Consensus group provides imaging criteria for assessment of geographic atrophy
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WAIKOLOA, Hawaii — In a series of published reports, the Classification of Atrophy Meeting group provided consensus-based imaging parameters for multimodal assessment of geographic atrophy.
The group also revised the definitions of specific features of geographic atrophy (GA) and identified features that may predict progression to atrophy.
“In the first CAM report, we described the imaging modalities that would be useful for evaluating macular atrophy, which include fundus autofluorescence (FAF), near infrared reflectance (NIR), fundus photography, fluorescein angiography (FA) and OCT,” Glenn J. Jaffe, MD, said at Retina 2022.
Although of all these imaging technologies contribute to detect, measure and define the boundaries of atrophic areas, the key method for evaluating macular atrophy is OCT, he said.
“On OCT, GA corresponds to a loss of retinal layers, loss of [retinal pigment epithelium], choroidal hypertransmission, border abnormalities and drusen. It allows us to measure choroidal thickness and to determine the proximity of the GA to the foveal center,” he said.
The CAM Report 3 defined the terminology and features of cRORA, which stands for complete retinal pigment epithelium and outer retinal atrophy. GA was defined as a non-neovascular age-related macular degeneration cRORA, and key features of cRORA were identified in the loss of the outer retina causing subsidence of the inner nuclear layer and outer plexiform layer, loss of the retinal pigment epithelium of 250 µm or greater, and choroidal hypertransmission of 250 µm or greater.
“At the Duke Reading Center, we currently use this approach to evaluate atrophy. We identify the atrophy with OCT using the cRORA definition, and then we measure the atrophy on FAF and adjunctive technology, such as OCT, NIR and FA,” Jaffe said.
Features that predict progression to atrophy were described in the CAM Report 5. They include specific types of drusen (namely soft drusen, cuticular drusen or drusen with hyporeflective core), drusenoid pigment epithelial detachment, subretinal drusenoid deposits, intraretinal hyperreflective foci, hyperreflective crystalline deposits and acquired vitelliform lesion.
“The risk factors for progression are also inclusion/exclusion criteria for studies. And once we have treatments, these features will be helpful in predicting who may benefit from them,” Jaffe said.
- References:
- Holz FG, et al. Ophthalmology. 2017;doi:10.1016/j.ophtha.2016.12.002.
- Jaffe GJ, et al. Ophthalmol Retina. 2021;doi:10.1016/j.oret.2020.12.009.
- Sadda SR, et al. Ophthalmology. 2018;doi:10.1016/j.ophtha.2017.09.028.
Jaffe reports consulting for Adverum, Allegro, Gemini, Iveric and Novartis.
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Jaffe GJ. Diagnosis and evaluation of GA and precursor lesions in AMD. Presented at: Retina 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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