OCT Features May Signal Risk of Retinal Atrophy, Study Suggests

A recent study from Sapienza University of Rome has indicated that optical coherence tomography (OCT) features such as type 2 macular neovascularization (MNV), reductions in outer nuclear layer (ONL) and central foveal thickness (CFT), and intraretinal fluid (IRF) presence at baseline could signal higher risks of retinal atrophy (RA) in treatment-naïve neovascular age-related macular degeneration (nAMD).1

AMD is the leading cause of blindness in most industrialized countries. The number of individuals with AMD globally is predicted to increase from 196 million in 2020 to 288 million by 2040. Additionally, patterns of AMD prevalence and phenotype are seen between geographical areas that are not fully explained by disparities in population structure.2

“AMD is a common and increasing disease and it is crucial to identify reliable indexes of progression, facilitating adequate plans of treatment and prevention,” wrote Oscar M. Gagliardi, MD, department of sense organs, Sapienza University of Rome, and colleagues. “In this study, we aimed to identify OCT features that may predict RA in patients with nAMD treated with aflibercept.”1

This retrospective, observational, cohort study collected 1085 clinical records during the review process. Of these, 703 patients underwent aflibercept treatment. Within this cohort, 653 did not meet other inclusion criteria. A 5-year follow-up was available for 50 patients, but 4 were excluded due to unreliable OCT images.1

A collective of 46 eyes were eligible, with a mean age of 78.37 years, and underwent intravitreal injections with aflibercept 4 mg/mL after an OCT diagnosis of nAMD. 21 eyes did not show RA at 5 years after diagnosis, while 25 met the Consensus Definition for Atrophy Associated with Age-Related Macular Degeneration on OCT (CAM) criteria of RA. Non-atrophic eyes were placed in group A, while atrophic ones entered group B. There was no significant variance in age between the groups (P = .112).1

Best-corrected visual acuity (BCVA) did not exhibit significant differences between the two groups at the point of diagnosis (T0), and the first (T1) or third (T2) aflibercept injection. 5 years post-diagnosis (T3), however, saw a substantially worse BCVA in patients with atrophy (35.19 +/- 5.7 vs 8.9 +/- 2.3; P <.001). Group A exhibited a BCVA improvement at T2 (90.48% vs 56%; P = .019) and T3 (85.71% vs 8%; P <.001).1

Baseline prevalence of types 1, 2, 3, and mixed type MNV were 36.96%, 21.74%, 0, and 41.3%, respectively. Group B exhibited a higher frequency of type 2 (4.76% vs 36%; P = .013), while no significant differences were found between the groups for type 1 (47.62% vs 28%; P = .225), mixed type (47.62% vs 36%; P = .550), and MNV diameter (2724.24 +/- 432.32 µm vs 3134.16 +/- 514.89 µm; P = .215).1

A thinner ONL at T0 (88.89 +/- 7.82 µm vs 71.38 +/- 14.14 µm; P = .033) and reduced CFT at T3 (190.14 +/- 22.79 µm vs 124.32 +/- 14.35 µm; P <.001) were more frequent in group B. SRF with or without IRF at diagnosis was comparable between the two groups, whereas IRF was most common in group B. Additionally, eyes with RA showed more IRF without SRF at T0 compared to those with atrophy at 5 years.1

Gagliardi and colleagues determined that these data indicate type 2 MNV, reductions in ONL and CFT, and IRF presence at baseline could potentially indicate a higher RA risk in nAMD patients. However, the team also indicated potential limitations of the study, namely a reliance on OCT for defining RA.1

“While OCT is a reference method for assessing RA, its limited scan field suggests that future studies might benefit from incorporating multiple imaging modalities,” Gagliardi and colleagues wrote. “Exploring different treatment regimens and other available [anti-vascular endothelial growth factors] anti-VEGFs is warranted.”1

References

1. Gagliardi OM, Alisi L, Visioli G, et al. OCT predictors of retinal atrophy in neovascular age-related macular degeneration treated with aflibercept. Int J Ophthalmol. 2025;18(4):648-655. Published 2025 Apr 18. doi:10.18240/ijo.2025.04.11

2. Keenan, T.D.L., Cukras, C.A., Chew, E.Y. (2021). Age-Related Macular Degeneration: Epidemiology and Clinical Aspects. In: Chew, E.Y., Swaroop, A. (eds) Age-related Macular Degeneration. Advances in Experimental Medicine and Biology, vol 1256. Springer, Cham. https://doi.org/10.1007/978-3-030-66014-7_1