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Purpose <p>To compare macular atrophy following neovascular age-related macular degeneration (nAMD) vs. geographic atrophy (GA) following dry AMD.</p> Methods <p>We analysed 60 eyes from 44 patients: 30 eyes with de novo GA and 30 with macular atrophy secondary to nAMD. All patients had monthly follow-ups before GA onset and continued for at least two years after. GA was defined as complete retinal pigment epithelium atrophy ≥250 μm using OCT scans. OCT biomarkers at GA onset, including central macular thickness (CMT), subfoveal choroidal thickness (SFCT), epiretinal membrane (ERM), double-layer sign (DLS), subretinal hyperreflective material (SRHM), hyperreflective foci (HRF), outer retinal tubulation (ORT), and intraretinal fluid (IRF), were assessed. Chi-square test, Spearman correlation, and linear mixed models were used.</p> Results <p>The mean age was 80.06 ± 8.60 years, with 50.0% male. Eyes with nAMD progressed to macular atrophy after 31.38 ± 30.72 months and 8.86 ± 10.84 anti-vascular endothelial growth factor (VEGF) injections. Compared to de novo GA, eyes with macular atrophy following nAMD had larger baseline atrophic area (3.791 ± 2.661 mm² vs. 1.115 ± 0.951 mm²; P &lt; 0.001) and greater atrophy growth (2.646 ± 2.014 mm² vs. 0.652 ± 0.722 mm²; P &lt; 0.001), with more frequent ERM, DLS, HRF, SRHM, ORT, and IRF. Atrophy growth correlated with baseline SFCT (r = –0.545, P = 0.002) and GA area (r = 0.501, P = 0.005) but not with the number of anti-VEGF injections (p &gt; 0.05).</p> Conclusion <p>Eyes with macular atrophy secondary to nAMD exhibit larger initial atrophic areas and faster progression compared to de novo GA. OCT biomarkers may detect previous exudation, helping identify cases where recently FDA-approved GA therapies may be relatively contraindicated due to prior disease.</p>

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Differentiation of macular atrophy secondary to neovascular age-related macular degeneration vs. de novo geographic atrophy: a multimodal analysis

  • 期刊论文

  • 发表日期：

    2026年2月19日

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  • Elham Sadeghi,
  • Joseph DeCicco,
  • Priyanka Gandhi,
  • Nasiq Hasan,
  • Benjamin DiCenzo,
  • Jessica Ye Jiang,
  • Elham Rahmanipour,
  • Jose-Alein Sahel,
  • Andrew W. Eller,
  • Jay Chhablani

摘要

Purpose

To compare macular atrophy following neovascular age-related macular degeneration (nAMD) vs. geographic atrophy (GA) following dry AMD.

Methods

We analysed 60 eyes from 44 patients: 30 eyes with de novo GA and 30 with macular atrophy secondary to nAMD. All patients had monthly follow-ups before GA onset and continued for at least two years after. GA was defined as complete retinal pigment epithelium atrophy ≥250 μm using OCT scans. OCT biomarkers at GA onset, including central macular thickness (CMT), subfoveal choroidal thickness (SFCT), epiretinal membrane (ERM), double-layer sign (DLS), subretinal hyperreflective material (SRHM), hyperreflective foci (HRF), outer retinal tubulation (ORT), and intraretinal fluid (IRF), were assessed. Chi-square test, Spearman correlation, and linear mixed models were used.

Results

The mean age was 80.06 ± 8.60 years, with 50.0% male. Eyes with nAMD progressed to macular atrophy after 31.38 ± 30.72 months and 8.86 ± 10.84 anti-vascular endothelial growth factor (VEGF) injections. Compared to de novo GA, eyes with macular atrophy following nAMD had larger baseline atrophic area (3.791 ± 2.661 mm² vs. 1.115 ± 0.951 mm²; P < 0.001) and greater atrophy growth (2.646 ± 2.014 mm² vs. 0.652 ± 0.722 mm²; P < 0.001), with more frequent ERM, DLS, HRF, SRHM, ORT, and IRF. Atrophy growth correlated with baseline SFCT (r = –0.545, P = 0.002) and GA area (r = 0.501, P = 0.005) but not with the number of anti-VEGF injections (p > 0.05).

Conclusion

Eyes with macular atrophy secondary to nAMD exhibit larger initial atrophic areas and faster progression compared to de novo GA. OCT biomarkers may detect previous exudation, helping identify cases where recently FDA-approved GA therapies may be relatively contraindicated due to prior disease.