Systematic review of prognostic factors associated with progression to late age-related macular degeneration: Pinnacle study report 2

Updates on novel and traditional OCT and OCTA biomarkers in nAMD

Predictivity of optical coherence tomography (OCT) examination for the development of neovascular age-related macular degeneration (nAMD) was demonstrated to be superior compared to other methods, suggesting it as an elective method for screening purposes. Moreover, OCT and OCT angiography (OCTA) have enabled us to provide accurate prognostic information to nAMD patients. Along with well-known prognostic biomarkers, such as the presence of reticular pseudodrusen, the volume of the pigment epithelial detachment (PED), subretinal fluid (SRF), intraretinal fluid (IRF) and hyperreflective foci (HRF), emerging parameters show promising results and may allow a further refinement of prediction and customization of treatment and follow up strategies. This review of the literature discusses the main OCT and OCTA biomarkers reported in literature for nAMD, with a special focus on recent updates on the subject. Future perspectives of clinical applications include the development of artificial intelligence models considering all the described biomarkers to allow automatic and detailed characterization of each lesion based on imaging information.

Alcohol Consumption and Risk of Age-Related Macular Degeneration and Geographic Atrophy Progression: Age-Related Eye Diseases Study 2 Report 34

PURPOSE

To examine potential relationships between alcohol consumption and age-related macular degeneration (AMD) progression, including progression to late AMD and geographic atrophy (GA) enlargement rate.

DESIGN

Post hoc analysis of cohorts within the Age-Related Eye Diseases Study 2.

PARTICIPANTS

A total of 6670 eyes (of 3673 participants) with no late AMD at baseline; 1143 eyes (of 841 participants) with GA at ≥2 consecutive visits.

METHODS

Color fundus photographs were collected at annual study visits and graded centrally for late AMD, GA area, and GA proximity. Alcohol consumption was calculated by food frequency questionnaire. Regression analyses of disease progression were performed according to alcohol consumption.

MAIN OUTCOME MEASURES

Progression to late AMD and its subtypes; GA area-based progression; GA proximity-based progression.

RESULTS

Over a mean follow-up of 4.5 years, 40.2% of eyes progressed to late AMD. In men, with alcohol tertile 1 (no regular consumption) as reference, hazard ratios for progression to late AMD were 0.69 (95% confidence interval [CI], 0.55-0.87; P = 0.0015) for tertile 2 and 0.85 (0.71-1.02; P = 0.079) for tertile 3. In women, hazard ratios were 1.12 (0.95-1.31, P = 0.17) and 0.85 (0.72-1.00, P = 0.046), respectively. Over a mean follow-up of 3.1 years, GA area-based progression was significantly faster in women than men, at 0.295 (95% CI, 0.278-0.311) and 0.260 mm/year (95% CI, 0.241-0.279), respectively (P = 0.007). In men, area-based progression differed significantly by alcohol tertile (P = 0.0001), at 0.275 (95% CI, 0.248-0.303), 0.183 (95% CI, 0.143-0.223), and 0.280 mm/year (0.254-0.306) in tertiles 1 to 3, respectively. In women, the area-based rate did not differ significantly by alcohol tertile (P = 0.11). In men only, Centers for Disease Control and Prevention-defined heavy drinking was associated with faster progression (P = 0.024), at 0.306 (95% CI, 0.262-0.349) versus 0.252 mm/year (95% CI, 0.233-0.270). In 808 eyes with noncentral GA, GA proximity-based progression did not differ significantly by alcohol tertile (P = 0.55).

CONCLUSIONS

Moderate alcohol consumption is associated with decreased risk of progression to late AMD in men. Geographic atrophy progression is faster in women, but its relationship with alcohol consumption is much stronger in men. In men, moderate consumption is associated with slower GA progression and higher consumption with faster progression. Although some of these associations may also relate to confounding, they might suggest that individuals with GA should avoid high alcohol consumption.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Age-related macular degeneration: natural history revisited in geographic atrophy

Progression of geographic atrophy varies significantly based on individual and lesion characteristics. Much research has strived to understand prognostic indicators of lesion progression over time, yet integrating findings to date may pose a challenge to clinicians. This review strives to synthesize current knowledge on genetic, behavioral, structural, and functional factors that influence geographic atrophy across the lifetime. Further, it highlights how vision-related quality of life allows for a more holistic appraisal of the impact of geographic atrophy on everyday functioning. The ultimate aim of this paper is to aid clinicians in counseling patients on medical management as well as providing accurate disease prognostication tailored to the individual patient.

Generalizable Deep Learning for the Detection of Incomplete and Complete Retinal Pigment Epithelium and Outer Retinal Atrophy: A MACUSTAR Report

Purpose

The purpose of this study was to develop a deep learning algorithm for detecting and quantifying incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) and complete retinal pigment epithelium and outer retinal atrophy (cRORA) in optical coherence tomography (OCT) that generalizes well to data from different devices and to validate in an intermediate age-related macular degeneration (iAMD) cohort.

Methods

The algorithm comprised a domain adaptation (DA) model, promoting generalization across devices, and a segmentation model for detecting granular biomarkers defining iRORA/cRORA, which are combined into iRORA/cRORA segmentations. Manual annotations of iRORA/cRORA in OCTs from different devices in the MACUSTAR study (168 patients with iAMD) were compared to the algorithm's output. Eye level classification metrics included sensitivity, specificity, and quadratic weighted Cohen's κ score (κw). Segmentation performance was assessed quantitatively using Bland-Altman plots and qualitatively.

Results

For ZEISS OCTs, sensitivity and specificity for iRORA/cRORA classification were 38.5% and 93.1%, respectively, and 60.0% and 96.4% for cRORA. For Spectralis OCTs, these were 84.0% and 93.7% for iRORA/cRORA, and 62.5% and 97.4% for cRORA. The κw scores for 3-way classification (none, iRORA, and cRORA) were 0.37 and 0.73 for ZEISS and Spectralis, respectively. Removing DA reduced κw from 0.73 to 0.63 for Spectralis.

Conclusions

The DA-enabled iRORA/cRORA segmentation algorithm showed superior consistency compared to human annotations, and good generalization across OCT devices.

Translational Relevance

The application of this algorithm may help toward precise and automated tracking of iAMD-related lesion changes, which is crucial in clinical settings and multicenter longitudinal studies on iAMD.

AI-based support for optical coherence tomography in age-related macular degeneration

Artificial intelligence (AI) has emerged as a transformative technology across various fields, and its applications in the medical domain, particularly in ophthalmology, has gained significant attention. The vast amount of high-resolution image data, such as optical coherence tomography (OCT) images, has been a driving force behind AI growth in this field. Age-related macular degeneration (AMD) is one of the leading causes for blindness in the world, affecting approximately 196 million people worldwide in 2020. Multimodal imaging has been for a long time the gold standard for diagnosing patients with AMD, however, currently treatment and follow-up in routine disease management are mainly driven by OCT imaging. AI-based algorithms have by their precision, reproducibility and speed, the potential to reliably quantify biomarkers, predict disease progression and assist treatment decisions in clinical routine as well as academic studies. This review paper aims to provide a summary of the current state of AI in AMD, focusing on its applications, challenges, and prospects.

Non-Neovascular Age-Related Macular Degeneration Assessment: Focus on Optical Coherence Tomography Biomarkers

The imagistic evaluation of non-neovascular age-related macular degeneration (AMD) is crucial for diagnosis, monitoring progression, and guiding management of the disease. Dry AMD, characterized primarily by the presence of drusen and retinal pigment epithelium atrophy, requires detailed visualization of the retinal structure to assess its severity and progression. Several imaging modalities are pivotal in the evaluation of non-neovascular AMD, including optical coherence tomography, fundus autofluorescence, or color fundus photography. In the context of emerging therapies for geographic atrophy, like pegcetacoplan, it is critical to establish the baseline status of the disease, monitor the development and expansion of geographic atrophy, and to evaluate the retina's response to potential treatments in clinical trials. The present review, while initially providing a comprehensive description of the pathophysiology involved in AMD, aims to offer an overview of the imaging modalities employed in the evaluation of non-neovascular AMD. Special emphasis is placed on the assessment of progression biomarkers as discerned through optical coherence tomography. As the landscape of AMD treatment continues to evolve, advanced imaging techniques will remain at the forefront, enabling clinicians to offer the most effective and tailored treatments to their patients.