Abstract
Purpose :
Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness in the elderly population. Macular atrophy (MA) is the end point of AMD, which causes irreversible blindness without proven effective treatments so far. Therefore, identifying biomarkers for the early prediction of MA is crucial. Currently, there is a lack of sensitive and specific biomarkers to monitor the progression from intermediate AMD to MA both in dry and wet AMD before significant vision loss occurs. Here, we present a new biomarker, the subsidence of the outer plexiform layer (OPL), to predict MA, and compare it to other conventional biomarkers.
Methods :
Using follow-up optical coherence tomography (OCT) images from 400 fully anonymized patients with AMD, the correlation between subsidence of OPL and MA conversion was analyzed, including the incidence of atrophy conversion and time to conversion. In addition, we compared this correlation to other conventional biomarkers (drusen and reticular pseudodrusen (RPD)).
Results :
The incidence of MA conversion from drusen, RPD and subsidence of OPL varied, but subsidence was found to be the most prevalent feature, both in dry AMD (96.2%) and wet AMD (87.9%). In addition, whenever there was an appearance of drusen or RPD, it was always accompanied with the presence of subsidence (Figure 1).
The average time to conversion from subsidence of OPL and drusen did not show any statistical difference, both in dry and wet AMD (Figure 2).
In dry AMD, there was no statistical difference of time to conversion between drusen and subsidence of OPL when converting to development of iRORA and cRORA. However, in wet AMD, eyes exhibiting subsidence of ONL appeared to progress faster to MA than those with drusen, with a statistically significant difference in converting to cRORA, compared to iRORA.
Conclusions :
We have presented several atrophic-related biomarkers, and among these, the presence of subsidence of OPL is validated to be the most reliable and sensitive biomarker with the highest prevalence for MA conversion, both in dry and wet AMD. It shows the potential use of this biomarker to early predict the subsequent MA conversion, 20 months on average before the conversion of MA.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.