Impact of optical coherence tomography angiography on the non-invasive diagnosis of neovascular age-related macular degeneration.

PURPOSE: To investigate the changes in imaging tool practice for the diagnosis of neovascular age-related macular degeneration (nAMD). METHODS: Retrospective analysis of consecutive patients diagnosed with nAMD in a tertiary care center, over a 6-month period in 2014, 2016, and 2018. Patient demographics were compared. Imaging modalities used in 2014 were fundus photography, fluorescein angiography (FA), and structural spectral-domain optical coherence tomography (SD-OCT), while OCT-angiography (OCT-A) was available from 2015. Imaging tools used in our practice were compared in the 3 cohorts. RESULTS: The 3 cohorts included 163, 99, and 167 patients, respectively. There was no difference in age or gender (mean age 81.7 years). OCT-A images were analyzable in 60.5% and 89.7% of patients respectively in 2016 and in 2018. In the 3 cohorts, all patients were imaged with fundus photography and structural OCT. FA was performed in 70.2, 28.8, and 22.1% of patients, respectively. CONCLUSION: This study showed a shift in practice of imaging tools used for the diagnosis of nAMD, non-invasive tools being increasingly used as the first-line imaging, and FA as the second-line imaging.

RETICULAR PSEUDODRUSEN ARE NOT A PREDICTIVE FACTOR FOR THE 1-YEAR RESPONSE TO INTRAVITREAL RANIBIZUMAB IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To investigate reticular pseudodrusen (RPD) as a potential baseline factor predictive of a poor 1-year response to intravitreal ranibizumab in eyes with neovascular age-related macular degeneration. METHODS: Retrospective, monocentric case series including 98 consecutive naive neovascular age-related macular degeneration patients. Presence of RPD was assessed by two graders based on color, blue-light, fundus autofluorescence pictures, and spectral-domain optical coherence tomography. A correlation between the presence of RPD and the visual change was investigated. Other baseline characteristics studied in a monovariate and multivariate analysis were the following: age, gender, affected side, loading dose, type of neovascularization, presence of retinal pigment epithelial detachment >250 µm, subretinal or intraretinal fluid, blood over >50% of the lesion, and subfoveal choroidal thickness. RESULTS: The presence of RPD was not associated with a visual change (P = 0.96), but with a thin subfoveal choroidal thickness at baseline (P < 0.0001). The monovariate analysis showed that the presence of blood at baseline was associated with visual gain (P = 0.007). CONCLUSION: The presence of RPD at baseline was not identified as a factor associated with a poor 1-year response to ranibizumab in eyes with neovascular age-related macular degeneration. Studies with a longer follow-up may be needed to assess the impact of RPD on the visual prognosis of eyes with neovascular age-related macular degeneration.

Predictive Value of Outer Retina En Face OCT Imaging for Geographic Atrophy Progression.

PURPOSE: We determined if the ellipsoid zone (EZ) disruption pattern could be predictive of the geographic atrophy (GA) pattern at 1 year in dry age-related macular degeneration (AMD). METHODS: A retrospective study was done of dry eyes in patients with AMD and GA from July to November 2013. Eyes with previous choroidal neovascularization were excluded. Based on spectral domain optical coherence tomography (SD-OCT), the GA was assessed at each timepoint, using a sub-RPE slab derived from the Cirrus Advanced RPE Analysis software encompassing the RPE (sub-RPE slab). Disruption of the EZ also was assessed at baseline, using en face extraction of a 20-µm-thick slab, 20 µm above the RPE (EZ slab) encompassing the EZ band using two different algorithms (RPE and RPE-fit). The EZ disruption area surrounding GA at baseline was quantified using ImageJ software. Primary endpoint was to identify en face pattern similarities between the baseline EZ disruption and the 1-year GA. Secondary endpoint was to correlate the baseline EZ disruption area surrounding GA with the GA enlargement over 1 year. Statistical analysis was performed using a correlation test (Pearson) and a t-test. RESULTS: We included 37 eyes of 31 patients with dry AMD. En face EZ disruption pattern correlated in two-thirds of cases with the 1-year GA pattern using both algorithms. The EZ disruption area surrounding GA at baseline and GA enlargement over 1 year were poorly correlated when RPE-fit algorithm (R = 0.17) was used. The correlation was still poor using an RPE algorithm (R = 0.38), but increased after selection of eyes without reticular pseudodrusen (R = 0.79). CONCLUSIONS: The EZ disruption pattern could be an indicator for GA pattern progression, but is not a good quantitative tool to predict the size of GA in the overall population over a 1-year period except for patients without reticular pseudodrusen. The results in this specific population must be confirmed by further studies.

Ranibizumab for exudative AMD in a clinical setting: differences between 2007 and 2010.

BACKGROUND/PURPOSE: Visual results of ranibizumab given pro re nata in clinical settings depend greatly from the achievement of the monthly follow-up. In 2007, a previous study performed in our tertiary care showed a mean visual gain of only + 0.7 ETDRS chart letters, probably because of insufficient number of follow-up visits and injections. We report a second retrospective study of patients whose eyes were treated in the same setting, and whose first injection was performed after April 1 2010. The aim was to check if the changes in the management of AMD patients between 2010 and 2007 achieved better visual results. METHOD: One hundred and twenty-two patients (125 eyes) with exudative age-related macular degeneration (AMD) were included. Age, gender, side, type of CNV, VA measured on an ETDRS chart at baseline and at 52 ± 6 weeks, the number of IVT performed, and follow-up visits were recorded. The series was compared to our former series of the year 2007. Results are expressed as means ± standard deviation. Mann-Whitney's non-parametric test was used to compare the statistical distribution of the parameters measured. Fisher's exact test was used for 2 × 2 categorical variables, and the chi-square test for others. RESULTS: In the 2010 series, the mean visual gain was +6.0 ± 11.0 l (-35 to + 34). During this period, the eyes had 5.0 ± 1.8 IVT and 7.8 ± 1.4 follow-up visits. No correlation was found between the change in VA and gender, type of CNV, age, or the numbers of IVT and visits. There was a reverse correlation between baseline VA and VA changes (r = -0.413, p < 0.0001): i.e., the higher the VA at presentation, the smaller the gain. Comparison between 2010 and 2007 showed that in 2010, patients were older (82.2 ± 7.0 vs 78.3 ± 7.0 y, p < 0.0001), had a better baseline VA (60.6 ± 12.7 vs 56.1 ± 14.6 l, p = 0.0191) and, despite the reverse correlation between change in VA and VA at presentation, visual results were better: +6.0 ± 11.0 vs +0.7 ± 11.99 l, p = 0.0003. In 2010, eyes received more injections: 5.0 ± 1.8 vs 3.8 ± 1.4 in 2007, p < 0.0001. However, the series did not differ for the number of visits, gender, side or type of CNV. CONCLUSIONS: In 2010, monotherapy with ranibizumab for exudative AMD achieved better visual results than in 2007 in our clinical setting, despite the treatment of older patients with better baseline VA. This is probably due to the greater number of IVT performed. Alternate strategies, such as "inject and extend" or maintenance therapy, may also account for the better visual results.