C (Consultant/Contractor); Mohymina Amjad None; Thomas Swain None; Mark Clark None; Gerald McGwin None; Cynthia Owsley Johnson & Johnson Vision, Code C (Consultant/Contractor); Kenneth Sloan None; SriniVas Sadda Abbvie/Allergan, Amgen, Apellis, Iveric, Novartis, Roche/Genentech, Regeneron, Janssen, Nanoscope, Biogen, Boehringer Ingelheim, Optos, Centervue, Heidelberg Engineering, Code C (Consultant/Contractor), Optos, Centervue, Heidelberg Engineering, Carl Zeiss Meditec, Nidek, Topcon, Code R (Recipient); Christine Curcio Apellis, Code C (Consultant/Contractor), Genentech/ Hoffman LaRoche, Regeneron, Code F (Financial Support)
  • Footnotes
    Support  NIH Grant R01EY029595
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 921. doi:
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    • Get Citation

      Deepayan Kar, Giulia Corradetti, Mohymina Amjad, Thomas A. Swain, Mark E. Clark, Gerald McGwin, Cynthia Owsley, Kenneth R Sloan, SriniVas R Sadda, Christine A. Curcio; Choriocapillaris flow impairment under the fovea is associated with delayed rod-mediated dark adaptation in the perifovea of eyes with early and intermediate age-related macular degeneration: ALSTAR2 baseline. Invest. Ophthalmol. Vis. Sci. 2023;64(8):921.

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

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Abstract

Purpose : To probe regions of metabolic vulnerability in age-related macular degeneration (AMD) by evaluating topographic associations between choriocapillaris flow deficits (FD%), choroidal thickness, and rod-mediated dark adaptation (RMDA).

Methods : This cross-sectional analysis included participants aged ≥60 years from the Alabama Study on Early Age-Related Macular Degeneration 2 (ALSTAR2) baseline. AMD status was determined using AREDS 9-step. RMDA was tested (AdaptDx, LumiThera, Harrisburg PA) at eccentricities of 5° (1.4 mm, superior parafovea) where rods are sparse and 12° (3.5 mm, superior perifovea) where rods are numerous. Using two adjacent 4.4 x 4.4 mm Spectralis OCTA (Heidelberg Engineering), FD% was quantified within annular regions with outer radii in mm of 0.5 (assigned to 0° location), 1.5 (5.2°), 2.2 (7.7°), 4.0 (14.0°), and 5.0 (17.5°) mm superiorly. Choroidal thickness was manually quantified 0°, 5° and 12° superiorly using a custom ImageJ plugin. Age-adjusted Spearman correlations (R) examined structure-function associations between regional FD% and choroidal thicknesses with RMDA at 5° and 12°.

Results : In 366 eyes of 366 participants (aged 71.3 ± 5.5 years), foveal FD% was more strongly associated with delayed RMDA at 5° (R=0.52, P<0.0001) than at 12° (R=0.39, P<0.0001). FD% was significantly worse with increasing AMD severity in all regions (overall P<0.05). The worst FD% was observed under the fovea (P<0.0001), decreasing at larger eccentricities. In pairwise comparisons, FD% was worse with greater AMD severity (P<0.05) at eccentricities <2.2 mm. At greater eccentricities, eyes with intermediate, but not early AMD differed from older normal eyes. Compared to FD%, choroidal thicknesses were more weakly associated with delayed RMDA at 5° and 12° (R=0.10-0.20, P<0.05) and were not associated with AMD severity (all P>0.10).

Conclusions : Reduced transport across choriocapillaris-Bruch’s membrane-RPE complex which contributes to high-risk soft drusen formation under the macula, also may impair retinoid resupply to rods close to the fovea. Microvascular impairment may precede macrovascular choroidal thinning, positioning FD% as a potential early imaging signature in AMD emergence. Further evaluation of spatio-temporal relationships is ongoing in the 3-year follow-up of ALSTAR2.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

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