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Age-related macular degeneration: choroidal ischaemia?
  1. D Jackson Coleman1,
  2. Ronald H Silverman1,2,
  3. Mark J Rondeau3,
  4. Harriet O Lloyd1,
  5. Aziz A Khanifar4,
  6. R V Paul Chan5
  1. 1Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA
  2. 2F.L. Lizzi Center for Biomedical Engineering, Riverside Research, New York, New York, USA
  3. 3The Self-Similar Group, LLC, New York, New York, USA
  4. 4The Retina Group of Washington, Silver Spring, Maryland, USA
  5. 5Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr D Jackson Coleman, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, 635 West 165th Street, New York, NY 10032, USA; djceye{at}gmail.com

Abstract

Aim Our aim is to use ultrasound to non-invasively detect differences in choroidal microarchitecture possibly related to ischaemia among normal eyes and those with wet and dry age-related macular degeneration (AMD).

Design Prospective case series of subjects with dry AMD, wet AMD and age-matched controls.

Methods Digitised 20 MHz B-scan radiofrequency ultrasound data of the region of the macula were segmented to extract the signal from the retina and choroid. This signal was processed by a wavelet transform, and statistical modelling was applied to the wavelet coefficients to examine differences among dry, wet and non-AMD eyes. Receiver operating characteristic (ROC) analysis was used to evaluate a multivariate classifier.

Results In the 69 eyes of 52 patients, 18 did not have AMD, 23 had dry AMD and 28 had wet AMD. Multivariate models showed statistically significant differences between groups. Multiclass ROC analysis of the best model showed an excellent volume-under-curve of 0.892±0.17. The classifier is consistent with ischaemia in dry AMD.

Conclusions Wavelet augmented ultrasound is sensitive to the organisational elements of choroidal microarchitecture relating to scatter and fluid tissue boundaries such as seen in ischaemia and inflammation, allowing statistically significant differentiation of dry, wet and non-AMD eyes. This study further supports the association of ischaemia with dry AMD and provides a rationale for treating dry AMD with pharmacological agents to increase choroidal perfusion.

ClinicalTrials.gov registration NCT00277784.

  • Choroid
  • Macula
  • Degeneration
  • Treatment Medical
  • Imaging

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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