OCT-based AI-assisted phenotyping of intermediate AMD in the prospective PINNACLE trial: PINNACLE Study Report 9

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Intermediate age-related macular degeneration (iAMD) progression is not fully understood.
• Large-scale prospective studies are needed for comprehensive characterization.

Purpose of the Study:

• To provide a detailed optical coherence tomography (OCT)-based morphological characterization of the PINNACLE intermediate age-related macular degeneration (iAMD) cohort.
• To analyze the prevalence, distribution, and intercorrelation of iAMD features.

Main Methods:

• Utilized expert grader readings and artificial intelligence (AI) for OCT image analysis.
• Quantified drusen, subretinal drusenoid deposits (SDD), hyperreflective foci (HRF), and outer retinal integrity (EZ, ONL).
• Assessed incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) and ellipsoid zone loss/choroidal hypertransmission (EZLHT).

Main Results:

• Drusen concentrated centrally; SDD predominantly in the superior perifoveal quadrant.
• Higher drusen volume correlated with HRF presence/volume but inversely with SDD.
• Outer retinal thinning (EZ, ONL) indicates photoreceptor compromise, especially with atrophy (iRORA, EZLHT).

Conclusions:

• Combined expert and AI OCT analysis on the largest prospective iAMD cohort.
• Morphological findings align with existing literature, offering substantial characterization.
• Data is valuable for interpreting longitudinal iAMD progression, refining trial criteria, and serving as a reference.