[Towards the new spectral-domain optical coherence tomography based classification of age-related macular degeneration]

Abstract

Introduction: Age-related macular degeneration (AMD) is major social and health problem in industrialised societies. The contribution of the new diagnostic techniques, mainly spectral-domain optical coherence tomography (SD-OCT), has led to a better understanding of this disease.

Aim: To review the current clinical classification of AMD, to describe the new tomographic classification of wet AMD, and to review the new topographical findings in dry AMD.

Development: There are two classically described forms of AMD: dry and wet; there are also three progressive stages of severity: early, intermediate and advanced. This purely clinical stratification does not take into account any criteria based on SD-OCT. On the other hand, a new SD-OCT based classification has been proposed for choroidal neovascularisations secondary to AMD: types 1 (equivalent to occult), 2 (equivalent to classic), and 3 (equivalent to retinal angiomatous proliferation). Finally, SD-OCT offers exclusive and valuable information on the evaluation of dry AMD as regards subretinal drusenoid deposits, drusenoid pigment epithelium detachments, drusen coalescence, or the appearance of subretinal fluid in absence of choroidal neovascularisation.

Conclusions: Dry AMD exhibits a range of tomographical signs that also have their own relative risk of progression to advance stages of the disease. We need an international consensus in order to follow-up and treat in the best way all those patients with AMD, not only with the wet but also with the dry form.