This material has been developed for use on desktop computers.

OCT knowledge checker:
Can you spot the OCT biomarkers of
disease activity in nAMD in 2 minutes?

Images provided by Richard Gale, York and Scarborough
Teaching Hospitals, NHS Foundation Trust

Adverse events should be reported.
Reporting forms and information can be found at
https://yellowcard.mhra.gov.uk/ or search MHRA
Yellow Card in Google Play or Apple App Store.
Adverse events should also be reported to Bayer plc.
Tel.: 0118 2063500, Fax.: 0118 2063703,
Email: pvuk@bayer.com

This material has been developed for use on a desktop computer.

Prescribing information for EYLEA (aflibercept) can be accessed by clicking the prescribing information link on the hosting website.

nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
This promotional OCT knowledge checker is organised and funded by Bayer and is intended for UK healthcare professionals only.

The information provided in this presentation is according to the views of the author.

July 2023 | PP-EYL-GB-1893

Disclosures

Fees for:

Apellis, AbbVie, Alimera, Bayer, Biogen, Boehringer Ingelheim, Heidelberg, Novartis, Notal vision, Roche, Santen

Disclaimers

 

The case studies presented are from real patients and are used with permission.

Patient with nAMD:

Click on the image to identify intraretinal fluid (IRF)

11/04/2019, OD
IR&OCT 30° ART
[HS] ART(15) Q: 29
Heidelberg
Engineering

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

What is the significance of intraretinal fluid (IRF) in nAMD?1

 

11/04/2019, OD
IR&OCT 30° ART
[HS] ART(15) Q: 29
Heidelberg
Engineering

 

IRF is seen as branching tubular structures that appear as round or ovoid hyporeflective spaces in the outer nuclear layer of the retina

The presence of IRF is associated with poor visual outcomes at baseline and throughout treatment in patients with nAMD

Visual outcomes can also be influenced by the amount and location of IRF

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.
1. Hanson RLW et al. Eye (Lond) 2022; 1–16; DOI: 1038/s41433-022-02360-4.

Patient with nAMD:

Click on the image to identify subretinal fluid (SRF)

01/11/2018, OD
IR&OCT 30° ART
[HS] ART(17) Q: 26
Heidelberg
Engineering

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

What is the significance of subretinal fluid (SRF) in nAMD?

 

01/11/2018, OD
IR&OCT 30° ART
[HS] ART(17) Q: 26
Heidelberg
Engineering

The image above shows persistent SRF after 12 months of treatment.
What would you do?

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

What is the significance of subretinal fluid (SRF) in nAMD?

 

01/11/2018, OD
IR&OCT 30° ART
[HS] ART(17) Q: 26
Heidelberg
Engineering

In this circumstance, you could tolerate SRF1

SRF manifests as hyporeflective spaces representing pockets of fluid, found between the neurosensory retina and the retinal pigment epithelium (RPE)2

Presence of SRF in the absence of other biomarkers of disease activity in some circumstances after the loading phase does not have a detrimental effect on visual outcomes; therefore, some residual SRF, in the absence of IRF, may be tolerated following the loading phase3

Some eyes with a small amount of stable SRF are associated with reduced formation of geographic atrophy (GA)2

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.
1. Information courtesy of speaker. 2. Hanson RLW et al. Eye (Lond) 2022; 1–16; DOI: 10.1038/s41433-022-02360-4 3. Chaikitmongkol V et al. Asia Pac J Ophthalmol (Phila) 2021; 10 (6): 507–518.

Patient with nAMD:

Click on the image to identify hyperreflective foci (HRF)

12/04/2018, OD
IR&OCT 30° ART
[HS] ART(16) Q: 34
Heidelberg
Engineering

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

What is the significance of hyperreflective foci (HRF) in nAMD?1

 

12/04/2018, OD
IR&OCT 30° ART
[HS] ART(16) Q: 34
Heidelberg
Engineering

 

HRF are characterised as small, well-defined hyperreflective dots in the neurosensory retina

HRF are associated with progression to late AMD and can be observed in eyes progressing to macular neovascularisation (MNV) and atrophy

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.
1. Hanson RLW et al. Eye (Lond) 2022; 1–16; DOI: 1038/s41433-022-02360-4.

Patient with nAMD:

Click on the image to identify the two imaging biomarkers that denote poor outcomes after 12 months of treatment

07/06/2019, OD
IR&OCT 30° ART
[HS] ART(9) Q: 13
Heidelberg
Engineering

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

What is the significance of hyperreflective material (HRM) in nAMD?1

 

07/06/2019, OD
IR&OCT 30° ART
[HS] ART(9) Q: 13
Heidelberg
Engineering

 

HRM (also known as subretinal HRM [SHRM] if found in the subretinal space) can be categorised as well-defined or poorly-defined depending on the degree of reflectivity of a region and the clarity of its boundaries

The presence of poorly-defined HRM can represent fibrin, a precursor to fibrosis2,3

Poorly-defined HRM can be responsive to treatment with anti–vascular endothelial growth factor (anti-VEGF)

Well-defined HRM often represents fibrosis, which is not responsive to treatment with anti-VEGF and is associated with poor visual acuity outcomes2

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.
1. Hanson RLW et al. Eye (Lond) 2022; 1–16; DOI: 10.1038/s41433-022-02360-4. 2. Bacheimer I et al. Surv Ophthalmol 2023; (23): 00049–8; DOI: 10.1016/j.survophthal.2023.03.004. 3. Loskutoff DJ et al. J Clin Invest 2000; 106 (12): 1441–1443.

Patient with nAMD:

Click on the image to identify outer retinal tubulations (ORT)

07/06/2019, OD
IR&OCT 30° ART
[HS] ART(9) Q: 13
Heidelberg
Engineering

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

What is the significance of outer retinal tubulations (ORT) in nAMD?1

 

07/06/2019, OD
IR&OCT 30° ART
[HS] ART(9) Q: 13
Heidelberg
Engineering

 

ORT appear as hyporeflective, branching, tubular structures with hyperreflective borders within the outer nuclear layer of the retina, often overlying fibrous scarring

The prevalence of ORT in nAMD increases over time and may be associated with poor visual outcomes

The CATT study demonstrated that eyes with ORT had reduced visual acuity after 5 years compared to those without2

The image presented is from a real patient.

ART, automatic real time; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.
1. Hanson RLW et al. Eye (Lond) 2022; 1–16; DOI: 10.1038/s41433-022-02360-4. 2. Jaffe JG et al. Ophthalmology 2019; 162 (2): 252–260.

Overview of OCT biomarkers that denote disease activity in nAMD

Summary

IRF is associated with poor visual outcomes in patients with nAMD1

Some residual SRF may be tolerated in the absence of other biomarkers of disease activity following the loading phase2

HRF are associated with progression to late AMD and can be seen in eyes progressing to MNV and atrophy1

Both poorly-defined HRM and well-defined HRM are associated with poor visual outcomes; however, poorly-defined HRM may be responsive to anti-VEGF treatment1

ORT are associated with poor visual outcomes in patients with nAMD and may represent undertreatment in some individuals1

Additional OCT disease biomarkers in nAMD:1

Pigment epithelial detachment (PED) is inconsistently associated with disease progression; however, it appears to be unrelated to visual outcomes

Eyes progressing to MNV demonstrate a faster increase in drusen volume than those developing macular atrophy (MA)

Subretinal drusenoid deposits (SDD) are also associated with the development of nAMD; however, confluent SDD are independently linked to the development of GA

GA, geographic atrophy; HRF, hyperreflective foci; HRM, hyperreflective material; IRF, intraretinal fluid; MNV, macular neovascularisation; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; ORT, outer retinal tubulations; SRF, subretinal fluid; VEGF, vascular endothelial growth factor.

1. Hanson RLW et al. Eye (Lond) 2022; 1–16; DOI: 10.1038/s41433-022-02360-4. 2. Chaikitmongkol V et al. Asia Pac J Ophthalmol (Phila) 2021; 10 (6): 507–518.

Thank you for completing this OCT knowledge checker

OCT, optical coherence tomography.

July 2023 | PP-EYL-GB-1893