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Quantifying macular atrophy in neovascular AMD using en face structural OCT imaging.

Chiara Olivieri1,2, Tommaso Tibaldi1,2, Alessandro Berni3,4

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Summary

En face swept-source OCT (SS-OCT) reliably quantifies macular atrophy in neovascular age-related macular degeneration (AMD), correlating strongly with green autofluorescence (GAF). However, factors like hyperpigmentation and fibrosis can affect accuracy.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Retinal Diseases

Background:

  • Neovascular age-related macular degeneration (AMD) is a leading cause of vision loss.
  • Accurate quantification of macular atrophy is crucial for monitoring disease progression and treatment efficacy.
  • Current imaging modalities have limitations in precisely assessing atrophy extent.

Purpose of the Study:

  • To evaluate the reliability of en face swept-source OCT (SS-OCT) for quantifying macular atrophy in neovascular AMD.
  • To compare SS-OCT atrophy measurements with green autofluorescence (GAF) imaging.
  • To identify limitations of SS-OCT in atrophy assessment.

Main Methods:

  • Prospective observational study of 30 patients with neovascular AMD and macular atrophy.
  • Multimodal imaging using en face SS-OCT and GAF.
  • Quantification of macular atrophy by masked graders based on hypoautofluorescence (GAF) and hypertransmission defects (SS-OCT).
  • Statistical analysis including Wilcoxon test and Spearman correlation.

Main Results:

  • Strong correlation (ρ = 0.998, p < 0.001) between SS-OCT and GAF atrophy measurements.
  • Significant difference in mean atrophy size (SS-OCT: 5.96 mm², GAF: 7.10 mm²).
  • Discrepancies noted due to hyperpigmentation, macular hemorrhages, and fibrosis affecting SS-OCT accuracy; inconsistent border delineation observed.

Conclusions:

  • En face SS-OCT is a reliable tool for quantifying macular atrophy in neovascular AMD, showing strong agreement with GAF.
  • Hyperpigmentation, fibrosis, and hemorrhages pose challenges for SS-OCT atrophy quantification.
  • Careful interpretation and addressing inter-modality discrepancies are essential for clinical and research use.