Abstract
PurposeThe purpose of this article is to describe the appearance of age‐related macular degeneration (AMD) phenotypes using infrared (IR) reflectance imaging. IR reflectance imaging of the retina has the potential to highlight specific sub‐retinal features and pathology. However, its role in macular disease, specifically AMD, is often underestimated and requires clarification.Recent findingsRecent advances in clinical methods, imaging and scientific knowledge may be integrated to improve the accuracy of disease stratification in AMD. In particular, IR imaging holds an underutilised sensitivity to detect reticular pseudodrusen, which have been repeatedly described as a high‐risk sign for late AMD.SummaryThis article provides clinically relevant descriptions of AMD phenotypes using IR reflectance imaging. The findings are integrated with images from cases seen at the Centre for Eye Health. As primary eye‐care providers assume a critical role in the detection, diagnosis and management of AMD, we also provide a chair‐side reference to assist clinicians in interpreting IR images in AMD.
Highlights
Age-related macular degeneration (AMD) is a leading cause of blindness and visual impairment worldwide.[1,2] Early and intermediate AMD are typically asymptomatic and may be detected via careful, routine eye examination using multiple imaging methods
The effective use of advanced imaging in the clinical evaluation and management of AMD is presently difficult for several reasons: (1) AMD is heterogeneous – the presentation is variable and various phenotypes exist, (2) the pathophysiology of the condition is complex, multifactorial and not well understood, which limits the interpretation of clinical signs, (3) clinical signs typically associated with AMD may be due to other macular disorders, (4) advanced imaging modalities have been rapidly adopted by eye-care professionals in general practice and no practical, standardised testing paradigm or widely disseminated clinical guidelines regarding the interpretation of advanced imaging in AMD exist
While use of these technologies can increase the likelihood of patients being recognised and treated as early as possible, it could potentially lead to an escalation of false positives and false negatives, as has been demonstrated in glaucoma.[3]
Summary
Age-related macular degeneration (AMD) is a leading cause of blindness and visual impairment worldwide.[1,2] Early and intermediate AMD are typically asymptomatic and may be detected via careful, routine eye examination using multiple imaging methods. The effective use of advanced imaging in the clinical evaluation and management of AMD is presently difficult for several reasons: (1) AMD is heterogeneous – the presentation is variable and various phenotypes exist, (2) the pathophysiology of the condition is complex, multifactorial and not well understood, which limits the interpretation of clinical signs, (3) clinical signs typically associated with AMD may be due to other macular disorders, (4) advanced imaging modalities have been rapidly adopted by eye-care professionals in general practice and no practical, standardised testing paradigm or widely disseminated clinical guidelines regarding the interpretation of advanced imaging in AMD exist While use of these technologies can increase the likelihood of patients being recognised and treated as early as possible, it could potentially lead to an escalation of false positives and false negatives, as has been demonstrated in glaucoma.[3]. Primary eye-care providers are often the first point of contact for individuals presenting with reduced
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