Choriocapillaris flow deficit associated with intraretinal hyperreflective foci in intermediate age-related macular degeneration

Tiosano, Liran; Byon, Ik Soo; Alagorie, Ahmed Roshdy; Ji, Yong‐Sok

doi:10.1007/s00417-020-04837-y

Cited by 26 publications

(21 citation statements)

References 38 publications

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“…Impairment of the choriocapillaris may also indicate progression to more advanced stages of the disease. Choriocapillaris flow deficits are worse in patients with hyperreflective foci, particularly directly under the hyperreflective focus [64]. These hyperreflective foci correlate with progression to late AMD and development of atrophy [65].…”

Section: Choriocapillaris Impairment In Non-neovascular Intermediate Amdmentioning

confidence: 99%

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Scharf

Corradetti

Corvi

et al. 2021

JCM

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The advent of optical coherence tomography angiography (OCTA) has allowed for remarkable advancements in our understanding of the role of the choriocapillaris in age-related macular degeneration (AMD). As a relatively new imaging modality, techniques to analyze and quantify choriocapillaris images are still evolving. Quantification of the choriocapillaris requires careful consideration of many factors, including the type of OCTA device, segmentation of the choriocapillaris slab, image processing techniques, and thresholding method. OCTA imaging shows that the choriocapillaris is impaired in intermediate non-neovascular AMD, and the severity of impairment may predict the advancement of disease. In advanced atrophic AMD, the choriocapillaris is severely impaired underneath the area of geographic atrophy, and the level of impairment surrounding the lesion predicts the rate of atrophy enlargement. Macular neovascularization can be readily identified and classified using OCTA, but it is still unclear if neovascularization features with OCTA can predict the lesion’s level of activity. The choriocapillaris surrounding macular neovascularization is impaired while the more peripheral choriocapillaris is spared, implying that choriocapillaris disruption may drive neovascularization growth. With continued innovation in OCTA image acquisition and analysis methods, advancement in clinical applications and pathophysiologic discoveries in AMD are set to follow.

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Section: Choriocapillaris Impairment In Non-neovascular Intermediate Amdmentioning

confidence: 99%

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Scharf

Corradetti

Corvi

et al. 2021

JCM

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“…Although photoreceptor loss is associated with aging 14 , both histopathological and imaging studies have displayed that intermediate AMD eyes may be characterized by a greater photoreceptor loss 15 , 16 . Alterations in CC flow are also associated with aging 13 , 17 – 19 and a greater reduction in CC flow was demonstrated to occur in intermediate AMD eyes 20 – 25 . Therefore, a greater reduction in CC flow in these eyes might provide a potential rationale for a damage in photoreceptors via an ischemic mechanism 11 .…”

Section: Introductionmentioning

confidence: 96%

Photoreceptor alteration in intermediate age-related macular degeneration

Borrelli

Sacconi

Zuccaro

et al. 2020

Sci Rep

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The aim of this study was to analyze photoreceptor alterations occurring in eyes with intermediate age-related macular degeneration (AMD) and to investigate their associations with choriocapillaris (CC) flow. In this retrospective case–control study, we collected data from 35 eyes with intermediate AMD from 35 patients who had swept source optical coherence tomography structural and angiography imaging obtained. A control group of 35 eyes from 35 healthy subjects was included for comparison. Our main outcome measure for comparison between groups was the normalized reflectivity of en face image segmented at the ellipsoid zone (EZ) level, which was calculated to quantify the photoreceptor damage. OCTA metrics to quantify CC flow signal were also computed. These metrics were measured in a circle centered on the fovea and with a diameter of 5 mm. In intermediate AMD eyes, the macular area occupied by drusen was identified. Therefore, the EZ reflectivity and CC flow signal were separately measured in regions without drusen (“drusen-free” region). Measurements were generated using previously published algorithms. Mean ± SD age was 74.1 ± 6.8 years in the intermediate AMD group and 72.1 ± 6.0 years in the control group (p = 0.206). The normalized EZ reflectivity was 0.76 ± 0.10 in the intermediate AMD group and 0.85 ± 0.08 in the control group (p < .0001). In the “drusen-free” region, the normalized EZ reflectivity was 0.77 ± 0.10 (p < .0001 vs. healthy controls) and was positively correlated with the CC flow signal density (ρ = − 0.340 and p = 0.020). In conclusion, eyes with intermediate AMD exhibit a diffuse reduced EZ normalized reflectivity, and this reduction is correlated with CC flow signal in the regions without drusen. This study supports the concept of the damage of the unit comprised of photoreceptor, CC, and intervening tissues as an early event in AMD.

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“…With recent advancements in imaging technologies, implementing multi-modal imaging has allowed to evaluate various aspects of structural changes that occur in AMD. [9][10][11][12][13] The implications of the findings reported in the current study when assessed using multi-modal imaging techniques not used in this study, needs to be explored further. We will continue to expand our study population to gather additional data and longitudinally track these subjects to observe for retinal structural and functional changes over time.…”

Section: Discussionmentioning

confidence: 96%

<p>Early Ophthalmic Changes in Macula Does Not Correlate with Visual Function</p>

Narayanan

Wallstrom²,

Rodriguez

et al. 2020

OPTH

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Purpose: Early detection and treatment of age-related macular degeneration require a clear understanding of the early progress of the disease. The purpose of this study was to investigate whether minimal macular ophthalmoscopic changes corresponded to changes in visual function. Methods: Color macular photos from a group of older subjects who were classified as grade 0 on AREDS simplified grading were further evaluated by a retinal specialist using 5x magnification for possible minimal macular anomalies. Group 0-A (N = 15) were defined as subjects with no visible macular anomalies while Group 0-B (N = 19) comprised subjects for whom minimal macular mottling, pigment changes or very small drusen (< 63 µm) were observed in the study eye. All subjects had best VA of 20/25 or better and had no evidence of other retinal diseases in the study eye. All subjects underwent a series of visual function tests such as standard ETDRS VA, low luminance ETDRS VA, Pelli-Robson contrast sensitivity, variable contrast flicker (VCF) sensitivity, and reading speed (words per minute, wpm) using both MNRead and low luminance reading on a tablet. Results: There was no significant difference between the mean age between the two groups (74.8 ± 5.2 years for 0-A vs 74.5 ± 4.4 for 0-B, p = 0.82). None of the visual function tests identified any significant difference between the two groups. Mean ETDRS VA was 0.0 ± 0.11 for 0-A subjects and 0.08 ± 0.12 for 0-B (p = 0.063). Mean Pelli-Robson log contrast sensitivity was 1.75 ± 0.29 for 0-A and 1.78 ± 0.17 for the 0-B group (p = 0.73). VCF threshold was 0.47 ± 0.25 for 0-A and 0.43 ± 0.22 for 0-B (p = 0.64). Reading speed using MNRead was 214 ± 47.4 wpm for 0-A and 210 ± 64.7 for 0-B (p = 0.85). Low luminance tablet reading speed was 137 ± 71.8 wpm for 0-A and 151 ± 39.4 (0-B) (p = 0.49). Conclusion: A panel of psychophysical tests did not demonstrate significant differences between subjects with and without minimal macular changes.

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Choriocapillaris flow deficit associated with intraretinal hyperreflective foci in intermediate age-related macular degeneration

Cited by 26 publications

References 38 publications

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Photoreceptor alteration in intermediate age-related macular degeneration

<p>Early Ophthalmic Changes in Macula Does Not Correlate with Visual Function</p>

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