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Sequence of Morphological Changes Preceding Atrophy in Intermediate AMD Using Deep Learning.

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Photoreceptor and outer nuclear layer thinning precede outer plexiform layer subsidence in intermediate AMD, indicating geographic atrophy progression. Artificial intelligence quantifies these early changes for personalized risk assessment.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Artificial Intelligence

Background:

  • Intermediate age-related macular degeneration (iAMD) can progress to geographic atrophy.
  • Outer plexiform layer (OPL) subsidence is a marker preceding geographic atrophy.
  • Early detection of iAMD progression is crucial for timely intervention.

Purpose of the Study:

  • To investigate the sequence of morphological changes before OPL subsidence in iAMD.
  • To utilize high-precision AI quantification on optical coherence tomography (OCT) imaging.
  • To identify early indicators of progression toward geographic atrophy.

Main Methods:

  • A longitudinal observational study of individuals with bilateral iAMD.
  • OCT volumes were analyzed for OPL subsidence, photoreceptor (PR) and outer nuclear layer (ONL) thickness, drusen height, and choroidal hypertransmission (HT).
  • AI-based quantification compared changes in areas of OPL subsidence (AS), drusen (AD), and reference (AR).

Main Results:

  • OPL subsidence occurred in 53 of 280 eyes, with 36 progressing to geographic atrophy.
  • PR and ONL thicknesses were significantly decreased in AS compared to AD and AR 12-18 months before OPL subsidence.
  • Accelerated thinning of PR and ONL was observed in AS, alongside drusen regression and increased HT.

Conclusions:

  • PR and ONL thinning are early subclinical features preceding OPL subsidence in iAMD.
  • OPL subsidence is an indicator of progression toward geographic atrophy.
  • AI algorithms can predict and quantify morphological precursors for personalized risk stratification of iAMD.