Incomplete RPE and Outer Retinal Atrophy (iRORA) Development in Dry Age-Related Macular Degeneration (AMD) in Patients with Fellow-Eye Neovascular AMD

Abstract

Purpose : To determine the risk for developing incomplete retinal pigment epithelium (RPE) and Outer Retinal Atrophy (iRORA) in dry age-related macular degeneration (AMD) in patients with fellow-eye neovascular AMD.

Methods : This was a retrospective, longitudinal study of patients with baseline neovascular AMD in one eye and dry AMD without iRORA or complete RPE and Outer Retinal Atrophy (cRORA) in the fellow eye. Optical Coherence Tomography 512x128 macular cubes (Cirrus HD-OCT, Zeiss, Dublin, CA) were evaluated in the dry AMD eye by trained graders for the presence of iRORA at 2 years. The presence of intraretinal hyperreflective foci (IHRF), hyporeflective drusen cores (hDC), subretinal drusenoid deposits (SDD), and drusen volume (mm³) at baseline were recorded. iRORA risk conferred by each biomarker was evaluated using Cox regression (p<0.05; Confidence interval (CI) 95%). Results were visualized using a Kaplan-Meier survival curve.

Results : 106 patients (106 eyes) met inclusion criteria with a median age of 80 years (IQR = 73 to 86, range = 57 to 94); 69 (65%) were female. Kaplan Meier survival analysis showed 32.08% (n=34) developed iRORA by 24 months (interquartile range (IQR) 23 to 24, range = 22 to 26) (Figure 1) while one eye (0.9%) developed cRORA. iRORA appeared at a median (IQR) interval of 4 (3 to 4.75) months. Baseline IHRF alone conferred increased risk for development of iRORA (HR [95% CI] = 2.046 [1.01; 3.93]; p=0.039) (Table 1).

Conclusions : In patients with fellow-eye neovascular AMD, the dry AMD eye had a 32% risk of iRORA development by 2 years. Baseline IHRF was associated with a 2-fold increased risk of iRORA development by 2 years. Further studies on the time to iRORA development are needed to explore the development of iRORA as a potential endpoint for future dry AMD clinical trials.

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

 

Figure 1. Development of iRORA in 106 eyes with early to intermediate AMD by 24 months.

 

Table 1. Cox Regression of OCT biomarkers, age, and sex on the risk of iRORA development by 24 months.