Abstract
Purpose :
The advent of novel treatments for atrophic non-exudative age-related macular degeneration (AMD) compels the need for risk stratification and earlier detection for geographic atrophy (GA). The aim of this study is to evaluate the longitudinal evolution of precursor lesions in eyes with intermediate AMD as measured using spectral domain-optical coherence tomography (OCT).
Methods :
We performed a retrospective, multicenter analysis of OCT images from patients diagnosed with bilateral intermediate AMD and no evidence of GA with at least 2-years follow-up (range 18-30 months) seen at two academic centers from 2014-2023. We collected demographic and clinical data, then graded longitudinal OCT images for the presence of intraretinal hyper-reflective foci (HRF), reticular pseudodrusen (RPD), incomplete retinal pigment epithelial and outer retinal atrophy (iRORA), and complete retinal pigment epithelial and outer retinal atrophy (cRORA) within each of 9 Early Treatment Diabetic Retinopathy Study (ETDRS) grid subfields to attain a 10-step severity score for each OCT biomarker from one eye per subject. Because HRF and RPD may progress to iRORA or cRORA, and iRORA may progress to cRORA, biomarkers were scored as present if a more advanced feature (iRORA or cRORA) was present. Statistical change in each OCT biomarker was measured using Wilcoxon Signed-Rank Test using SPSS software, where p<0.05 was considered statistically significant.
Results :
We evaluated 96 eyes of 96 patients (mean age 75.5 ± 8.4 years, 68% female, 75% non-Hispanic White). At baseline, 33.3% of eyes had HRF, 76% of eyes had RPD, and 2.1% of eyes had iRORA, with a mean (SD) severity score of 0.70 (±1.22), 3.01 (±2.83), and 0.03 (±0.23) respectively. None of the eyes had cRORA at baseline. At 2 years, mean (SD) HRF severity increased from 0.70 (±1.22) to 1.52 (±1.91) (p <0.0001), RPD severity increased from 3.01 (±2.83) to 3.93 (±3.17) (p <0.0001), and iRORA severity increased from 0.03 (±0.23) to 0.39 (±1.07) (p = 0.0002). 11.46% of eyes developed cRORA over 2 years.
Conclusions :
Use of a 10-step severity score to measure AMD biomarkers from OCT based on ETDRS subfields demonstrate measurable progression over 2 years and may serve as a clinical endpoint for intermediate AMD studies.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.