Macular atrophy is a common complication in neovascular age-related macular degeneration (AMD) and is associated with poorer visual outcomes. This study evaluated inter-reader and inter-modality variability in measuring macular atrophy in previously-treated neovascular AMD eyes without exudation, using six imaging modalities. Prospective, cohort study. Thirty participants with previously-treated neovascular AMD, showing no signs of exudation at the time of enrollment, and exhibiting macular atrophy. During the same clinic visit, patients were imaged using six different imaging modalities: color fundus photography (CFP; Clarus, Carl Zeiss Meditec), near-infrared imaging (NIR; Spectralis; Heidelberg Engineering, Heidelberg, Germany), structural optical coherence tomography (OCT; Spectralis; Heidelberg Engineering, Heidelberg, Germany), green fundus autofluorescence (GAF; Clarus, Carl Zeiss Meditec), blue fundus autofluorescence (BAF; Spectralis; Heidelberg Engineering, Heidelberg, Germany), and pseudocolor imaging (MultiColor; Spectralis; Heidelberg Engineering, Heidelberg, Germany). Two readers independently measured the macular atrophy area. Inter-reader and inter-modality agreement. The 95% coefficient of repeatability (CR) was 5.98 mm² for CFP, 4.46 mm² for MultiColor, 3.90 mm² for BAF, 3.92 mm² for GAF, 4.86 mm² for NIR, and 3.55 mm² for OCT. Similarly, the coefficient of variation (CV) was lowest for the OCT-based grading at 0.08 and highest for the NIR-based grading at 0.28. Accordingly, the intraclass correlation coefficient (ICC) was 0.742 for CFP, 0.805 for MultiColor, 0.857 for BAF, 0.850 for GAF, 0.755 for NIR, and 0.917 for OCT. The 6 different imaging modalities presented measurements with different mean values, with only a limited number of comparisons not significantly different between the instruments, although measurements were correlated. The largest size of macular atrophy was with the structural OCT-based grading (median=4.65 mm²; interquartile range [IQR]=4.78 mm²) and the smallest was with the CFP-based grading (median=3.86 mm²; IQR=5.06 mm²). Inconsistencies arose from various factors. In patients with neovascular AMD, macular atrophy measurements vary significantly depending on the imaging technique used. CFP-based assessments yielded the smallest macular atrophy sizes, while structural OCT-based assessments produced the largest. These discrepancies stem from both the inherent limitations of each modality in assessing RPE atrophy and factors related to neovascularization, such as the coexistence of fibrosis.

Background and objectives: Age-related macular degeneration (AMD) is a complex and multifactorial condition that can lead to permanent vision loss once it progresses to the neovascular exudative stage. This review aims to summarize the use of deep learning in neovascular AMD. Materials and Methods: Pubmed search. Results: Deep learning has demonstrated effectiveness in analyzing structural OCT images in patients with neovascular AMD. This review outlines the role of deep learning in identifying and measuring biomarkers linked to an elevated risk of transitioning to the neovascular form of AMD. Additionally, deep learning techniques can quantify critical OCT features associated with neovascular AMD, which have prognostic implications for these patients. Incorporating deep learning into the assessment of neovascular AMD eyes holds promise for enhancing clinical management strategies for affected individuals. Conclusion: Several studies have demonstrated effectiveness of deep learning in assessing neovascular AMD patients and this has a promising role in the assessment of these patients.

Choriocapillaris in Age-Related Macular Degeneration - Turkish Journal of Ophthalmology

To evaluate baseline structural OCT biomarkers associated with the development of macular atrophy or fibrosis in treatment-naïve eyes with exudative neovascular age-related macular degeneration (AMD) managed with a treat-and-extend (T&E) anti-VEGF regimen. A retrospective, cohort study. Eighty-nine eyes of 89 patients with newly diagnosed exudative neovascular AMD, treated with a T&E regimen and followed for 24 months. Eyes with evidence of macular atrophy or fibrosis at baseline were excluded. Structural OCT scans were assessed at baseline for morphological features including, macular neovascularization (MNV) subtype and presence of subretinal fluid, intraretinal fluid (IRF), subretinal hyperreflective material, hyperreflective foci, and subretinal drusenoid deposits. Two masked graders independently evaluated each scan, with adjudication for discrepancies. Cox regression models were used to determine baseline predictors of macular atrophy and fibrosis over 24 months. Development of macular atrophy or fibrosis during 24 months, expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). During follow-up, 28 eyes (31.5%) developed macular atrophy and 12 eyes (13.5%) developed macular fibrosis, with 10 eyes showing both complications. Multivariate Cox regression identified baseline IRF (HR, 6.07; 95% CI, 2.23–16.48) and type 3 MNV (HR, 4.38; 95% CI, 1.63–11.73) as independent predictors of macular atrophy, whereas type 1 MNV was protective (HR, 0.23; 95% CI, 0.09–0.61). Type 2 MNV emerged as the strongest predictor of macular fibrosis (HR, 7.28; 95% CI, 1.51–35.10). Baseline OCT biomarkers, particularly IRF and type 3 MNV, strongly predict macular atrophy, while type 2 MNV predicts fibrosis in eyes with exudative neovascular AMD treated with a T&E regimen. Type 1 MNV may confer protection against atrophy. These exploratory findings underscore the value of comprehensive baseline OCT assessment for anticipating long-term structural outcomes and guiding clinical management. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: To evaluate visual and anatomical outcomes after switching to aflibercept 8 mg in eyes with neovascular age-related macular degeneration (nAMD), and to assess outcomes according to the clinical indication for switching. Methods: Multicentre retrospective observational study including 300 eyes with nAMD previously treated with anti-vascular endothelial growth factor therapy and switched to aflibercept 8 mg for non-response (n:74, 24.7%), suboptimal response (n:159, 53.0%), or durability-driven reasons (n:67, 22.3%). Longitudinal data from the 6 months preceding the switch and post-switch visits at 3 and 6 months were analyzed. The primary outcome was change in best-corrected visual acuity (BCVA, ETDRS letters) from the switch visit to the 3-month post-switch visit. Secondary outcomes included changes in central subfield thickness (CST) and retinal fluid status. Results: During the pre-switch period, mean BCVA declined by − 1.9 ± 8.2 letters and CST increased. At 3 months after switching, BCVA improved by + 2.0 ± 9.2 letters (95% CI, + 0.8 to + 3.2; p < 0.01), with greater gains in eyes switched for non-response (+ 2.8 ± 12.6 letters). Mean CST decreased by − 45.3 ± 79.8 µm (95% CI, − 55.4 to − 35.2; p < 0.001), with corresponding reductions in retinal fluid. Anatomical improvements were more pronounced in eyes switched for non-response, whereas more modest but consistent changes were observed in suboptimal and durability-driven groups. Visual and anatomical outcomes were maintained at 6 months. Conclusions: In previously treated nAMD eyes, switching to aflibercept 8 mg was associated with reversal of pre-switch anatomical worsening, reduction in retinal fluid, and modest visual gains. Greater responses were observed in eyes with inadequate pre-switch disease control, supporting its role as a treatment escalation strategy in clinical practice.