This material has been developed for use on desktop computers.

OCT knowledge checker:
Differential diagnosis of nAMD

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

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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.

April 2024 | PP-EYL-GB-2184

Disclosures

Fees for:

AbbVie, Alimera Sciences, Allergan, Amgen, Bayer, Biogen, Boehringer Ingelheim, Gilead Sciences, Heidelberg Pharma, Lux Biosciences, Notal Vision, Novartis, Roche, Santen.

Disclaimers

 

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

OCT, optical coherence tomography.

Does this image show nAMD?

 

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.

Patient with nAMD

Click on the image to identify two biomarkers of disease activity in nAMD

Yes, this image shows nAMD. Can you identify two biomarkers of disease activity in nAMD that are visible in this image?

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.

Biomarkers of disease activity in nAMD

 

  • Intraretinal fluid and hyperreflective material are two biomarkers of disease activity in nAMD1
  • You can learn more about biomarkers of nAMD in the ‘OCT biomarkers of disease activity in nAMD’ knowledge checker

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.

This patient is aged 48; does this image show nAMD?

 

The image presented is from a real patient.

nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author.

This patient is aged 48; does this image show nAMD?

 

  • The patient was diagnosed with chronic CSCR1
    • PED is present in 56%–96% of CSCR-affected eyes2
    • CNV is more common in eyes with chronic CSCR than acute CSCR3
      • Chronic CSCR involves the persistence of fluid beyond 3–6 months4
      • CNV has been reported in 2%–18% of patients with chronic CSCR5

No, this is unlikely to be nAMD due to the patient's age, and the presence of thickened choroid, SRF (visible in right image), and dependent fluid (visible in left image)1

The image presented is from a real patient.

CNV, choroidal neovascularisation; CSCR, central serous chorioretinopathy; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; PED, pigment epithelial detachment.
Image courtesy of author.
1. Information courtesy of author. 2. Feenstra HMA et al. Prog Retin Eye Res 2024; 101236. 3. Sahoo NK et al. Eye 2023; 37: 732–738. 4. Gupta A and Tripathy K. Central Serous Chorioretinopathy. In: StatPearls [Internet]. USA: StatPearls Publishing; 2023. 5. Rijssen TJ et al. Prog Ret Eye Res 2019; 73: 100770.

CSCR can also be visualised using autofluorescence

 

Chronic subretinal fluid
leads to an increase
in autofluorescence

The image presented is from a real patient.

ART, automated real time; BAF, blue-light fundus autofluorescence; CSCR, central serous chorioretinopathy; HR, high resolution; OCT, optical coherence tomography; OS, oculus sinister (left eye).
Image and information courtesy of author.

This patient is a 55-year-old male; does this image show nAMD?

 

The image presented is from a real patient.

nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author.

This patient is a 55-year-old male; does this image show nAMD?

 

No, this patient does not appear to have nAMD1

  • This patient was diagnosed with macular telangiectasia type 2 (MacTel)1
    • MacTel is characterised by elongated hyporeflective outer retinal spaces with draped ILM over the spaces2
    • Eyes with MacTel have a low chance of developing CNV (proliferative MacTel); one study found that the incidence of CNV was 10.6% (n=7) in Indian eyes with non-proliferative MacTel that had a minimum of three years of follow-up1,3

The image presented is from a real patient.

ILM, internal limiting membrane; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author. 1. Information courtesy of author. 2. Kedarisetti KC et al. Clin Ophthalmol 2022; 16: 3297–3309. 3. Marsonia K et al. Semin Ophthalmol 2022; 37 (2): 136–141.

This patient is a 73-year-old female; does this image show nAMD?

 

The image presented is from a real patient.

nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author.

This patient is a 73-year-old female; does this image show nAMD?

 

No, this patient does not appear to have nAMD1

  • This patient was diagnosed with a vitelliform lesion1
    • Vitelliform lesions are characterised by material between the retinal pigment epithelium and ellipsoid zone1,2
    • Vitelliform lesions can be classified as:1,3
      • Primary – genetically determined, for example, as part of Best disease, a pattern dystrophy, or adult-onset vitelliform macular dystrophy
      • Secondary – acquired, with a number of possible causes, including vitreomacular traction or AMD
    • One study found that in eyes with acquired vitelliform lesions with >6 months follow-up, the likelihood of developing CNV was 7.5% (n=15/199)4

The image presented is from a real patient.

AMD, age-related macular degeneration; CNV, choroidal neovascularisation; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author. 1. Information courtesy of author. 2. Brinkmann M et al. Am J Ophthalmol 2022; 240: 99–114. 3. Iovino C et al. Surv Ophthalmol 2023; 68 (3): 361–379. 4. Balaratnasingham C et al. Am J Ophthalmol 2016; 172: 28–38.

Vitelliform lesions can also be visualised using autofluorescence

 

Vitelliform lesions
are characterised
by an increase
in autofluorescence

The image presented is from a real patient.

ART, automated real time; BAF, blue-light fundus autofluorescence; OCT, optical coherence tomography; OD, oculus dexter (right eye).
Image and information courtesy of author.

This patient is an 83-year-old male who had cataract surgery in his left eye six weeks ago; does this image show nAMD?

 

The image presented is from a real patient.

nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author.

This patient is an 83-year-old male who had cataract surgery in his left eye six weeks ago; does this image show nAMD?

 

No, this patient does not appear to have nAMD1

  • This patient was diagnosed with post-operative cystoid macular oedema (post-op CMO)1
    • Post-op CMO most commonly occurs 4–6 weeks after cataract surgery2
    • Post-op CMO is usually treated with topical steroid and NSAID eye drops2

The image presented is from a real patient.

nAMD, neovascular age-related macular degeneration; NSAID, non-steroidal anti-inflammatory drug; OCT, optical coherence tomography.
Image courtesy of author. 1. Information courtesy of author. 2. Erikitola O-O et al. Eye 2021; 35: 584–591.

This patient is a 78-year-old female; does this image show nAMD?

 

The image presented is from a real patient.

nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author.

This patient is a 78-year-old female; does this image show nAMD?

 

No, this patient does not appear to have nAMD1

  • This patient was diagnosed with focal vitreomacular traction (VMT)1
    • Focal VMT is characterised by loss of the foveal depression that is visible on OCT and the presence of a central yellow spot that is visible using slit lamp biomicroscopy2
    • Focal VMT can progress to a full thickness macular hole2

The image presented is from a real patient.

nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.
Image courtesy of author. 1. Information courtesy of author. 2. Theodossiadis G et al. Eye 2014; 28: 1452–1460.

Summary: Imaging techniques for differential diagnosis of nAMD

There are a number of differential diagnoses for nAMD, including:

  • CSCR
  • MacTel
  • Vitelliform lesions
  • Post-operative CMO
  • Vitreomacular traction
  • DMO
  • Macular oedema secondary to RVO

Some of these diseases can be complicated by the presence of choroidal neovascular membrane

OCT is a useful tool for making a diagnosis of nAMD

Sometimes, additional imaging techniques may be required, including:

  • OCT-A
  • Fundus autofluorescence
  • Dye-based imaging

CMO, cystoid macular oedema; CSCR, central serous chorioretinopathy; DMO, diabetic macular oedema; MacTel, macular telangiectasia type 2; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography; OCT-A, optical coherence tomography angiography; RVO, retinal vein occlusion. Information courtesy of author.

Thank you for completing this OCT knowledge checker

OCT, optical coherence tomography.

April 2024 | PP-EYL-GB-2184