OCT minimum intensity as a predictor of geographic atrophy enlargement.

PURPOSE: We determined whether the minimum intensity (MI) of the optical coherence tomography (OCT) A-scans within the retina can predict locations of growth at the margin of geographic atrophy (GA) and the growth rate outside the margin. METHODS: The OCT scans were analyzed at baseline and 52 weeks. Expert graders manually segmented OCT images of GA. The 52-week follow-up scans were registered to the baseline scan coordinates for comparison. The OCT MI values were studied within a 180-µm margin around the boundary of GA at baseline. Baseline MI values were compared in areas of progression and nonprogression of the GA, and sensitivity and specificity were assessed for prediction of growth at the margin. Average MI values in the margins were compared to overall growth rates to evaluate the prediction of growth outside the margins. RESULTS: A statistically significant increase in MI (P < 0.05) was seen in areas of growth in 21/24 cases (88%), and 22/24 cases (92%) when the foveal subfield was excluded. Locations of growth within the margins at 52 weeks were predicted with 61% sensitivity and 61% specificity. The MI values correlated significantly with overall growth rate, and high and low growth rate subjects were identified with 80% sensitivity and 64% specificity. CONCLUSIONS: The MI may be increased at the margins of GA lesions before enlargement, which may indicate disruption or atrophy of the photoreceptors in these areas before GA becomes apparent. Increased MI may help predict areas of enlargement of GA, and may relate to overall growth rate and be a useful screening tool for GA. (ClinicalTrials.gov number, NCT00935883.).

Comparison of geographic atrophy measurements from the OCT fundus image and the sub-RPE slab image.

PURPOSE: To compare two different approaches to measuring areas of geographic atrophy (GA) using spectral-domain optical coherence tomography (SD-OCT). METHODS: Fifty eyes with GA were imaged with an SD-OCT instrument. OCT fundus images and sub- retinal pigment epithelium (RPE) slab images were generated. Three graders manually drew the GA boundaries on both en face images. An automated algorithm was used to segment the GA boundaries from the sub-RPE slabs. RESULTS: The agreement between the three manual measurements on both OCT fundus images (ICC = .998) and sub-RPE slabs (ICC = .999) was excellent. Area measurements from OCT fundus images and sub-RPE slabs were highly correlated. The agreement between manual and automated measurements on the sub-RPE slabs was very good (ICC = .795). CONCLUSION: Both OCT fundus images and sub-RPE slab images proved useful for measuring GA in age-related macular degeneration. The automated algorithm typically provided useful measurements of GA area from the sub-RPE slabs.

Management of submacular hemorrhage secondary to neovascular age-related macular degeneration with anti-vascular endothelial growth factor monotherapy.

PURPOSE: To report the visual and anatomic outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy in the management of marked submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD). DESIGN: Retrospective, interventional, consecutive case series. METHODS: Nineteen eyes of 18 patients with neovascular AMD and fovea involving submacular hemorrhage comprising greater than 50% of the lesion area were treated with anti-VEGF monotherapy. Main outcome measures included mean visual acuity change from baseline, mean central lesion thickness change from baseline, mean number of injections at 6 months, and adverse events. Snellen visual acuity was converted to approximate ETDRS letter score for the purpose of statistical analysis. RESULTS: The mean change in approximate ETDRS letter score from baseline was +12 letters at 3 months (P = .003), +18 letters at 6 months (P = .001), and +17 letters at 12 months follow-up (P = .02). Seven eyes received ranibizumab, 6 eyes received bevacizumab, and 6 eyes received both at various time points. The mean number of injections at 6 months was 4.7. The mean OCT central lesion thickness decreased from 755 µm to 349 µm at 6 months follow-up (P = .0008). CONCLUSIONS: Management with anti-VEGF monotherapy may yield visual and anatomic improvements in eyes with marked submacular hemorrhage secondary to neovascular AMD.