This material has been developed for use on desktop computers.

OCT knowledge checker:
Using OCT to recognise GA in AMD

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.

AMD, age-related macular degeneration; GA, geographic atrophy; 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.

November 2023 | PP-EYL-GB-1998

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.

Treatment for geographic atrophy is not licensed in the UK.

Why is geographic atrophy (GA) important?

  • Approximately 10% of patients with dry age-related macular degeneration (AMD) will develop GA, which is estimated to account for approximately 26% of legal blindness in the UK1,2
  • Treatments for GA are licensed in the USA as of 2023 and are currently under review by the relevant regulatory authorities for Europe and the UK3,4

Treatment for geographic atrophy is not licensed in the UK.

1. Gehrs KM et al. Ann Med 2006; 38 (7): 450–471. 2. Boyer DS et al. Retina 2017; 37 (5): 819–835. 3. FDA. Novel drug approvals for 2023. Available at: https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/novel-drug-approvals-2023. Accessed November 2023. 4. Eye news. Emerging therapies for geographic atrophy: complement inhibitors show potential to slow progression and preserve RPE and photoreceptor integrity. Available at: https://www.eyenews.uk.com/features/ophthalmology/post/emerging-therapies-for-geographic-atrophy-complement-inhibitors-show-potential-to-slow-progression-and-preserve-rpe-and-photoreceptor-integrity. Accessed November 2023.

Can you identify the GA and name the image modality type?

Click on the images to identify the atrophy and image type

The images presented are from real patients.

GA, geographic atrophy.
Images courtesy of author.

Can you identify the GA and name the image modality type?

Click on the images to identify the atrophy and image type

Colour fundus photography
Sharp demarcation of borders alongside visible choroidal vessels can be used to identify GA1

The images presented are from real patients.

GA, geographic atrophy.

1. Brader HS et al. Ophthalmology 2013; 120 (9): 1871–1879.

Images courtesy of author.

Can you identify the GA and name the image modality type?

Click on the images to identify the atrophy and image type

Infrared imaging
GA appears as well-demarcated zones of hyperreflectance1

The images presented are from real patients.

GA, geographic atrophy.
1. Crincoli E et al. Transl Vis Sci Technol 2022; 11 (11): 21.
Images courtesy of author.

Can you identify the GA and name the image modality type?

Click on the images to identify the atrophy and image type

OCT (optical coherence tomography)
GA on OCT can be identified as loss of the outer retina and the retinal pigment epithelium (RPE), and choroidal hypertransmission1

The images presented are from real patients.

GA, geographic atrophy.
1. Guymer RH et al. Ophthalmology 2020; 127 (3): 394–409.
Images courtesy of author.

Can you identify the GA and name the image modality type?

Click on the images to identify the atrophy and image type

Fundus autofluorescence (FAF) imaging
GA can be identified through hypoautofluorescence of the central atrophic tissue, which is often surrounded by a hyperautofluorescent border1

The images presented are from real patients.

GA, geographic atrophy.
1. Massamba N et al. Med Hypothesis Discov Innov Ophthalmol 2019; 8 (4): 298–305.
Images courtesy of author.

Which imaging modality is considered the best way to identify GA?

Click on the image type that is considered the most accurate way to identify GA

The images presented are from real patients.

GA, geographic atrophy.
Images courtesy of author.

Which imaging modality is considered the best way to identify GA?

 

OCT

  • OCT is now accepted as an extremely accurate way of identifying atrophy and may be an easier method to recognise atrophy than other methods such as colour fundus photography and FAF1,2
  • GA on OCT can be further defined in AMD as:
    • Complete RPE and outer retinal atrophy (cRORA)3
    • Incomplete RPE and outer retinal atrophy (iRORA)3
  • cRORA and iRORA were classified as part of the Classification of Atrophy Meeting (CAM) program3

The image presented is from a real patient.

AMD, age-related macular degeneration; FAF, fundus autofluorescence; GA, geographic atrophy; OCT, optical coherence tomography; RPE, retinal pigment epithelium.
1. Gale R et al. Presentation at the European Society of Retina Specialists (EURETINA) Annual Congress; 5–8 October 2023. 2. Massamba N et al. Med Hypothesis Discov Innov Ophthalmol 2019; 8 (4): 298–305. 3. Guymer RH et al. Ophthalmology 2020; 127 (3): 394–409. Image courtesy of author.

cRORA

Click on the image to identify the OCT-defined anatomical features of cRORA

The image presented is from a real patient.

cRORA, complete retinal pigment epithelium and outer retinal atrophy; OCT, optical coherence tomography.
Image courtesy of author.

cRORA

 

International consensus classification for OCT-defined anatomical features of cRORA1

  1. A region of hypertransmission ≥250 μm in diameter
  2. A zone of attenuation or disruption of the RPE ≥250 μm in diameter
  3. Evidence of overlying photoreceptor degeneration
  4. Absence of scrolled RPE or other signs of an RPE tear

The image presented is from a real patient.

cRORA, complete retinal pigment epithelium and outer retinal atrophy; OCT, optical coherence tomography; RPE, retinal pigment epithelium.
1. Sadda S et al. Ophthalmology 2018; 125 (4): 537–548.
Image courtesy of author.

iRORA

International consensus classification for OCT-defined anatomical features of iRORA*,1

  1. A region of signal hypertransmission into the choroid
  2. A corresponding zone of attenuation or disruption of the RPE, with or without persistence of basal laminar deposits
  3. Evidence of overlying photoreceptor degeneration

*The term iRORA should not be used when there is an RPE tear.
iRORA, incomplete retinal pigment epithelium and outer retinal atrophy; OCT, optical coherence tomography; RPE, retinal pigment epithelium.
1. Guymer RH et al. Ophthalmology 2020; 127 (3): 394–409.

Biomarkers that may result in GA

Click on the image to identify the relevant biomarker that can lead to GA

The image presented is from a real patient.

ART, automatic real time; GA, geographic atrophy; HR, high resolution; IR, infrared; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

Biomarkers that may result in GA

 

Serous pigment epithelial detachment (PED)

  • PEDs are a common complication of AMD and collapsing serous PED can lead to atrophy1,2

The image presented is from a real patient.

AMD, age-related macular degeneration; ART, automatic real time; GA, geographic atrophy; HR, high resolution; IR, infrared; OCT, optical coherence tomography; OD, oculus dexter (right eye).
1. Khanani AM et al. Retina 2018; 38 (11): 2103–2117. 2. Karampelas M et al. Ophthalmol Ther 2020; 9 (4): 739–756.
Image courtesy of author.

Biomarkers that may result in GA

Click on the image to identify the relevant biomarker that can lead to GA

The image presented is from a real patient.

ART, automatic real time; GA, geographic atrophy; HS, Heidelberg Spectralis; IR, infrared; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

Biomarkers that may result in GA

 

Drusen

  • Drusen represent a significant risk factor for the development of atrophy1

The image presented is from a real patient.

ART, automatic real time; GA, geographic atrophy; HS, Heidelberg Spectralis; IR, infrared; OCT, optical coherence tomography; OD, oculus dexter (right eye).
1. Au A et al. Invest Ophthalmol Vis Sci 2022; 63 (11): 24.
Image courtesy of author.

Biomarkers that may result in GA

Click on the image to identify typical biomarkers of Retinal Angiomatous Proliferation (RAP) lesions

The image presented is from a real patient.

ART, automatic real time; GA, geographic atrophy; HS, Heidelberg Spectralis; IR, infrared; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

Biomarkers that may result in GA

 

RAP lesion

  • RAP lesions more commonly lead to atrophy than other types of nAMD2

The image presented is from a real patient.

ART, automatic real time; GA, geographic atrophy; HS, Heidelberg Spectralis; IR, infrared; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OD, oculus dexter (right eye); PED, pigment epithelial detachment; SRF, subretinal fluid.
1. Hwang DDJ et al. Sci Rep 2021; 11 (1): 9275. 2. Daniel E et al. Ophthalmology 2016; 123 (3): 609–616. Image courtesy of author.

Does this image show GA?

The image presented is from a real patient.

ART, automatic real time; GA, geographic atrophy; IR, infrared; HS, Heidelberg Spectralis; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image courtesy of author.

Does this image show GA?

This image shows a RPE tear, which can be the consequence of a serous PED1,2

The image presented is from a real patient.

ART, automatic real time; GA, geographic atrophy; IR, infrared; Heidelberg Spectralis; OCT, optical coherence tomography; OD, oculus dexter (right eye); PED, pigment epithelial detachment; RPE, retinal pigment epithelium.
1. Rachitskaya A et al. Curr Ophthalmol Rep 2015; 3 (1): 26–33. 2. Information courtesy of author. Image courtesy of author.

Key takeaways

  • A substantial amount of vision loss experienced by patients with AMD can be attributed to GA1
  • There are a number of imaging modalities that can help identify atrophy in AMD, including:2
    • Colour fundus photography
    • FAF imaging
    • Infrared imaging
    • OCT
  • OCT is considered an extremely accurate method to identify atrophy and may be an easier method to recognise atrophy than other modalities, such as colour fundus photography and FAF3,4
    • Atrophy on OCT can be defined as iRORA or cRORA as per the CAM program5
  • Biomarkers such as serous PED, drusen and RAP lesions can lead to GA6–8

AMD, age-related macular degeneration; CAM, Classification of Atrophy Meeting; FAF, fundus autofluorescence; GA, geographic atrophy; cRORA, complete retinal pigment epithelium and outer retinal atrophy; iRORA, incomplete retinal pigment epithelium and outer retinal atrophy; OCT, optical coherence tomography; PED, pigment epithelial detachment; RAP, Retinal Angiomatous Proliferation.
1. Neelam K et al. Ophthalmic Epidemiol 2008; 15 (6): 389–401. 2. Information courtesy of author. 3. Gale R et al. Presentation at the European Society of Retina Specialists (EURETINA) Annual Congress; 5–8 October 2023. 4. Massamba N et al. Med Hypothesis Discov Innov Ophthalmol 2019; 8 (4): 298–305. 5. Guymer RH et al. Ophthalmology 2020; 127 (3): 394–409. 6. Khanani AM et al. Retina 2018; 38 (11): 2103–2117. 7. Au A et al. Invest Ophthalmol Vis Sci 2022; 63 (11): 24. 8. Daniel E et al. Ophthalmology 2016; 123 (3): 609–616.

Thank you for completing this OCT knowledge checker

OCT, optical coherence tomography.

November 2023 | PP-EYL-GB-1998