Optical Coherence Tomography Angiography in Age-Related Macular Degeneration

To review and synthesize current evidence regarding the importance of optical coherence tomography angiography (OCTA) in the assessment of choriocapillaris alterations and macular neovascularization (MNV) across the spectrum of age-related macular degeneration (AMD), focusing on disease progression and clinical implications.

Selective review of the specialized literature, concentrating on both qualitative and quantitative OCTA analyses of the retinal and choroidal microvasculature in AMD. We focused on measures related to choriocapillaris flow deficits, the morphology and maturity of MNV, and their associations with structural changes like drusen, geographic atrophy, and exudative conditions. The review included findings from both spectral-domain and swept-source OCTA systems.

OCTA enables non-invasive, depth-resolved visualization of choriocapillaris and MNV alterations throughout the progression of AMD. In the early and intermediate stages of AMD, localized choriocapillaris flow deficits are often observed beneath drusen and around lesion areas. In more advanced stages, there is significant choriocapillaris damage, especially near geographic atrophy and macular neovascularization. Quantitative OCTA biomarkers, such as density and flow deficit percentage, show strong correlations with disease stage, progression risk, and treatment response. Additionally, the maturity patterns of MNV identified through OCTA seem to affect the integrity of the surrounding choriocapillaris and the dynamics of atrophy.

The reviewed studies support a close relationship between choriocapillaris dysfunction, the development of macular neovascularization, and the progression of AMD. These findings reinforce the concept that vascular alterations play a central role throughout the disease spectrum and highlight the potential of OCTA to provide biomarkers that may improve prognostic assessment and treatment monitoring. However, further standardization of imaging protocols and quantitative analysis methods is needed before these biomarkers can be fully integrated into routine clinical practice.

OCTA has become a crucial imaging tool for understanding microvascular changes in AMD. The quantitative evaluation of the choriocapillaris and detailed analysis of MNV morphology offer important insights into disease mechanisms, progression risk, and treatment monitoring. Incorporating OCTA-derived biomarkers into routine clinical practice could improve personalized management strategies for patients across the spectrum of AMD.