Purpose: To correlate spectral domain optical coherence tomography (SD OCT)–determined morphologic alterations in eyes with geographic atrophy because of age-related macular degeneration with lesion size, enlargement rate, and the presence of multifocal patches of atrophy.
Methods: Forty-three eyes of 43 patients with age-related macular degeneration–associated geographic atrophy were visualized by SD OCT and fundus autofluorescence imaging. The baseline area of geographic atrophy and enlargement rates over at least 24 weeks were calculated from the fundus autofluorescence images. The mean and median follow-up times were 47.4 and 48 weeks, respectively. Morphologic alterations were evaluated in the baseline SD OCT images. Ninety-seven SD OCT scans per eye were graded and included in the analysis. Correlations between morphologic alterations and the rate of lesion enlargement, size, and focality, and the diffuse trickling fundus autofluorescence pattern were determined.
Results: The mean and median enlargement rates were 2.07 mm2/year (n = 43; SD, 1.30) and 2.02 mm2/year, respectively. Outer retinal tubulations (P = 0.003) and irregular elevations of the retinal pigment epithelium/Bruch membrane complex (P < 0.001) in the atrophic region, and splitting of the retinal pigment epithelium/Bruch membrane complex at 2 junctional zone borders (P = 0.02) correlated with faster enlargement. Outer retinal tubulations (P = 0.096), irregular elevations of the retinal pigment epithelium/Bruch membrane complex (P = 0.010), and crown-like elevations with debris beneath in the atrophic region (P = 0.063) correlated with larger lesion size. Hyperreflective plaques in the outer retina appeared more frequently in eyes with multifocal patches of atrophy (P = 0.005).
Conclusion: Distinct morphologic alterations visible on SD OCT imaging in eyes with geographic atrophy because of age-related macular degeneration are associated with faster enlargement rates, larger lesion size, and multifocal patches of atrophy.
Spectral domain optical coherence tomography–determined microstructural alterations in eyes with age-related macular degeneration–associated geographic atrophy have recently been identified. In this study, the authors correlated these alterations with lesion enlargement rate, size, and the presence of multifocal patches of atrophy. The data support the usefulness of spectral domain optical coherence tomography to predict disease progression.
*Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; and
†Department of Ophthalmology, Asan Medical Center, University of Ulsan, Seoul, Korea.
Reprint requests: Glenn J. Jaffe, MD, Duke Reading Center, Duke Eye Center, Box 3802, Durham, NC 27710; e-mail: firstname.lastname@example.org
G.J.J. is a consultant for Heidelberg Engineering. None of the other authors have conflicts of interest to disclose.