gms | German Medical Science

Purpose: Identify spectral domain OCT (SD-OCT) features in eyes with early age-related macular degeneration (AMD) which predict transition to neovascular AMD (NVAMD) within the next 12 months.

Methods: From a database of AMD cases we retrospectively selected eyes that transitioned to NVAMD with SD-OCT documentation (cube scans, 512x128). All scans were taken within 12 months prior to the clinical diagnosis of choroidal neovascularization (CNV). SD-OCT scans from a control group of patients with high risk (AREDS 3 or 4) early AMD who did not transition were also selected for masked grading. Graded parameters included: break/thickening/thinning/integrity of the RPE-band, internal reflectivity of pigment epithelial detachments (PED), retinal atrophy (RA), quantification (# of B-scans, maximum height) of any subretinal fluid (SRF), cystoid macular edema (CME), or intraretinal hyperreflective foci (HRF).

Results: 23 eyes from the transitional group (TG) and 23 control eyes were included. The logistic regression model showed a significant predictive power of HRF (>10 B-scans, odds ratio (OR) 6.18, 95% confidence interval (CI) 1.03 to 37.13), internal PED reflectivity (OR 7.92, CI 1.02 to 61.51), and RA (OR 0.07, CI 0.01 to 0.72) with regard to transitioning to NVAMD. Interestingly, 4 eyes in the TG showed a subtle presence of SRF or CME, although clinically they were classified as dry AMD at that timepoint.

Conclusions: Eyes with HRF or PED with heterogenous internal reflectivity on OCT seem to be at risk for transitioning. While validation in a prospective series is warranted, we advise close monitoring of patients exhibiting these features.