Progression Patterns in Foveal-Sparing Geographic Atrophy With Double-Layer Sign Due to Neovascularization or Basal...

Area of Science:

• Ophthalmology
• Retinal Diseases
• Medical Imaging

Background:

• Age-related macular degeneration (AMD) is a leading cause of vision loss.
• Geographic atrophy (GA) is an advanced form of AMD characterized by RPE and photoreceptor loss.
• Foveal involvement in GA significantly impacts visual acuity.

Purpose of the Study:

• To investigate the prognostic significance of the double-layer sign (DLS) in eyes with foveal-sparing geographic atrophy (GA).
• To differentiate the impact of DLS subtypes on GA progression and foveal preservation.

Main Methods:

• Retrospective observational cohort study of 46 eyes with foveal-sparing GA and DLS.
• Utilized fundus autofluorescence (FAF), near-infrared reflectance (NIR), optical coherence tomography (OCT), and OCT angiography (OCTA).
• DLS defined as thick basal laminar deposits (BLamD) or non-exudative macular neovascularization (NE-MNV); GA growth rates evaluated.

Main Results:

• Eyes with NE-MNV had significantly thicker DLS compared to BLamD eyes.
• NE-MNV eyes exhibited larger foveal sparing areas and maintained stability over time.
• BLamD subgroup showed a significant reduction in foveal sparing area.

Conclusions:

• OCT angiography provides pathogenic insights into the DLS.
• A neovascular DLS is associated with better protection of the retinal pigment epithelium and outer retina.
• Neovascular DLS contributes to prolonged foveal preservation in eyes with GA.