title: Spectral domain optical coherence tomography-determined morphologic predictors of age-related macular degeneration-associated geographic atrophy progression.
abstract: OBJECTIVE
  To correlate spectral domain optical coherence tomography (SD OCT)-determined morphologic alterations in eyes with geographic atrophy because of age-related macular degeneration with lesion size, enlargement rate, and the presence of multifocal patches of atrophy.
  
  
  METHODS
  Forty-three eyes of 43 patients with age-related macular degeneration-associated geographic atrophy were visualized by SD OCT and fundus autofluorescence imaging. The baseline area of geographic atrophy and enlargement rates over at least 24 weeks were calculated from the fundus autofluorescence images. The mean and median follow-up times were 47.4 and 48 weeks, respectively. Morphologic alterations were evaluated in the baseline SD OCT images. Ninety-seven SD OCT scans per eye were graded and included in the analysis. Correlations between morphologic alterations and the rate of lesion enlargement, size, and focality, and the diffuse trickling fundus autofluorescence pattern were determined.
  
  
  RESULTS
  The mean and median enlargement rates were 2.07 mm(2)/year (n = 43; SD, 1.30) and 2.02 mm(2)/year, respectively. Outer retinal tubulations (P = 0.003) and irregular elevations of the retinal pigment epithelium/Bruch membrane complex (P < 0.001) in the atrophic region, and splitting of the retinal pigment epithelium/Bruch membrane complex at 2 junctional zone borders (P = 0.02) correlated with faster enlargement. Outer retinal tubulations (P = 0.096), irregular elevations of the retinal pigment epithelium/Bruch membrane complex (P = 0.010), and crown-like elevations with debris beneath in the atrophic region (P = 0.063) correlated with larger lesion size. Hyperreflective plaques in the outer retina appeared more frequently in eyes with multifocal patches of atrophy (P = 0.005).
  
  
  CONCLUSIONS
  Distinct morphologic alterations visible on SD OCT imaging in eyes with geographic atrophy because of age-related macular degeneration are associated with faster enlargement rates, larger lesion size, and multifocal patches of atrophy.
authors.affiliation: Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Kareem
authors.initials: K
authors.lastname: Moussa
authors.forename: Joo Yong
authors.initials: JY
authors.lastname: Lee
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Jaffe
mesh_terms: D016570:Bruch Membrane / Q000473:pathology; D018450:Disease Progression; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D057092:Geographic Atrophy / Q000175:diagnosis*; D006801:Humans; D055213:Retinal Pigment Epithelium / Q000473:pathology; D041623:Tomography, Optical Coherence / Q000379:methods*