Decreased Macular Choriocapillaris Perfusion Correlates with Contrast Sensitivity Function in Dry Age-Related Macular Degeneration.

To investigate the relationships between contrast sensitivity (CS), choriocapillaris perfusion, and other structural OCT biomarkers in dry age-related macular degeneration (AMD). Cross-sectional, observational study. One hundred AMD eyes (22 early, 52 intermediate, and 26 late) from 74 patients and 45 control eyes from 37 age-similar subjects. All participants had visual acuity (VA) assessment, quantitative CS function (qCSF) testing, macular OCT, and 6 × 6-mm swept-source OCT angiography scans on the same day. OCT volumes were analyzed for subretinal drusenoid deposits and hyporeflective drusen cores, and to measure thickness of the outer nuclear layer. OCT angiography scans were utilized to calculate drusen volume and inner choroid flow deficit percentage (IC-FD%), and to measure the area of choroidal hypertransmission defects (HTDs). Inner choroid flow deficit percentage was measured from a 16-μm thick choriocapillaris slab after compensation and binarization with Phansalkar's method. Generalized linear mixed-effects models were used to evaluate the associations between functional and structural variables. To explore the associations between qCSF-measured CS, IC-FD%, and various AMD imaging biomarkers. Age-related macular degeneration exhibited significantly reduced qCSF metrics eyes across all stages compared with controls. Univariate analysis revealed significant associations between various imaging biomarkers, reduced qCSF metrics, and VA in both groups. Multivariate analysis confirmed that higher IC-FD% in the central 5 mm was significantly associated with decreases in all qCSF metrics in AMD eyes (β = -0.74 to -0.25, all P < 0.05), but not with VA (P > 0.05). Outer nuclear layer thickness in the central 3 mm correlated with both VA (β = 2.85, P < 0.001) and several qCSF metrics (β = 0.01-0.90, all P < 0.05), especially in AMD eyes. Further, larger HTD areas were associated with decreased VA (β = -0.89, P < 0.001) and reduced CS at low-intermediate frequencies across AMD stages (β = -0.30 to -0.29, P < 0.001). The significant association between IC-FD% in the central 5 mm and qCSF-measured CS reinforces the hypothesis that decreased macular choriocapillaris perfusion contributes to visual function changes in AMD, which are more pronounced in CS than in VA. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Romano F ，Vingopoulos F ，Yuan M ，Ding X ，Garcia M ，Ploumi I ，Rodriguez J ，Garg I ，Tracy JH ，Bannerman A ，Choi H ，Stettler I ，Bennett C ，Overbey KM ，Laìns I ，Kim LA ，Vavvas DG ，Husain D ，Miller JW ，Miller JB ... -  《-》

Associations Between Contrast Sensitivity, Optical Coherence Tomography Features and Progression From Intermediate to Late Age-related Macular Degeneration.

Establishing associations between structure, function, and clinical outcomes in intermediate age-related macular degeneration (iAMD) remains an unmet need. This study aims to (1) cross-sectionally investigate the relationships between optical coherence tomography (OCT) biomarkers and quantitative contrast sensitivity function (qCSF)-measured contrast sensitivity (CS), and (2) longitudinally assess their relationship with progression from iAMD to late stages of the disease. Cross-sectional and cohort study. Our study was conducted at Massachusetts Eye and Ear (Boston, MA, USA) and included eyes with (1) baseline diagnosis of iAMD, (2) same-day OCT and qCSF test, (3) visual acuity ≥20/200 Snellen, and (4) 24+ months of follow-up. qCSF metrics included the area under the logCSF curve, contrast acuity, and CS thresholds at 1- to 18-cycle-per-degree (cpd). Two independent graders reviewed macular OCT scans for various biomarkers, and outer nuclear layer (ONL) thickness and retinal pigment epithelium (RPE) volume were measured. Progression to wet AMD or geographic atrophy (GA) was confirmed using imaging studies. Generalized linear mixed-effects models assessed associations between qCSF and OCT biomarkers, while Cox regression models evaluated their association with progression to late AMD. We included 205 iAMD eyes from 134 patients (age: 73 [69-78] years; 63% female). Higher RPE volume in the central subfield and a greater number of intraretinal hyperreflective foci were associated with reduced area under the logCSF curve, contrast acuity, and CS at 6 to 12 cpd (P < .05). ONL thinning in the inner ring and a greater number of intraretinal hyperreflective foci were associated with reduced CS at 1 and 3 cpd (P < .05). During follow-up, 35 eyes developed wet AMD (17%) and 53 progressed to GA (26%). subretinal drusenoid deposit, ONL thinning in the inner ring, and reduced CS at 1.5 cpd were associated with wet AMD (P < .05). Higher RPE volume in the inner ring, hyporeflective drusen cores, subretinal drusenoid deposit, higher HRF count, and reduced CS at 1 cpd were associated with GA (P < .05). Our study reveals significant structure-function relationships between OCT biomarkers and qCSF-measured CS in iAMD. These findings highlight the impact of AMD alterations on CS function and offer valuable insights for patient stratification and prognostication in research and clinical settings.

Bennett C ，Romano F ，Vingopoulos F ，Garcia M ，Ding X ，Bannerman A ，Ploumi I ，Ntentakis D ，Stettler I ，Overbey K ，Baldwin G ，Bejjani R ，Garg I ，Rodriguez J ，Laìns I ，Kim LA ，Vavvas D ，Husain D ，Miller JW ，Miller JB ... -  《-》

Pachy-Reticular Pseudodrusen.

To characterize the features of a peculiar association between reticular pseudodrusen (RPD) and pachychoroid (pachy-RPD) and to compare them with eyes affected by RPD and normal/leptochoroid. Observational, retrospective, case-control study. Among a cohort of patients with intermediate age-related macular degeneration (AMD), we selected eyes with RPD and pachychoroid (i.e., choroidal thickness of >50 μm). A control group of RPD eyes but without pachychoroid (i.e., a choroidal thickness of <250 μm) was included. Number and stages of RPD were evaluated in each ETDRS subfield. Furthermore, choroidal perfusion was investigated using the choroidal vascularity index (CVI), and choriocapillaris perfusion density (PD) on structural OCT and OCT angiography. Description of the multimodal imaging features of pachy-RPD and differences with RPD associated with normal/leptochoroid. Among 111 RPD eyes, 37 were included in the pachy-RPD group and 74 in the control group. Patients with pachy-RPD were significantly younger than patients with RPD and normal/leptochoroid (mean age, 75 ± 16 and 82 ± 7 years, respectively; P = 0.002). Total RPD number was comparable between the 2 groups (P = 0.220). However, pachy-RPD eyes showed a significantly higher number of stage 1 RPD in comparison to the controls (P < 0.001), and a lower number of stage 3 (P < 0.001) and stage 4 RPD (P = 0.052). The CVI and choriocapillaris PD were greater in pachy-RPD than in the control group (P < 0.001 and P= 0.010, respectively). Pachy-RPD are characterized by a different distribution of RPD stages (i.e., more early stages and fewer advanced stages) in comparison to RPD with normal/leptochoroid. Furthermore, pachy-RPD eyes showed greater perfusion indices of the choroid. These features suggest that the presence of pachychoroid could be a protective factor in the RPD evolution to the advanced AMD forms. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Sacconi R ，Fazzari G ，Capuano V ，Menean M ，Beretta F ，El Matri K ，Bandello F ，Souied E ，Querques G ... -  《-》

A Novel Grid Strategy for Correlating Focal Macular Anatomic Changes With Focal Changes in Choriocapillaris Perfusion.

Hiya FE ，Cheng Y ，Shen M ，Li J ，Berni A ，Zhou SW ，Herrera G ，O'Brien RC ，Gregori G ，Wang RK ，Rosenfeld PJ ... -  《-》

Quantitative Multimodal Imaging Characterization of Intraretinal Cysts versus Degenerative Pseudocysts in Neovascular Age-Related Macular Degeneration.

To differentiate intraretinal fluid (IRF) cysts from degenerative pseudocysts in neovascular age-related macular degeneration (AMD) by quantitative multimodal imaging. Observational, cross-sectional. Patients affected by macular neovascularization secondary to AMD. All patients were analyzed by OCT, OCT angiography (OCTA), and dense automatic real-time (ART) OCTA. New-onset cysts were considered IRF, whereas those cysts that were found to be persistent for at least 3 months were categorized as degenerative pseudocysts. Intraretinal cysts were automatically segmented to calculate cyst circularity. Peri-cyst space was quantitatively analyzed to assess the presence of perfusion signal and hyperreflective foci (HF). Best-corrected visual acuity, cyst circularity, peri-cyst perfusion, peri-cyst HF, fibrosis, and outer retinal atrophy. We analyzed 387 cysts collected from 35 eyes of 35 patients with neovascular AMD (14 men; mean age, 80 ± 5 years). We classified 302 IRF cysts and 85 degenerative pseudocysts. Intraretinal fluid cysts were characterized by significantly higher circularity (0.86; range, 0.81-0.91), perfusion signal in the peri-cyst space, and peri-cyst HF in 89% of cases (all P < 0.05). Degenerative pseudocysts showed significantly lower circularity (0.68; range, 0.64-0.76), no perfusion signal in the peri-cyst space, and peri-cyst HF in only 29% of cases (all P < 0.05). The adopted quantitative metrics significantly correlated with disease duration, number of injections, fibrosis, and outer retinal atrophy. Intraretinal fluid cysts can be discriminated from degenerative pseudocysts using a quantitative multimodal imaging approach. These findings are clinically relevant and should be included in future training models for artificial intelligence algorithms to improve the diagnostic power and fluid monitoring in neovascular AMD. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Arrigo A ，Aragona E ，Battaglia Parodi M ，Bandello F ... -  《-》