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Spatial Selective Choroidal Stromal and Vascular Changes in Intermediate AMD: Insights From High-Density Optical
Meenakshi Kumar1,2, Matt Trinh1,2, Rupesh Agrawal3,4,5,6
1School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Investigative Ophthalmology & Visual Science
|May 19, 2026
Summary
Intermediate age-related macular degeneration (iAMD) shows specific changes in choroidal vascularity and thickness. High-density OCT reveals subfoveal increases and parafoveal decreases in vascularity, suggesting vascular deficits contribute to iAMD progression.
Area of Science:
- Ophthalmology
- Medical Imaging
- Vascular Biology
Background:
- Intermediate age-related macular degeneration (iAMD) is a significant cause of vision impairment.
- Understanding the early structural changes in the choroid is crucial for iAMD management.
- High-density optical coherence tomography (OCT) offers detailed insights into ocular microvasculature.
Purpose of the Study:
- To characterize spatially selective alterations in choroidal angioarchitecture in intermediate AMD (iAMD).
- To utilize high-density OCT analysis for precise measurement of choroidal metrics.
- To investigate the relationship between choroidal changes and disease progression in iAMD.
Main Methods:
- Retrospective analysis of Spectralis OCT macular cube scans from 83 iAMD eyes and 83 controls.
- Development of a custom Python pipeline to compute choroidal thickness (CT), choroidal vascularity index (CVI), lumen area (LA), and stromal area (SA).
- Evaluation of spatial variations using Early Treatment Diabetic Retinopathy Study (ETDRS) sectors and eccentricity-based modeling.
Main Results:
- Global analysis revealed significant reductions in CVI and LA in iAMD eyes compared to controls (P < 0.0001).
- Spatial analysis showed significant distinctions between peripheral and near-periphery regions, with a subfoveal increase and parafoveal loss in CVI and LA.
- Choroidal thickness (CT) exhibited central thinning, while stromal area (SA) demonstrated a pattern of loss consistent with vascular changes.
Conclusions:
- Choroidal metrics in iAMD display spatially selective changes, with CT thinning centrally and CVI increasing subfoveally while decreasing parafoveally.
- Alterations in SA and LA correlate with CT and CVI changes, indicating their role in driving thickness and vascularity modifications.
- Parafoveal selectivity in early iAMD may stem from choroidal vascular deficits, underscoring the utility of high-density OCT in detecting subtle choroidal remodeling.
