Study provides multimodal assessment of geographic atrophy precursors
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A study presented at Angiogenesis, Exudation, and Degeneration 2024 provided insights on how geographic atrophy precursors present across multiple imaging modalities.
“Based on years of research, we have an understanding of the development of GA particularly from drusen,” Amitha Domalpally, MD, PhD, said, with pigment changes occurring and then geographic atrophy (GA) developing. “We want to understand, where do the current OCT biomarkers — nGA, iRORA and cRORA — fall in the sequence of events?”
The study analyzed the OCT scans, fundus autofluorescence (FAF) images and color fundus photographs (CFP) from AREDS2 participants. Out of 100 eligible eyes from 69 patients, 73 had intermediate age-related macular degeneration; 26 lesions were identified as nascent geographic atrophy (nGA), 42 as incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA), and 89 as complete RPE and outer retinal atrophy (cRORA).
cRORA was the easiest to interpret, with 99% of cRORA lesions corresponding to hypo-FAF. About 60% of the eyes with nGA and iRORA showed predominantly hypo-FAF, and the remaining eyes were split between iso-FAF and hyper-FAF. On CFP, about 50% of the eyes with cRORA had GA, and the remaining had drusen with or without pigment changes, with a handful having just pigment changes.
“When we go to iRORA and nGA, there is no geographic atrophy on the color at all. But we do see drusen and pigment changes ... . Maybe there’s a little more of drusen only on nGA and a little more of pigment changes on iRORA, but these are small,” Domalpally said.
In summary, the study showed that nGA and iRORA are similar, covering the earliest stages of the disease process, with nGA showing no AMD features on CFP but drusen and some pigment changes, iRORA showing a little more pigment change, and cRORA traversing this entire spectrum from drusen to pigment changes to GA.
“Multimodal imaging offers an added perspective of AMD progression,” Domalpally said. “We need more detailed studies like this on larger data sets to bridge this gap between advanced AMD biomarkers and clinical features.”
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Domalpally A. Multimodal assessment of OCT biomarkers of GA and its precursors. Presented at: Angiogenesis, Exudation, and Degeneration 2024; Feb 3, 2024 (virtual meeting).
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