Incomplete RPE and Outer Retinal Atrophy (iRORA) Development in Eyes With Fellow-eye Neovascular Age-related Macular...

Area of Science:

• Ophthalmology
• Retinal Diseases
• Medical Imaging

Background:

• Intermediate age-related macular degeneration (iAMD) is a precursor to advanced stages.
• The clinical utility of incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) as an endpoint in iAMD requires elucidation.
• Understanding the progression of iAMD is crucial for predicting outcomes.

Purpose of the Study:

• To determine the time to development of iRORA in eyes with iAMD.
• To identify predictors of iRORA development in iAMD patients with fellow-eye neovascular AMD (nAMD).

Main Methods:

• Retrospective analysis of 101 eyes with iAMD and fellow-eye nAMD from 2010-2019.
• Spectral Domain Optical Coherence Tomography (SD-OCT) assessed for iRORA and complete RPE and Outer retinal atrophy (cRORA) over 24 months.
• Univariable Cox regression analyzed baseline OCT characteristics (including intraretinal hyperreflective foci, subretinal drusenoid deposits, hyporeflective drusen cores, drusen volume), age, and gender as predictors.

Main Results:

• 28.7% of iAMD eyes developed iRORA within 24 months; 2.97% developed cRORA without prior iRORA.
• Median time to iRORA or cRORA development was 20 months.
• Baseline intraretinal hyperreflective foci (IHRF) significantly increased the risk of iRORA development (HR=2.28, P=0.019).

Conclusions:

• Approximately one-third of iAMD eyes with fellow-eye nAMD progress to iRORA within two years.
• Intraretinal hyperreflective foci are a significant risk factor for iRORA development in iAMD.
• iRORA shows potential as a clinical endpoint for monitoring iAMD progression.