IDENTIFYING FEATURES OF EARLY AND LATE AGE-RELATED MACULAR DEGENERATION: A Comparison of Multicolor Versus Traditional Color Fundus Photography.

PURPOSE: To compare multicolor (MC) and traditional color fundus photography (CFP) in their ability to detect features of early and late age-related macular degeneration (AMD). METHODS: Study design: Observational case series. PARTICIPANTS: fundus images captured using standard CFP and MC imaging from 33 patients attending hospital clinics and 26 participants from the pilot phase of the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA). Systematic grading of early and late AMD features; (hard drusen, soft drusen, reticular pseudodrusen, pigment clumping, non-geographic atrophy hypopigmentation, atrophy, hemorrhage, and fibrosis) on CFP and MC. RESULTS: There were 105 eyes with gradable images for comparison. Using CFP as the gold standard, sensitivity values for MC ranged from 100% for atrophy, non-geographic atrophy hypopigmentation, and fibrosis to 69.7% for pigment clumping. Specificity values were high: >80% for all features. On using MC as the comparator, CFP had lower sensitivity for the detection of early AMD features (27.8% for reticular drusen to 77.8% for non-geographic atrophy hypopigmention). Analysis of OCT in discrepant cases showed better agreement with MC for all AMD lesions, except hemorrhage and non-geographic atrophy hypopigmentation. For pigment clumping, CFP and MC were in equal agreement with OCT. CONCLUSION: Multicolor retinal imaging allowed for improved detection and definition of AMD features.

Morphometric analysis of angiograms of exudative lesions in age-related macular degeneration.

OBJECTIVES: To analyze the morphometric composition of lesion components in exudative age-related macular degeneration and to study the relationships between individual lesion components and choroidal neovascularization (CNV) subtype, at 2 time points. METHODS: Morphometric analysis of 98 sets of angiograms separated by an interval of at least 3 weeks, with no treatment delivered in the intervening period between angiograms. Area measurements of individual lesion components were made from digitally captured angiograms. Choroidal neovascularizations were classified into subtypes based on the proportions of classic CNV. Fully corrected distance visual acuity measured on logMAR Early Treatment of Diabetic Retinopathy Study charts was available at baseline and at a subsequent visit in 78 subjects. Data were analyzed using parametric and nonparametric tests, linear regression, and McNemar test of equal proportions. RESULTS: Wholly and predominantly classic CNVs were significantly smaller at initial presentation than minimally classic or occult with no classic CNVs. Lesions containing blood and lipid were also significantly larger than lesions not exhibiting these features. Lesions containing any classic CNV expanded at a significantly greater rate than lesions without classic CNV. Approximately 40% of lesions categorized as wholly classic CNV converted to predominantly classic CNV between baseline and the next follow-up visit. CONCLUSION: The presence of classic leakage in exudative age-related macular degeneration is the most important risk factor for rapid expansion of CNV.