Prognostic Ability of Automated RPE Sinuosity for Late AMD Supersedes Qualitative Outer Retinal Band Assessment

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Outer retinal band integrity is a key predictor of late age-related macular degeneration (AMD).
• Current subjective assessments of outer retinal band integrity are prone to intergrader variability.
• Objective quantification methods are needed for reliable AMD prognostication.

Purpose of the Study:

• To quantify retinal pigment epithelium (RPE) sinuosity using automated optical coherence tomography (OCT) segmentations.
• To evaluate the ability of RPE sinuosity to predict the progression to late AMD.
• To compare the predictive performance of RPE sinuosity against qualitative assessments.

Main Methods:

• Retrospective analysis of intermediate AMD patients who progressed to late AMD (n=69) or remained stable (n=198).
• Quantitative measurement of RPE sinuosity (RPE:RPE-fit line length ratio) on macular OCT B-scans.
• Qualitative grading of RPE and ellipsoid zone continuity and other AMD biomarkers.

Main Results:

• Median RPE sinuosity was the strongest predictor of progression to late AMD within 5 years (OR=2.52) and over the study period (OR=2.35).
• Pigmentary abnormalities, subretinal drusenoid deposits, drusen volume, and fellow eye late AMD were associated with progression.
• Qualitative measures did not predict late AMD within any timeframe.

Conclusions:

• RPE sinuosity is a reliable and repeatable quantitative measure for predicting late AMD.
• RPE sinuosity outperforms qualitative assessments of outer retinal band integrity.
• Further prospective studies with diverse OCT devices are recommended to integrate RPE sinuosity into clinical risk models.