Progression from early to neovascular age-related macular degeneration: Predictive factors on spectral-domain optical coherence tomography

Session Details

Session Title: Free Paper Session 4: AMD II

Session Date/Time: Thursday 07/09/2017 | 11:00-12:30

Paper Time: 11:48

Venue: Room 111

First Author: : I.Carneiro PORTUGAL

Co Author(s): :    J. Coelho   A. Abreu   M. Macedo   M. Furtado   M. Lume                 

Abstract Details

Purpose:

Patients with neovascular age-related macular degeneration (nvAMD) are known to have high risk of bilateral involvement. Although several potential biomarkers have been investigated to evaluate the risk of development of nvAMD in fellow eyes of patients with unilateral nvAMD, spectral-domain optical coherence tomography (SD-OCT) studies are lacking. This study aims to investigate the risk factors predictive of nvAMD development, using SD-OCT.

Setting:

Department of Ophthalmology of a tertiary referral centre in Oporto, Portugal – Centro Hospitalar Universitário do Porto.

Methods:

Retrospective study enrolling 22 patients with dry AMD who developed nvAMD throughout a follow-up period of at least 6 months. The study group was compared to a control group of 28 patients with early AMD, who remained stable for at least 9 months. In addition to demographic data, morphological tomographic findings including disruption of external limiting membrane, ellipsoid zone and retinal pigment epithelium were evaluated. Other anatomical findings were analyzed such as the presence of serous drusen, reticular pseudo-drusen, intra-retinal hyper reflective foci and subfoveal choroidal and retinal thicknesses.

Results:

The mean age of the study and control groups was 78 and 77 years-old, respectively. Among the 22 eyes of the 22 patients belonging to the study group, with active nvAMD, 17 showed intra-retinal fluid, 12 fibrovascular retinal pigment epithelium detachment (PED), 8 serous PED and 3 haemorrhagic PED. The SD-OCT evaluation showed that integrity of external limiting membrane, inner ellipsoid band and retinal pigment epithelium bands was significantly more prevalent in the control group (OR: 0.235, CI95%= 0.067-0.824, p=0.042) than in patients that progressed to nvAMD. The presence of small and big serous drusen, reticular drusen, intra-retinal hyper reflective foci were not significantly different between the two groups (p>0.05). Neither choroidal nor foveal thicknesses were identified as a predictive factor (p>0.05).

Conclusions:

Although SD-OCT has clearly revolutionized the assessment of patients with AMD, the full potential of SD-OCT predicting AMD progression remains to be established. Our study suggests that disruption of external limiting membrane, ellipsoid zone and retinal pigment epithelium seem to significantly increase the risk of progression for nvAMD. In conclusion, SD-OCT may not only be an essential adjunct for diagnosis and monitoring of AMD patients, but also a risk predictor of nvAMD development in dry AMD patients.

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