Philipp L Müller1,2, Maximilian Pfau1,3, Philipp T Möller1,3, Jennifer Nadal4, Matthias Schmid4, Moritz Lindner1,5, Luis de Sisternes6,7, Heidi Stöhr8, Bernhard H F Weber8, Christine Neuhaus9, Philipp Herrmann1,2, Steffen Schmitz-Valckenberg1,3, Frank G Holz1,2,3, Monika Fleckenstein1,3. 1. Department of Ophthalmology, University of Bonn, Bonn, Germany. 2. Center for Rare Diseases, University of Bonn, Bonn, Germany. 3. GRADE Reading Center, Bonn, Germany. 4. Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany. 5. The Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom. 6. Department of Radiology, Stanford University, Stanford, California, United States. 7. Carl Zeiss Meditec, Inc., Dublin, California, United States. 8. Institute of Human Genetics, University of Regensburg, Regensburg, Germany. 9. Center for Human Genetics Bioscientia, Ingelheim, Germany.
Abstract
Purpose: To investigate the choroidal blood flow in areas within and adjacent to retinal pigment epithelium (RPE) atrophy secondary to late-onset Stargardt disease (STGD1) and age-related macular degeneration (AMD). Methods: A total of 43 eyes (23 STGD1 and 20 AMD) of patients with RPE atrophy and 25 eyes of healthy controls without ocular pathology underwent multimodal imaging including optical coherence tomography angiography (OCT-A; PLEX Elite 9000 Swept-Source OCT). Using an exploratory approach, choriocapillaris and deeper choroid OCT-A slabs were evaluated in order to detect differences between STGD1 and AMD. The magnitude of absence-of-flow signal (AFS) was investigated in terms of area-fraction and size-frequency distribution. Results: Qualitative and quantitative analysis of areas of RPE atrophy revealed more pronounced rarefaction of the choriocapillaris flow signal in STGD1 as compared to AMD (AFS area fraction: 33.15% ± 6.86% vs. 31.68% ± 8.39%; P = 0.517), while outside RPE atrophy rarefaction was less pronounced in STGD1 (AFS area fraction: 17.41% ± 5.67% vs. 21.59% ± 6.90%; P < 0.001), to the level of nonsignificance compared to controls (13.27% ± 2.99%, P = 0.368). Given this discrepancy, the ratio of the AFS area fraction within/outside of RPE atrophy could be used to differentiate between STGD1 and AMD with 65.0% sensitivity and 92.3% specificity. Conclusions: Using OCT-A, comparison of choroidal flow signal within and outside the area of RPE atrophy revealed distinct differences between STGD1 and AMD, potentially implicating a differential role of the choroid in the pathogenesis of RPE atrophy in these two diseases.
Purpose: To investigate the choroidal blood flow in areas within and adjacent to retinal pigment epithelium (RPE) atrophy secondary to late-onset Stargardt disease (STGD1) and age-related macular degeneration (AMD). Methods: A total of 43 eyes (23 STGD1 and 20 AMD) of patients with RPE atrophy and 25 eyes of healthy controls without ocular pathology underwent multimodal imaging including optical coherence tomography angiography (OCT-A; PLEX Elite 9000 Swept-Source OCT). Using an exploratory approach, choriocapillaris and deeper choroidOCT-A slabs were evaluated in order to detect differences between STGD1 and AMD. The magnitude of absence-of-flow signal (AFS) was investigated in terms of area-fraction and size-frequency distribution. Results: Qualitative and quantitative analysis of areas of RPE atrophy revealed more pronounced rarefaction of the choriocapillaris flow signal in STGD1 as compared to AMD (AFS area fraction: 33.15% ± 6.86% vs. 31.68% ± 8.39%; P = 0.517), while outside RPE atrophy rarefaction was less pronounced in STGD1 (AFS area fraction: 17.41% ± 5.67% vs. 21.59% ± 6.90%; P < 0.001), to the level of nonsignificance compared to controls (13.27% ± 2.99%, P = 0.368). Given this discrepancy, the ratio of the AFS area fraction within/outside of RPE atrophy could be used to differentiate between STGD1 and AMD with 65.0% sensitivity and 92.3% specificity. Conclusions: Using OCT-A, comparison of choroidal flow signal within and outside the area of RPE atrophy revealed distinct differences between STGD1 and AMD, potentially implicating a differential role of the choroid in the pathogenesis of RPE atrophy in these two diseases.
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