Association between Foveal Photoreceptor Integrity and Visual Outcome in Neovascular Age-related Macular Degeneration

doi:10.1016/j.ajo.2009.01.017

American Journal of Ophthalmology

Volume 148, Issue 1, July 2009, Pages 83-89.e1

https://doi.org/10.1016/j.ajo.2009.01.017 Get rights and content

Purpose

To evaluate the correlation between visual outcome and foveal photoreceptor integrity after successful treatment of eyes with neovascular age-related macular degeneration (AMD).

Design

Retrospective chart review.

Methods

We retrospectively studied the medical records of 51 eyes of 51 patients with neovascular AMD who were treated successfully with photodynamic therapy (PDT). All eyes were followed-up for more than 24 months after the initial treatment. Using spectral-domain optical coherence tomography, the status of the inner segment and outer segment (IS/OS) photoreceptor junction was assessed as a hallmark of the integrity of the foveal photoreceptor layer.

Results

At the final visit, no eyes showed an exudative change. A complete or discontinuous IS/OS line was detected beneath the fovea in 8 (15.7%) and 25 (29.4%) eyes, respectively, whereas 28 (54.9%) had no IS/OS line. Eyes with a continuous or discontinuous IS/OS line beneath the fovea had better final visual acuity (VA) than did eyes without an IS/OS line (P < .001, respectively). Of the 51 eyes, 36 showed polypoidal choroidal vasculopathy (PCV), whereas 15 were diagnosed as having typical AMD without PCV. Visual outcome was significantly better in eyes with PCV (P = .026). Most eyes (13/15; 86.7%) with typical AMD had no IS/OS line at the final visit, whereas only 13 (36.1%) of the 36 eyes with PCV had no IS/OS line beneath the fovea.

Conclusions

Integrity of the photoreceptor layer beneath the fovea is associated with the final VA in neovascular AMD after successful PDT.

Section snippets

Patient Population

We retrospectively reviewed the medical records of 51 eyes of 51 consecutive patients with subfoveal neovascular AMD who were treated successfully with PDT and who were followed-up for more than 24 months after the initial treatment. At the initial visit, all patients showed subfoveal exudative changes, including serous retinal detachment (RD) or macular edema. At the final visit, all eyes were examined with SD-OCT to confirm resolution of the exudative changes. Those eyes with a foveal

Results

Before treatment, all studied eyes showed serous RD or retinal edema beneath the fovea resulting from the subfoveal CNV associated with AMD. Treatment with PDT resolved these exudative changes. At the final visit, mean foveal RT ± SD was reduced to 153.6 ± 60.0 μm. Mean VA ± SD was maintained successfully with PDT, being 0.55 ± 0.33 logMAR units before treatment and 0.64 ± 0.42 logMAR units at the final visit (P = .14). Despite the reduced foveal thickness, however, some eyes showed a poor

Discussion

The present study of 51 eyes with AMD showed that VA after successful treatment by PDT is correlated significantly with OCT findings on the status of the IS/OS, rather than with the foveal RT. Final VA was better in those eyes in which the IS/OS line was detected beneath the fovea. When eyes with AMD are treated successfully with PDT and when the exudative change has resolved, the condition of the outer segment of the foveal photoreceptor layer is involved in visual outcome.

Although many

Hisako Hayashi, MD, graduated from Hiroshima University Medical School, and obtained her MD in 2003. She completed the residency program at Kyoto University Hospital, Kyoto, Japan. Dr Hayashi is pursuing her PhD degree in the application of genomics for ophthalmology at the Department of Ophthalmology at Kyoto University Graduate School of Medicine. Dr Hayashi's interest includes the genomics for multifactorial ocular diseases including macular diseases.

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Rosen et al. studied 30 eyes with macular disease and demonstrated how the simultaneous visualization of en face images with other imaging techniques, such as ICG angiograms, allows for a more precise correlation between leakage sites and retinal structures [40]. EF-OCT could also be a useful tool to evaluate photoreceptor integrity, Hayashi et al. found an association between the integrity of the inner segment/outer segment (IS/OS) photoreceptor junction and the final VA in AMD after treatment [41]. Also, Kiernan et al. found a correlation between the IS/OS junction area and VA in patients with wet AMD [42].
En face optical coherence tomography (EF-OCT) is a rapid, non-invasive, high-resolution imaging technique that has evolved in recent years to be a routine examination for the assessment and follow-up of various vitreoretinal diseases. With the introduction of swept-source OCT (SS-OCT), which can achieve up to 100,000 A-scans per second and better-quality imaging of deeper structures using a longer wavelength (1050 nm), EF-OCT reconstruction can produce high-resolution frontal images of the retina and choroid (C-Scans) that give an overview of disease extent. These images allow a more accurate study of vitreoretinal interface pathologies such as epiretinal membranes, macular holes, and vitreomacular traction. They also provide key information in the study of various retinal vascular diseases and the differential diagnosis of cystic macular edema. EF-OCT provides valuable information about the severity of vitreoretinal interface alterations and precisely assesses the choriocapillaris and choroidal vasculature in pachychoroid disorders. Finally, this technique provides valuable information about atrophic and neovascular age-related macular degeneration and various uveitic entities. This review aims to describe the current clinical applications of EF-OCT in various vitreoretinal diseases as well as the latest findings and future perspectives.
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Original articleAssociation between Foveal Photoreceptor Integrity and Visual Outcome in Neovascular Age-related Macular Degeneration

Purpose

Design

Methods

Results

Conclusions

Section snippets

Patient Population

Results

Discussion

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials—TAP report

Arch Ophthalmol

Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization—verteporfin in photodynamic therapy report 2

Am J Ophthalmol

Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials-tap report 2

Arch Ophthalmol

Angiographic and optical coherence tomographic results of the MARINA Study of ranibizumab in neovascular age-related macular degeneration

Ophthalmology

Treatment of polypoidal choroidal vasculopathy with photodynamic therapy

Retina

Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy

Br J Ophthalmol

The therapeutic effects of intravitreal bevacizumab in a patient with recalcitrant idiopathic polypoidal choroidal vasculopathy

Semin Ophthalmol

Using optical coherence tomography to monitor photodynamic therapy in age-related macular degeneration

Am J Ophthalmol

Photodynamic therapy for age-related macular degeneration in Japanese patients: results after one-year

Jpn J Ophthalmol

Relationships between clinical measures of visual function, fluorescein angiographic and optical coherence tomography features in patients with subfoveal choroidal neovascularisation

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Original article
Association between Foveal Photoreceptor Integrity and Visual Outcome in Neovascular Age-related Macular Degeneration