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Evaluating the persistence of large choroidal hypertransmission defects using SS-OCT imaging.

Sara Beqiri1, Gissel Herrera1, Jeremy Liu2

  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Experimental Eye Research
|October 5, 2024
PubMed
Summary

Large choroidal hypertransmission defects (hyperTDs) in age-related macular degeneration (AMD) are persistent, indicating a point-of-no-return in disease progression. These findings confirm hyperTDs as a potential clinical trial endpoint for AMD therapies.

Keywords:
Age-related macular degeneration (AMD)En face imagingPersistent choroidal hypertransmission defects (HyperTDs)Swept-source optical coherence tomography angiography (SS-OCTA)

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Retinal Diseases

Background:

  • Large choroidal hypertransmission defects (hyperTDs), defined as bright lesions ≥250 μm on en face OCT, arise from retinal pigment epithelium (RPE) attenuation or loss in age-related macular degeneration (AMD).
  • Previous research indicated that larger hyperTDs tend to persist, unlike smaller, transient lesions, marking a critical stage in AMD progression.

Purpose of the Study:

  • To confirm the persistence of large choroidal hyperTDs in age-related macular degeneration (AMD).
  • To evaluate the potential of large hyperTDs as a clinical trial endpoint for therapies targeting AMD progression.

Main Methods:

  • Analysis of an independent dataset from a prospective swept-source OCT (SS-OCT) natural history study of AMD eyes.
  • Identification and tracking of large choroidal hyperTDs (≥250 μm GLD) in 202 eyes (1725 hyperTDs) over an average of 46.6 months.

Main Results:

  • Overwhelming persistence of large hyperTDs was observed, with 1718 out of 1725 (99.6%) persisting.
  • Only 7 large hyperTDs (0.4%) were non-persistent, with an average baseline greatest linear dimension (GLD) of 385 μm.
  • Non-persistence was often associated with the accumulation of hyperreflective material, presumed to be aggregated RPE cells, over the hyperTD site.

Conclusions:

  • Large choroidal hyperTDs demonstrate remarkable persistence in AMD, reinforcing their role as a significant indicator of disease progression.
  • The high persistence rate supports the utility of large hyperTDs as a reliable endpoint for clinical trials investigating interventions for intermediate to late-stage AMD.