Incidence and Progression of Geographic Atrophy

Joachim, Nichole; Mitchell, Paul; Kifley, Annette; Rochtchina, Elena; Hong, Thomas; Wang, Jie Jin

doi:10.1016/j.ophtha.2013.03.029

Cited by 63 publications

(31 citation statements)

References 38 publications

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“…Focal RPE atrophy increased with an identical pattern. Compared to GA in dry AMD, presenting with larger RPE atrophy lesions, 25–27 RPE atrophy in neovascular AMD and associated treatment showed multiple smaller and more diffusely distributed focal atrophic RPE lesions. The multilobular GA structure frequently observed in eyes with CNV of the present study may represent an underlying disease substrate, for example, the choroidal vasculature, recently reported by Xu and associates.…”

Section: Discussionmentioning

confidence: 77%

Progression of Retinal Pigment Epithelial Atrophy in Antiangiogenic Therapy of Neovascular Age-Related Macular Degeneration

Schütze

Wedl

Baumann

et al. 2015

American Journal of Ophthalmology

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PurposeTo monitor retinal pigment epithelial (RPE) atrophy progression during antiangiogenic therapy of neovascular age-related macular degeneration (AMD) over 2 years using polarization-sensitive optical coherence tomography (OCT).DesignProspective interventional case series.Methodssetting: Clinical practice. study population: Thirty patients (31 eyes) with treatment-naïve neovascular AMD. observation procedures: Standard intravitreal therapy (0.5 mg ranibizumab) was administered monthly during the first year and pro re nata (PRN; as-needed) during the second year. Spectral-domain (SD) OCT and polarization-sensitive OCT (selectively imaging the RPE) examinations were performed at baseline and at 1, 3, 6, 12, and 24 months using a standardized protocol. RPE-related changes were evaluated using a semi-automated polarization-sensitive OCT segmentation algorithm and correlated with SD OCT and fundus autofluorescence (FAF) findings. main outcome measures: RPE response, geographic atrophy (GA) progression.ResultsAtrophic RPE changes included RPE thinning, RPE porosity, focal RPE atrophy, and development of GA. Early RPE loss (ie, RPE porosity, focal atrophy) increased progressively during initial monthly treatment and remained stable during subsequent PRN-based therapy. GA developed in 61% of eyes at month 24. Mean GA area increased from 0.77 mm2 at 12 months to 1.10 mm2 (standard deviation = 1.09 mm2) at 24 months. Reactive accumulation of RPE-related material at the lesion borders increased until month 3 and subsequently decreased.ConclusionsProgressive RPE atrophy and GA developed in the majority of eyes. RPE migration signifies certain RPE plasticity. Polarization-sensitive OCT specifically images RPE-related changes in neovascular AMD, contrary to conventional imaging methods. Polarization-sensitive OCT allows for precisely monitoring the sequence of RPE-related morphologic changes.

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Section: Discussionmentioning

confidence: 77%

Progression of Retinal Pigment Epithelial Atrophy in Antiangiogenic Therapy of Neovascular Age-Related Macular Degeneration

Schütze

Wedl

Baumann

et al. 2015

American Journal of Ophthalmology

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“…16 The growth rate of 0.33 mm/year observed in our study is within the range of growth rates reported previously. 20,21 Several papers have expressed growth of GA in mm 2 /year and have reported growth rates ranging between 1.28 to 2.6 mm 2 /year 22-29 . If we calculate our results in mm 2 , the mean GA growth in our study is 1.52 (0.12) mm 2 /year, a value that is within that range.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Growth of Geographic Atrophy during 5 Years of Comparison of Age-Related Macular Degeneration Treatments Trials

et al. 2017

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Purpose To estimate the incidence, size and growth rate of geographic atrophy (GA) during 5 years of follow up among participants in the Comparison of Age-related Macular Degeneration (AMD) Treatments Trials (CATT). Design Cohort within clinical trial. Participants Participants included in CATT Methods 1185 CATT participants were randomly assigned to ranibizumab or bevacizumab treatment and to 3 treatment regimens. Participants were released from protocol treatment at 2 years and examined at approximately 5 years (N=647). Two masked graders assessed presence and size of GA in digital color photographs (CP) and fluorescein angiograms (FA) taken at baseline and years 1, 2 and 5. Cox proportional hazard models were used to identify risk factors for incidence of GA. Annual change in the square root of the total area of GA was the measure of growth. Multivariate linear mixed models including baseline demographic, treatment, and ocular characteristics on CP/FA and OCT as candidate risk factors were used to estimate adjusted growth rates, standard errors (SE), and 95% confidence intervals. Main outcome measures GA incidence and growth rate. Results Among the 1011 participants who did not have GA at baseline and had follow-up images gradable for GA, the cumulative incidence was 12% at 1 year, 17% at 2 years, and 38% at 5 years. At baseline, older age, hypercholesterolemia, worse visual acuity, larger CNV area, RAP lesion, GA in the fellow eye, and intraretinal fluid were associated with higher risk of incident GA. Thicker subretinal tissue complex and presence of subretinal fluid were associated with less GA development. The overall GA growth rate was 0.33 (SE, 0.02) mm/year. Eyes treated with ranibizumab in the first 2 years of the clinical trial had a higher growth rate than eyes treated with bevacizumab (adjusted growth rate 0.38 vs.0.28 mm/year, p=0.009). GA in the fellow eye, hemorrhage and absence of subRPE fluid at baseline were associated with higher growth rate. Conclusion Development of GA is common 5 years after initiating therapy. Several risk factors identified previously at 2 years of follow up persist at 5 years of follow up.

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“…Collectively, our data show that the soft drusen plus SDD group had the largest total flow void area in the CC, likely revealing the connection with the high risk of MNV formation. On the other hand, strong evidence has not been reported regarding the specific risk of soft drusen plus SDD for the progression of GA, although both the soft drusen-only and SDD-only groups are associated with GA 21 – 23 . For the development and progression of GA, RPE-associated pathological conditions might be needed in addition to a CC flow deficit.…”

Section: Discussionmentioning

confidence: 99%

“…Lee et al reported that soft drusen plus SDDs showed the highest risk for macular neovascularization (MNV) development in the contralateral eye followed by the soft drusen only and SDD only groups, suggesting a devastating effect of nAMD development in the mixed type of drusen 15 . For GA, the specific risk of soft drusen plus SDD for the progression of GA is not known well, although both the soft drusen only and SDD only groups are associated with GA 21 – 23 . Therefore, the analysis of each drusen subtype, including mixed type based on both CC flow and Haller vessel morphology analyzed together, might unveil the specific characteristics of the choroidal environment in each subtype of drusen.…”

Section: Introductionmentioning

confidence: 99%

Integrative analysis of the choroid by quantifying Haller vessel and choriocapillaris parameters in different drusen subtypes

Lee

Kim

et al. 2021

Sci Rep

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This study aimed to quantify the Haller vessel and choriocapillaris (CC) parameters in drusen subtypes in nonexudative age-related macular degeneration (AMD) and pachydrusen. Ninety-five eyes of 80 patients and 28 control eyes were categorized into soft drusen, subretinal drusenoid deposit (SDD), soft drusen plus SDD, pachydrusen, and control groups. The diameter, length and intersections of Haller vessels and the total area, size and number of CC flow voids were quantified using en face optical coherence tomography (OCT) or OCT angiography. The pachydrusen group showed the largest Haller vessel area and diameter and shortest total length but similar CC parameters to those in the control group. The soft drusen plus SDD group showed the largest CC flow void area and size, while the Haller parameters were similar to those in the control group. The area and size of the flow voids in the SDD group were smaller than those in the soft drusen plus SDD group. Based on unsupervised machine learning, the eyes were classified into 4 clusters—the control, pachydrusen, soft drusen plus SDD and soft drusen plus SDD groups. Cluster 3 showed a larger diameter and shorter total length of the Haller vessels than cluster 4.

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Incidence and Progression of Geographic Atrophy

Cited by 63 publications

References 38 publications

Progression of Retinal Pigment Epithelial Atrophy in Antiangiogenic Therapy of Neovascular Age-Related Macular Degeneration

Progression of Retinal Pigment Epithelial Atrophy in Antiangiogenic Therapy of Neovascular Age-Related Macular Degeneration

Incidence and Growth of Geographic Atrophy during 5 Years of Comparison of Age-Related Macular Degeneration Treatments Trials

Integrative analysis of the choroid by quantifying Haller vessel and choriocapillaris parameters in different drusen subtypes

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