Progressing geographic atrophy: choroidal thickness and retinal sensitivity identify two clinical phenotypes

Pilotto, Elisabetta; Guidolin, Francesca; Convento, Enrica; Stefanon, Francesco Giuseppe; Parrozzani, Raffaele; Midena, Edoardo

doi:10.1136/bjophthalmol-2014-306338

Cited by 13 publications

(6 citation statements)

References 26 publications

(26 reference statements)

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“…The same association was less pronounced in eyes with SDD; but in these SDD-eyes, it vanished upon adjusting for the other independent predictors of GA. While SDD stipulate thinner choroids that cannot prognosticate progression to GA, SDD-free eyes with choroidal thickness that is age-appropriate may be protected against new-onset GA. By asserting claims from other studies, 44,45 our findings showed that choroidal thickness and SDD will help distinguish at least two different pathophysiologic mechanisms. Briefly, the findings of this study pointed to structural SDOCT markers that act as independent contributors to the risk of GA, and which may help in deciphering the pathophysiologic mechanisms leading to GA.…”

Section: Discussionsupporting

confidence: 62%

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

et al. 2017

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Purpose The appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral domain optical coherence tomography (SDOCT). We aimed to build SDOCT-based risk assessment models for 5-year new onset of GA and central GA on CP. Design Prospective longitudinal study. Participants Age-related macular degeneration (AMD) patients with bilateral large drusen and/or non-central GA, and at least one eye without advanced disease (n=317) enrolled in the multicenter Age-Related Eye Disease Study 2 (AREDS2) Ancillary SDOCT study. Methods For one eye per participant, qualitative and quantitative SDOCT variables were derived, respectively, from standardized grading and semi-automated segmentation at baseline. Up to 7 years later, annual outcomes were extracted and analyzed to fit multivariate logistic regression models and build a risk calculator. Main Outcome Measures New onset of CP-visible GA and central GA. Results Over a follow-up median of 4.0 years and among 292 AMD eyes (without advanced disease at baseline) with complete outcome data, 46 (15.8%) developed central GA. Among a subset of 265 eyes without any GA on baseline CP, 70 (26.4%) developed CP-visible GA. Final multivariate models were adjusted for age. In the model for GA, the independent predicting SDOCT factors (p <0.001 to 0.03) were (1) hyperreflective foci (HF) and (2) retinal pigment epithelium layer atrophy or absence (RPEA), followed by (3) choroidal thickness in absence of subretinal drusenoid deposits, (4) photoreceptor outer segment loss, (5) RPE drusen complex (RPEDC) volume and (6) RPEDC abnormal thinning (RAT) volume. For central GA, the independent predicting SDOCT factors (p<0.001) were (1) RAT volume, (2) intraretinal fluid or cystoid spaces, (3) HF, and (4) RPEA. The models yielded a calculator that computes the probabilities of CP-visible new-onset GA and central GA after 1 through 5 years. Conclusions For AMD eyes with large drusen and no advanced disease, we built a novel risk assessment model – based on age and SDOCT segmentation, drusen characteristics, and retinal pathology – for progression to CP-visible GA over up to 5 years. This calculator may simplify SDOCT grading and, with future validation, have a promising role as a clinical prognostic tool.

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Section: Discussionsupporting

confidence: 62%

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

et al. 2017

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“…The arithmetic mean of overall retinal threshold is unable to detect subtle functional changes in atrophic macular disease. Several studies have recognized this limitation and investigated the use of additional scotoma-related measures to detect progression, including number and/or proportion of NS, 17 DS, 15 , 16

, 14 – 17

, and

. 13 – 17 In the light of this, we reported TRV values for each of these measures in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Intersession test—retest variability of conventional and novel parameters using the MP-1 microperimeter

Wong

Mackey

Morgan

et al. 2015

OPTH

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PurposeTo investigate the intersession test–retest variability (TRV) of topography- and threshold-based parameters derived from the Nidek MP-1.DesignProspective observational study.MethodsSixteen participants with and without central scotoma underwent microperimetry in one eye over three sessions at 1-month intervals in a single institution. We calculated 95% coefficient of repeatability (CR) for the number of normal-suspect (NS) loci, relative scotoma (RS) and dense scotoma (DS), median macular sensitivity (MS), mean sensitivity of responding loci (RLS), perilesional loci (PLS), and extralesional loci (ELS). Topographical agreement score of mapping NS and DS loci (TASNS and TASDS) were also calculated for each patient.ResultsMean (range) age was 50 (21–86) years. The CR (95% confidence intervals) for NS, RS, and DS were 9.9 (6.5–13.3), 9.5 (6.2–12.7), and 3.0 (1.1–4.1) respectively. CR (95% CIs) for median MS, mean RLS, PLS, and ELS were 3.4 (2.3–4.5), 1.6 (1.1–2.2), 1.8 (0.9–2.6), and 2.8 (1.5–4.0) dB. We found significant change in thresholds between Test 1, and Tests 2 and 3 (both P=0.03), but not between Tests 2 and 3 (P=0.8). Medians (range) TASNS and TASDS were 74% (39%–100%) and 77% (0%–97%), respectively, between Tests 2 and 3.ConclusionWe recommend the use of four DS loci (upper limit of CR) as the limit of TRV for assessing change. There was large interindividual variability in NS or DS mapping agreement. We recommend discarding the first microperimetry test and caution the use of a change in spatial distribution to determine disease progression.

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“…Recently, it has been observed that patients with bilateral GA and those with GA in one eye and CNV in the fellow eye (unilateral GA) differ for both retinal sensitivity and choroidal thickness changes. 69 In patients with unilateral GA, choroid was thinner compared to patients with bilateral GA, and became thinner during follow-up. Otherwise, patients with bilateral GA had a significant reduction in retinal sensitivity from baseline, whereas retinal sensitivity did not significantly change in patients with unilateral GA.…”

Section: Microperimetry In Early Age-related Macular Degenerationmentioning

confidence: 91%

“…On the contrary, photoreceptors are primarily involved in patients with bilateral GA, and the progression of the GA probably depends on their dysfunction, with secondary decrease of visual function. 69…”

Section: Microperimetry In Early Age-related Macular Degenerationmentioning

confidence: 99%

Microperimetry in age: related macular degeneration

Midena

Pilotto

2017

Eye

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Age-related macular degeneration (AMD) is one of the major causes of visual loss and legal blindness in people over 55. Visual function tests are the cornerstone of visual function investigation and any therapeutic approach to AMD implies, as primary endpoint, the maintenance or improvement of visual function. The progression of visual impairment and the quantification of final residual visual function are currently determined by means of visual acuity quantification. The quantification of high-contrast visual acuity though has many drawbacks and cannot be considered a complete functional examination. Microperimetry is a non-invasive method used to analyse fixation and central visual field defects in a topographic related manner. The introduction of mesopic and more recently scotopic microperimetry, in research and clinical practice of macular disorders, now allows us to better investigate macular function as it strictly relates to macular morphology. We therefore can monitor the functional natural history and quantify the beneficial or detrimental effects of different therapies. The application of microperimetry in clinical studies has provided interesting diagnostic and prognostic information on functional macular changes in AMD patients. The present review brings new updates on the correlation between macular changes, mainly described with optical coherence tomography, and microperimetry changes in patients with AMD.

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Progressing geographic atrophy: choroidal thickness and retinal sensitivity identify two clinical phenotypes

Abstract: During follow-up, changes in Se and choroidal thickness differed in patients with GA with or without CNV in the fellow eye. These results identify at least two GA phenotypes, in which the development and progression of GA may be primarily due to different pathophysiologic mechanisms.

Cited by 13 publications

References 26 publications

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

Intersession test—retest variability of conventional and novel parameters using the MP-1 microperimeter

Microperimetry in age: related macular degeneration

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Progressing geographic atrophy: choroidal thickness and retinal sensitivity identify two clinical phenotypes

Abstract: During follow-up, changes in Se and choroidal thickness differed in patients with GA with or without CNV in the fellow eye. These results identify at least two GA phenotypes, in which the development and progression of GA may be primarily due to different pathophysiologic mechanisms.

Cited by 13 publications

References 26 publications

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

Intersession test&mdash;retest variability of conventional and novel parameters using the MP-1 microperimeter

Microperimetry in age: related macular degeneration

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Product

Resources

About

Intersession test—retest variability of conventional and novel parameters using the MP-1 microperimeter