Abstract
Early and intermediate AMD patients represent a heterogeneous population with an important but variable risk of progression to more advanced stages of the disease. The five-year progression from early and intermediate AMD to late disease is known to range from 0.4% to 53%. This wide variation explains the particular interest in searching predictive AMD biomarkers. Clinical parameters such as drusen size, presence of pigmentary abnormalities, and fellow eye status were, traditionally, the more important predictive elements. Multimodal retinal assessment (Color Fundus Photography, Optical Coherence Tomography, Optical Coherence Angiography and Fundus Autofluorescence) is providing new and accurate image biomarkers, useful in research and in daily practice. If individual progression risk could be anticipated, then management plans should be adapted accordingly, considering follow-up intervals and therapeutic interventions. Here, we reviewed the most important image progression biomarkers of early and intermediate AMD with relevant interest in clinical practice.
Highlights
Age-related macular degeneration (AMD) is the leading cause of irreversible severe vision loss in individuals over 55 years old in the developed world [1,2]
The Age Related Eye Disease Study (AREDS) group classifies AMD into three categories based on the type and severity of fundus lesions, including drusen dimensions and pigmentary changes [1,3]: (a) early AMD, defined as the presence of medium drusen (63 to 125 μm) with no pigmentary abnormalities; (b) intermediate AMD, defined as the presence of large drusen (>125 μm) or medium drusen in the presence of pigmentary abnormalities; and (c) advanced AMD, characterized by exudative neovascularization and/or geographic atrophy (GA) [1] involving the center of the macula
The main Optical Coherence Tomography (OCT) biomarkers related to progression to advanced AMD include drusen volume, hyperreflective foci (HRF), reticular pseudodrusen or subretinal drusenoid deposits (SDD), incomplete retinal pigment epithelial and outer retinal atrophy, hyper-transmission defects, and OCT-reflective drusen substructures (ODS) [9,10,11,12,13,26,27,28]
Summary
Age-related macular degeneration (AMD) is the leading cause of irreversible severe vision loss in individuals over 55 years old in the developed world [1,2]. Other studies found that the most important risk factor is the presence of advanced disease in the fellow eye, reporting less significance in drusen size and total drusen area, in the risk of conversion to neovascular AMD [21]. Drusen area can be calculated from manually tracing drusen or by semiautomatic drusen analysis from color fundus images Those estimates are considerably subjective, depending on aspects related to the observer and related to the patient (opacities, pigmentation, and variability of drusen appearance). The main OCT biomarkers related to progression to advanced AMD include drusen volume, hyperreflective foci (HRF), reticular pseudodrusen or subretinal drusenoid deposits (SDD), incomplete retinal pigment epithelial and outer retinal atrophy (iRORA), hyper-transmission defects, and OCT-reflective drusen substructures (ODS) [9,10,11,12,13,26,27,28]
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