The Role of New Imaging Methods in Managing Age-Related Macular Degeneration

Abstract

The use of imaging for age-related macular degeneration (AMD) depends on how it benefits clinical management and on reimbursement. The latter should relate to the former. This review assesses how different forms of AMD can be imaged and what information this provides. For nonneovascular AMD high-resolution optical coherence tomography (OCT), autofluorescence, and near infrared imaging can identify the type of drusen, such as reticular pseudodrusen, which influences prognosis, and the amount of atrophy, for which phase 3 trials are underway. Clarifying the correct diagnosis for late-onset Stargardt and macular telangiectasia, if treatment becomes available, will be especially important. Choroidal thickness can be measured and changes with anti‒vascular endothelial growth factor treatment, but how this influences management is less clear. The finding of a thick choroid may alter the diagnosis to pachychoroid neovasculopathy, which may have a different treatment response. Peripheral retinal changes are commonly found on ultrawide-field imaging but their importance is not yet determined. The mainstay of imaging is OCT, which can detect neovascular AMD by detecting thickening and be used for follow-up, as the presence or absence of thickening is the main determinant of treatment. Higher resolution systems and now OCT angiography are able to distinguish neovascular type, especially type 2 choroidal neovascularization but also polypoidal choroidal vasculopathy and retinal angiomatous proliferation. Fundus fluorescein and indocyanine green angiographies still have a role, although that partly depends on whether photodynamic therapy is being considered. Automated image analysis and machine learning will be increasingly important in supporting clinician decisions.

Imaging, Genetic, and Demographic Factors Associated With Conversion to Neovascular Age-Related Macular Degeneration

“…Use of artificial intelligence applications in ophthalmic imaging has been increasing rapidly. Analysis of features from OCT images and the development of algorithms to estimate progression of AMD have been applied to improve early diagnosis and prevention . de Sisternes et al were among the first to automatically extract drusen features from SD-OCT images to estimate future AMD progression from an early or intermediate nonexudative stage to an advanced exudative stage.…”

An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management

“…The technique of near-infrared autofluorescence (NIR AF) using confocal scanning laser ophthalmoscope (SLO) system has been employed in the study of various retinal diseases. NIR AF originates from the melanin of the RPE and has applicability in various conditions such as AMD and CNV due to various causes [ 81 – 85 ]. Among patients with neovascular AMD, NIR AF often shows signal blockade due to subretinal hemorrhage due to CNV.…”

Geographic atrophy: pathophysiology and current therapeutic strategies

“…OCT is a sensitive examining tool for GA evaluation as it provides a detailed characterization of retinal layers ( 3 ). This method can be used to visualize drusen deposits, choroidal neovascularization, detachment of RPE, and subretinal fluid ( 21 , 30 ). The choroidal vascularity index, as determined by structural OCT analysis, can be used to predict GA progression ( 31 ).…”