Developing prognostic biomarkers in intermediate age‐related macular degeneration: their clinical use in predicting progression

Abstract

Age-related macular degeneration is a common, complex and blinding eye disease. When early and intermediate levels of severity are detected in one or both eyes, there is a wide-ranging 0.4 to 53 per cent risk of progression to advanced disease in five years. In order to maximise visual outcomes for their patients, practising eye-care professionals must be able to stratify patients according to their risk of progression, intervene (for example by recommending smoking cessation or nutritional supplements and Amsler grid self-monitoring in intermediate disease) and monitor accordingly. With the aid of ocular imaging, a range of under-recognised yet meaningful risk factors have been identified. The purpose of this review is to assist the eye-care practitioner in stratifying the risk of progression in intermediate age-related macular degeneration using the range of established and emerging precursory signs that herald loss of vision.

Multispectral Pattern Recognition Reveals a Diversity of Clinical Signs in Intermediate Age-Related Macular Degeneration

“…Drusen subtypes have also been identified, and this subtyping may be applied to better identify an individual's overall risk of progression. 10 The accurate assessment of AMD is further complicated by the advent of multiple advanced imaging modalities that are now widely available for the clinical evaluation and differential diagnosis of macular structure (optical coherence tomography; infrared imaging; monochromatic retinal photography-blue-, red-, or green-filtered images; and fundus autofluorescence). These technologies enable earlier and more accurate disease detection by providing detailed phenotype data with high sensitivity.…”

Optometry Australia's chairside reference for the diagnosis and management of age‐related macular degeneration

“…The appearance of RPD has been described in Table 3 and appear on OCT as deposits in the subretinal space above the RPE, unlike classical drusen which are below the RPE. 44 Using other modalities, such as FAF or NIR, they typically appear as collections of semi-regular, interlacing, hypo-autofluorescent or hypo-reflective ribbons or spots.…”

“…Hyper-reflective foci represent a five-fold increased risk of progression to late AMD. 44 They are best visualised using OCT as intraretinal, hyper-reflective dots and often correspond with hyper-pigmentary abnormalities using fundoscopy ( Figure 3).…”

“…Advances in OCT have enhanced our ability to detect structural retinal and retinal pigment epithelium (RPE) changes that may precede the development of late AMD 44 and vision loss, such as reticular pseudodrusen, 40 hyper-reflective foci 44 and nascent GA. 45 Refined phenotyping of macular atrophy is also possible. 37 See the 'Prognostic biomarkers' section for more detail.…”

An evidence‐based approach to the routine use of optical coherence tomography

“…Scrutiny of the photoreceptor layers is important and may be considered in conjunction with drusen height, ultrastructure, area and volume as predictive ‘biomarkers’ of disease progression . For example, subretinal drusenoid deposits confer a 2–6‐fold higher risk of progression to late AMD . Choroidal thickness is also garnering increasing interest and may hold prognostic value for identifying patients who have or are at risk of developing AMD‐related macular atrophy (particularly if the subfoveal choroidal thickness is ≤ 124 μm) .…”