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Imaging

Diagnosis in Sight

From Detection to Progression

Imaging plays a critical role in both the early diagnosis of geographic atrophy (GA) and in the monitoring of disease progression.

Diagnosis Hallmarks of Age-Related Macular Degeneration (AMD)

Early

Multiple small (<63 µm) and a few intermediate (63-124 µm) drusen, or retinal pigment epithelium (RPE) abnormalities1,2

Intermediate

Extensive intermediate drusen (63-124 µm) or more than 1 large druse (≥125 µm).1,2 May also be accompanied by degenerative changes in the choriocapillaris, RPE, and photoreceptors1-3

Advanced

Progressive atrophy of choriocapillaris, RPE, and photoreceptors.2,3 As well as new and growing lesions2

Optical Coherence Tomography (OCT)

oct-1

Intermediate AMD

oct-2

Advanced AMD (GA)

Key Features1,4

(1) Degeneration of overlying photoreceptors increases reflectivity below Bruch’s membrane

(2) Hyper-reflective foci corresponds to attenuation or disruption of the RPE

(3) Atrophy of the RPE

(4) Area of choroidal hypertransmission

Images are from separate patients.

Color Fundus Photography (CFP)

cfp-1

Intermediate AMD

cfp-2

Advanced AMD (GA)

Key Features4-6

(1) Drusen and (2) fundus abnormalities are identifiable as hyperpigmented areas

(3) GA lesion borders are sharply demarcated with increased choroidal vessel visibility (dashed circle)

Images are from separate patients.

Fundus Autofluorescence (FAF)

faf-1

Intermediate AMD

faf-2

Advanced AMD (GA)

Key Features1,7

(1) Reticular pseudodrusen appearing as multiple, clustered, regularly networked, round areas of low-contrast hypo-autofluorescence may be prognostic of advancing AMD
(2) Areas of hypo-autofluorescence with sharply demarcated borders indicate atrophic lesions

(3) Abnormal patterns of hyperautofluorescence surrounding atrophic lesions

Images are from separate patients.

References

  1. Holz FG, Schmitz-Valckenberg S, Fleckenstein M. Recent developments in the treatment of age-related macular degeneration. J Clin Invest. 2014;124(4):1430-1438.
  2. Fleckenstein M, Mitchell P, Freund KB, et al. The progression of geographic atrophy secondary to age-related macular degeneration. Ophthalmology. 2018;125(3):369-390.
  3. Boyer DS, Schmidt-Erfurth U, van Lookeren Campagne M, Henry EC, Brittain C. The pathophysiology of geographic atrophy secondary to age-related macular degeneration and the complement pathway as a therapeutic target. Retina. 2017;37(5):819-835.
  4. Sadda SR, Chakravarthy U, Birch DG, Staurenghi G, Henry EC, Brittain C. Clinical endpoints for the study of geographic atrophy secondary to age-related macular degeneration. Retina. 2016;36(10):1806-1822.
  5. Mones J, Garcia M, Biarnes M, Lakkaraju A, Ferraro L. Drusen ooze: a novel hypothesis in geographic atrophy. Ophthalmol Retina. 2017;1(6):461-473.
  6. Ambati J, Ambati BK, Yoo SH, Ianchulev S, Adamis AP. Age-related macular degeneration: etiology, pathogenesis, and therapeutic strategies. Surv Ophthalmol. 2003;48(3):257-293.
  7. Sunness JS, Rubin GS, Applegate CA, et al. Visual function abnormalities and prognosis in eyes with age-related geographic atrophy of the macula and good visual acuity. Ophthalmology. 1997;104(10):1677-1691.