OCT Biomarkers May Predict Retinal Atrophy Risk in nAMD Patients: Study

A new study published in the International Journal of Ophthalmology showed specific optical coherence tomography (OCT) features (type 2 macular neovascularization, reduced outer nuclear layer and central foveal thickness, and presence of intraretinal fluid) may be early indicators of increased risk for retinal atrophy in treatment-naïve patients with neovascular age-related macular degeneration.

Submacular fibrosis, photoreceptor shrinkage, and irreversible loss of central vision are all signs of advanced AMD. During the fundus oculi examination, retinal atrophy (RA) can be identified by the feature known as "geographic atrophy," which is the existence of delineated atrophic lesions of the outer retina brought on by the loss of photoreceptors, RPE, and choriocapillaris.

A noninvasive method for producing high-resolution cross-sectional pictures of the retina and underlying components is swept-source optical coherence tomography (SS-OCT). In order to predict retinal atrophy (RA) and visual function in patients receiving intravitreal aflibercept, this study was set to identify optical coherence tomography characteristics present at the diagnosis of neovascular age-related macular degeneration.

Analysis was done on OCT data obtained at the time of the diagnosis of AFM (T0), following the first (T1) and third (T2) intravitreal aflibercept injections, and 5 years after the diagnosis (T3). 46 eyes from individuals receiving therapy were included in the research. Visual acuity (VA) development over time and the relationship between OCT characteristics and RA were assessed.

The patients with RA at T3 had a lower rate of recovery or stability at T2 (90.48% vs 56.00%, P=0.019) and T3 (85.71% vs 8.00%, P<0.001), as well as a poorer VA (35.19±5.7 vs 8.90±2.3, P<0.001).

Type 2 macular neovascularization (MNV; 4.76% vs 36.00%, P=0.013), a thinner outer nuclear layer (ONL, 88.89±7.82 µm vs 71.38±14.14 µm, P=0.033), intraretinal fluid (IRF, 42.86% vs 80.00%, P=0.014), IRF without subretinal fluid at T0 (SRF, 4.76% vs 32.00%, P=0.027), and decreased central foveal thickness at T3 (CFT, 190.14±22.79 µm vs 124.32±14.35 µm, P<0.001) were all associated with the development of RA at T3.

Both groups had similar levels of SRF with or without IRF at diagnosis (90.48% vs. 68.00%; P=0.084). Overall, the significance of these OCT characteristics in early risk assessment and management methods is highlighted by the fact that type 2 MNV lowers ONL and CFT, and the presence of IRF at baseline may indicate a greater risk of RA in treatment-naive AMI patients.

Source:

Gagliardi, O. M., Alisi, L., Visioli, G., Dini, F., Albanese, G. M., Scordari, S., Marenco, M., Lambiase, A., & Giustolisi, R. (2025). OCT predictors of retinal atrophy in neovascular age-related macular degeneration treated with aflibercept. International Journal of Ophthalmology, 18(4), 648–655. https://doi.org/10.18240/ijo.2025.04.11