Abstract
We compared the retinal vessel density and inner retinal thickness in patients who had one eye with geographic atrophy (GA) and a fellow eye with intermediate age-related macular degeneration (iAMD). The vessel density from the superficial vascular complex (SVC) and deep vascular complex (DVC) through optical coherence tomography angiography and the thickness of the nerve fiber layer, ganglion cell–inner plexiform layer (GCIPL), inner nuclear layer (INL), outer nuclear layer (ONL) on a structural optical coherence tomography thickness map were measured in 28 eyes of 14 GA patients with iAMD in the fellow eye. GA eyes had significantly lower vessel density in the SVC (26.2 ± 3.9% vs. 28.3 ± 4.4%; p = 0.015) and DVC (24.2 ± 2.6% vs. 26.8 ± 1.9%; p = 0.003) than fellow eyes (iAMD). GCIPL and ONL were significantly thinner in GA eyes than in the fellow eyes (p = 0.032 and 0.024 in the foveal areas, p = 0.029 and 0.065 in the parafovea areas, respectively). Twenty-four eyes of 12 patients were followed up for 2 years and seven of the fellow eyes (58.3%) developed GA during the follow-up period and showed reduced vessel density in the SVC (26.4 ± 3.0% vs. 23.8 ± 2.9%; p = 0.087) and DVC (25.8 ± 2.2% vs. 22.4 ± 4.4%; p = 0.047) compared to baseline. Vessel density and GCIPL thickness map measurements are potential GA markers in non-neovascular AMD.
Highlights
Advanced age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in developed countries [1]
geographic atrophy (GA) was defined following Classification of Atrophy Meetings (CAM) report 3, as lesions of complete retinal pigment epithelium (RPE) and outer retinal atrophy that showed a region of hyper-transmission of at least 250 μm in length, a zone of attenuation or disruption of the RPE of at least 250 μm in length, overlying the ellipsoid zone degeneration on spectral-domain Optical coherence tomography (OCT) imaging (Heidelberg Engineering, Heidelberg, Germany) without signs of RPE tear and choroidal neovascularization (CNV) [5]
The mean retinal vessel densities (%) were significantly lower in eyes with GA than in fellow eyes in the superficial vascular complex (SVC) (26.2 ± 3.9% vs. 28.3 ± 4.4%; p = 0.015) and deep vascular complex (DVC) (24.2 ± 2.6 vs. 26.8 ± 1.9%; p = 0.003) (Figure 3)
Summary
Advanced age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in developed countries [1]. While early stages of AMD present with drusen and pigmentary changes, advanced AMD includes geographic atrophy (GA) characterized by retinal pigment epithelium (RPE) and photoreceptor loss or the development of choroidal neovascularization (CNV) in neovascular (exudative) AMD [2]. GA has traditionally been defined on color fundus photographs as a discrete area of RPE atrophy measuring at least 175 μm in diameter observed together with photoreceptor loss [4]. GA primarily affects the outer retina including photoreceptors and RPE, studies have previously demonstrated secondary inner nuclear layer and ganglion cell loss in addition to outer retinal atrophy [7–9]
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