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. 2024 Nov:248:110117.
doi: 10.1016/j.exer.2024.110117. Epub 2024 Oct 3.

Evaluating the persistence of large choroidal hypertransmission defects using SS-OCT imaging

Sara Beqiri  1 , Gissel Herrera  1 , Jeremy Liu  2 , Mengxi Shen  1 , Alessandro Berni  3 , Omar S El-Mulki  1 , Yuxuan Cheng  4 , Omer Trivizki  5 , James Kastner  1 , Robert C O'Brien  1 , Giovanni Gregori  1 , Ruikang K Wang  6 , Philip J Rosenfeld  7
Affiliations

Evaluating the persistence of large choroidal hypertransmission defects using SS-OCT imaging

Sara Beqiri et al. Exp Eye Res. 2024 Nov.

Abstract

In age-related macular degeneration (AMD), large choroidal hypertransmission defects (hyperTDs) are identified on en face optical coherence tomography (OCT) images as bright lesions measuring at least 250 μm in greatest linear dimension (GLD). These choroidal hyperTDs arise from focal attenuation or loss of the retinal pigment epithelium (RPE). We previously reported that once large hyperTDs formed, they were likely to persist compared with smaller lesions that were more likely to be transient. Due to their relative persistence, these large persistent choroidal hyperTDs are a point-of-no-return in the progression of intermediate AMD to the late stage of atrophic AMD. Moreover, the onset of these large choroidal hyperTDs can serve as a clinical trial endpoint when studying therapies that might slow disease progression from intermediate AMD to late atrophic AMD. To confirm the persistence of these large choroidal hyperTDs, we studied an independent dataset of AMD eyes enrolled in an ongoing prospective swept-source OCT (SS-OCT) natural history study to determine their overall persistence. We identified a total of 202 eyes with large choroidal hyperTDs containing 1725 hyperTDs followed for an average of 46.6 months. Of the 1725 large hyperTDs, we found that 1718 (99.6%) persisted while only 7 hyperTDs (0.4%) were non-persistent. Of the 7 non-persistent large hyperTDs in 6 eyes, their average GLD at baseline was 385 μm. Of the large hyperTDs ranging in size between 250 and 300 μm when first detected, only one was not persistent with a baseline GLD of 283 μm. In 6 of the non-persistent hyperTDs, the loss of a detectable large hyperTD was due to the accumulation of hyperreflective material along the retinal pigment epithelium (RPE) and in the retina over the area where the hyperTD was located. This hyperreflective material is thought to represent the migration and aggregation of RPE cells into this focal region where the choroidal hyperTD arose due to attenuated or lost RPE.

Keywords: Age-related macular degeneration (AMD); En face imaging; Persistent choroidal hypertransmission defects (HyperTDs); Swept-source optical coherence tomography angiography (SS-OCTA).

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Conflict of interest statement

Declaration of competing interest Giovanni Gregori, Philip J. Rosenfeld and Ruikang K. Wang received research support from Carl Zeiss Meditec, Inc. Giovanni Gregori and the University of Miami co-own a patent that is licensed to Carl Zeiss Meditec, Inc. Dr. Rosenfeld also received research funding from Gyroscope Therapeutics. He is also a consultant for Abbvie, Annexon, Apellis, Bayer Pharmaceuticals, Boehringer-Ingelheim, Carl Zeiss Meditec, Chengdu Kanghong Biotech, Genentech/Roche, InflammX Therapeutics, Ocudyne, Regeneron Pharmaceuticals, and Unity Biotechnology. He also has equity interest in Apellis, InflammX, Ocudyne, and Valitor. Ruikang K. Wang received other financial support from Colgate Palmolive Company, Estee Lauder lnc, and is a consultant for Carl Zeiss Meditec. He also has several patents: US8, 750, 586, US8, 180, 134, US9, 282,905, US9, 759,544, US10, 354,378, US10, 529,061. The remaining authors have no disclosures.

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