PubMed ID: 40893620
Author(s): Wu Z, Blodi BA, Holz FG, Jaffe GJ, Liakopoulos S, Sadda SR, Schmitz-Valckenberg S, Bonse M, Brown T, Choong J, Clifton B, Corradetti G, Hodgson LAB, Lentzsch AM, Mahmoudi A, Pak JW, Sassmannshausen M, Skalak C, von der Emde L, Winkler J, Guymer RH. OCT-Defined Atrophic Age-Related Macular Degeneration Changes Associated with Deep Visual Sensitivity Losses: A Multicenter Study. Ophthalmol Sci. 2025 Jul 16;5(6):100884. doi: 10.1016/j.xops.2025.100884. eCollection 2025 Nov-Dec. PMID 40893620
Journal: Ophthalmology Science, Volume 5, Issue 6, 2025
PURPOSE To identify combination(s) of OCT changes that define atrophic age-related macular degeneration (AMD) lesions associated with repeatable deep visual sensitivity defects.
DESIGN Reader study.
PARTICIPANTS One hundred seventy-one OCT scans from 60 eyes of 53 participants.
METHODS Participants underwent 2 high-density targeted microperimetry tests (Macular Integrity Assessment device with Goldmann Size III stimuli) per visit of a 3.5° (approximately 1000 μm) diameter region-of-interest that had evidence of at least incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA). OCT B-scans within the region sampled on microperimetry were annotated by 12 readers from 6 established reading centers for 7 different features related to RPE and outer retinal atrophy. The prevalence of the presence of a repeatable ≤10 decibel (dB) defect on microperimetry for lesions categorized by 18 different combinations of such features, or criteria, was determined.
MAIN OUTCOME MEASURES The criteria for OCT-defined atrophic changes showing a ≥90% prevalence of a repeatable ≤10 dB defect, which has previously shown to be characteristic of regions with a truly nonresponding test location on microperimetry.
RESULTS Sixty percent of complete RPE and outer retinal atrophy (cRORA) lesions-based on the presence of hypertransmission and RPE abnormalities ≥250 μm in width, with evidence of overlying photoreceptor (PR) degeneration, on an OCT B-scan-had a repeatable ≤10 dB defect. However, between 92% and 98% of lesions with both hypertransmission and complete RPE loss ≥500 μm, and with evidence of any size of any feature of overlying PR degeneration, had a repeatable ≤10 dB defect, depending on the criteria considered. Between 92% and 95% of lesions with hypertransmission ≥500 μm and either overlying external limiting membrane disruption, or outer plexiform layer and inner nuclear layer subsidence, and/or hyporeflective wedge-shaped band(s) ≥500 μm, with or without RPE abnormalities, had a repeatable ≤10 dB defect.
CONCLUSIONS This study identified various criteria for OCT-defined atrophic AMD lesions with functional characteristics that can be expected of regions with a truly nonresponding test location on high-density targeted microperimetry testing (i.e., having a ≥90% prevalence of a repeatable ≤10 dB defect). Such OCT-defined lesions could thus serve as functionally relevant clinical endpoints of end-stage atrophic AMD to facilitate preventative treatment trials.
FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
© 2025 by the American Academy of Ophthalmologyé.