Introduction
Method
Detection and Assessment of MA
Color Fundus Photography
Fundus Fluorescein Angiography
Fundus Autofluorescence
Near-Infrared Reflectance
Near-Infrared Autofluorescence
Optical Coherence Tomography
OCT Angiography
Methods of MA Detection and Assessment in Clinical Studies
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The Comparison of Age-related Macular Degeneration Treatments Trials (CATT) study and HARBOR study, both of which relied on CFP and/or FFA to detect atrophy of the macula [13, 42‐48]. In comparison, the authors of the Inhibition of VEGF in Age-related choroidal Neovascularization (IVAN) study, Tanaka et al., and Kuroda et al. utilized OCT in addition to CFP and FFA for atrophy assessment [12, 16, 19, 24].
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Schütze et al. [18] used a polarization-sensitive OCT segmentation algorithm and correlated the algorithm with SD-OCT and FAF findings.
Study | Term used | Atrophy detection criteria | Imaging modality used to assess MAa | |||
---|---|---|---|---|---|---|
CFP/FFA | FAF | OCT | NIR /NIA | |||
GA | Presence of ≥ 1 patches within the macular vascular arcades, ≥ 250 µm in maximum linear dimension, of partial/complete depigmentation on CFP that had ≥ 1 of these additional characteristics: sharply demarcated borders on CFP and/or FFA; underlying choroidal vessels visible; excavated or punched-out appearance on stereoscopic CFP or FFA; or uniform hyperfluorescence bounded by sharp borders on late-phase FFA | ++ | − | − | − | |
GA | Area ≥ 175 µm in maximum linear dimension with ≥ 2 relevant features on CFP: (well-defined margins; underlying choroidal vessels visible; scalloped edges) and consistent finding on FFA (early hyperfluorescence persisting through the FFA sequence and fading in late images) | ++ | − | + | − | |
HARBOR [44] | MA | Sharply demarcated areas of RPE depigmentation with visibility of underlying choroidal vessels on CFP/FFA, 250 µm in diameter, corresponding to flat areas of well-demarcated staining on FFA. Atrophy immediately within, adjacent, and nonadjacent to CNV lesions (active or regressed) was included | ++ | − | − | − |
MA | Definite decreased autofluorescence on FAF | − | ++ | − | − | |
MA/RPE atrophy | Three criteria were required to make an OCT diagnosis of MA: choroidal hypertransmission, attenuation of the RPE band, and collapse/loss of the outer retinal layers. The presence of two or three of the three criteria in an area ≥ 125 µm was sufficient to make the OCT diagnosis of atrophy | + | ++ | ++ | + | |
Young et al. [28] | RPE atrophy | RPE atrophy area was measured with OCT (without any minimum requirement) in areas within a 5mm-circle where RPE is absent or has lost integrity and is accompanied by choroidal hypertransmission | − | − | ++ | − |
Xu et al. [17] | GA | A brighter area on NIR of ≥ 250 µm in its maximum linear dimension, of variable shapes but sharp borders, with choroidal hypertransmission on OCT. FAF was used as an adjunct when available | − | + | ++ | ++ |
Kuroda et al. [24] | RPE atrophy | (1)Within the macular vascular arcade; (2) A roughly round/oval area of partial/complete RPE depigmentation, with thinning of the overlying neurosensory retina; (3) > 250 µm in maximum linear dimension; (4) atrophic changes of RPE and photoreceptor layer with choroidal hypertransmission on OCT; and (5) at least 1 of the additional characteristics: sharply demarcated borders, visibility of underlying choroidal vessels, or uniformly reduced autofluorescence with sharp borders on FAF | ++ | ++ | ++ | − |
Schütze et al. [18] | RPE atrophy/GA | Using polarization-sensitive OCT-related algorithm, both GA and RPE atrophy other than GA (i.e., depigmented RPE without clearly defined boundaries) were defined | − | ++ | ++ | − |
Wons et al. [29] | CNV-independent RPE loss | Area of choroidal hypertransmission on OCT of > 300 μm diameter in lesions without signs of suspected CNV on OCT, within the 20° × 15° scan frame | − | − | ++ | − |
Hata et al. [22] | RPE atrophy | (1)Within the macular vascular arcade; (2) A roughly round/oval area of partial/complete RPE depigmentation, with thinning of the overlying neurosensory retina; (3) > 250 µm in maximum linear dimension; (4) atrophic changes of RPE and photoreceptor layer with choroidal hypertransmission on OCT; and (5) at least one of the additional characteristics: sharply demarcated borders, visibility of underlying choroidal vessels, or uniformly reduced autofluorescence with sharp borders on FAF | ++ | ++ | ++ | − |
Tanaka et al. [16] | GA of the RPE | An area of partial/complete RPE depigmentation, with thinning of the overlying neurosensory retina with the addition of at least 2 of the following three characteristics (on CFP, and when available, red-free fundus photographs and FFA): roughly round/oval shape, sharp margins, and visibility of underlying choroidal vessels | ++ | − | + | − |
Zarubina et al. [23] | MA | (1) A hyperreflective area on NIR with a sharp border spanning ≥ 250 μm in maximum linear dimension, and (2) corresponding degeneration of RPE and outer retina with choroidal hypertransmission on OCT | − | − | ++ | ++ |
Phenotype Characteristics Associated With Macular Atrophy
Study | Risk factors for developing MAa | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CNV location | CNV size | Central IRF | PED | SCT thinning | SHRM | Hb | SDD | RAP | Refractile drusen | Age | Contralateral MA | Poor baseline VA | Hyper-cholesterolaemia | |
+ | + | + | § | − | − | + | § | + | § | + | + | + | + | |
CATT (5 year) [48] | + | + | + | § | − | − | + | § | + | § | + | + | + | + |
§ | § | § | + | § | § | § | § | § | § | § | § | § | § | |
§ | § | + | + | § | § | § | § | § | § | § | + | § | § | |
§ | § | § | + | + | + | + | § | § | § | § | § | § | § | |
Young et al. [28] | − | − | − | − | − | − | − | − | − | § | + | − | − | − |
Xu et al. [17] | − | − | − | − | − | − | − | − | − | § | − | − | − | − |
Tanaka et al. [16] | + | § | § | § | § | § | § | § | § | § | § | § | § | § |
Kuroda et al. [24] | § | § | § | § |
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| § | § | § | § | § | § | § | § | § |
Zarubina et al. [23] | § | § | § | § | § | § | § | + | § | § | § | § | § | § |
Schütze et al. [18] | § | § | + | § | § | § | § | § | § | § | § | § | § | § |
Thavikulwat et al. [25] | § | § | § | § | § | § | § | § | § | § | + | § | § | § |
Hata et al. [22] | § | § | § | § | § | § | § | § | § | + | § | § | § | § |
Study | Protective factors from developing MAa | |||||
---|---|---|---|---|---|---|
Type 1 CNV | Blocked fluorescence | SRF | PCV | Sub-RPE complex thickness | Vitromacular attachment | |
++ | ++ | ++ | § | ++ | ++ | |
CATT (5 year) [48] | ++ | + | ++ | § | ++ | + |
§ | § | ++ | § | § | § | |
Xu et al. [17] | ++ | § | § | § | § | § |
Kuroda et al. [24] | § | § | § | ++ | § | § |