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Retinal pigment epithelial features indicative of neovascular progression in age-related macular degeneration
  1. Philipp K Roberts1,
  2. Bernhard Baumann2,
  3. Ferdinand G Schlanitz1,
  4. Stefan Sacu1,
  5. Matthias Bolz1,
  6. Michael Pircher2,
  7. Michael Hagmann3,
  8. Christoph K Hitzenberger2,
  9. Ursula Schmidt-Erfurth1
  1. 1Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  2. 2Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
  3. 3Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Professor Ursula Schmidt-Erfurth, Department of Ophthalmology and Optometry of the Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria;{at}


Background/aims To identify characteristic retinal pigment epithelium (RPE) changes in fellow eyes of patients with neovascular age-related macular degeneration (nAMD) using polarisation-sensitive optical coherence tomography (PS-OCT).

Methods Thirty-one fellow eyes of 31 patients with unilateral nAMD were evaluated in this cohort study of a prospective interventional trial. PS-OCT as well as conventional imaging including spectral-domain (SD)-OCT and fluorescein angiography (FA) were performed using a standardised protocol. Monitoring visits were performed continuously at 1-month intervals. Morphological RPE features associated with the development of choroidal neovascularisation (CNV) were systematically analysed.

Results Mean follow-up was 29 months (±17, SD). Thirteen (42%) of 31 eyes developed de novo CNV: 9 eyes type I CNV, 2 eyes type II CNV, 2 eyes a retinal angiomatous proliferation lesion. RPE thickening and reticular pseudodrusen (RPD) were observed significantly more often in eyes that developed CNV than in eyes without CNV development (p<0.01). Monthly increase in drusen volume was higher in the CNV group with a median increase of +2.2% in area and +2.9% in volume compared with +0.8% and +0.6% in the non-progressing group. RPE migration within the neurosensory retina and at the level of the RPE resulting in RPE thickening was seen topographically and chronologically associated with CNV development.

Conclusions Conversion to CNV is associated with RPE-related changes such as RPE migration, RPE thickening, drusen volume or the presence of RPD. Early detection of these features may allow more efficient screening in risk eyes and timely vision-preserving treatment in eyes developing neovascular disease.

  • Macula
  • Neovascularisation
  • Retina
  • Imaging

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  • Contributors PKR contributed to the conception and design of the study, the analysis and interpretation of data, data collection, literature search and wrote the article. BB, FGS, MB, MP and CKH contributed to the analysis and interpretation of data, the critical revision of the article, provision of technical resources for data collection as well as technical support; MH contributed his statistical expertise and interpretation of the data; SS and FGS contributed to the data collection, analysis and interpretation and US-E contributed to the conception and design of the study, interpretation of the data, provision of resources, the obtaining of funding, administrative support and a critical revision of the article including final approval for submitting.

  • Funding CKH has received support by an independent scientific grant (FWF grant P19624-B02, Austrian Science Fund, Vienna, Austria), the European Union (FP7 HEALTH programme grant 201880, FUN-OCT, Brussels, Belgium) and Canon (Tokyo, Japan).

  • Competing interests US-E receives consultancy, lecture fees and travel support from Alcon Laboratories (Fort Worth, Texas), Bayer Healthcare (Vienna, Austria), Novartis (Basel, Switzerland), Allergan (Irvine, California) and Boehringer (Ingelheim, Germany). PKR, CKH, MP and BB have received support from Canon (Tokyo, Japan).

  • Ethics approval Ethics committee of the Medical University of Vienna.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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