Longitudinal Assessment of Ellipsoid Zone Integrity, Subretinal Hyperreflective Material, and Subretinal Pigment Epithelium Disease in Neovascular Age-Related Macular Degeneration

Justis P. Ehlers, Robert Zahid, Peter K. Kaiser, Jeffrey S. Heier, David M. Brown, Xiangyi Meng, Jamie Reese, Thuy K. Le, Leina Lunasco, Ming Hu, Sunil K. Srivastava

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Purpose: To assess longitudinally the effect of anti–vascular endothelial growth factor (VEGF) treatment on ellipsoid zone (EZ) integrity, subretinal hyperreflective material (SHRM), and the sub–retinal pigment epithelium (sub-RPE) compartment in eyes with neovascular age-related macular degeneration (nAMD). Design: Post hoc analysis of the OSPREY clinical trial, a prospective, double-masked, phase 2 study comparing brolucizumab 6 mg with aflibercept 2 mg over 56 weeks. Participants: Participants with treatment-naïve nAMD at the initiation of the trial were included in the analysis. Methods: Eyes were evaluated with spectral-domain OCT at 4-week intervals in the OSPREY trial (n = 81). Spectral-domain OCT scans collected from each visit were segmented automatically using a proprietary, machine learning–enabled higher-order feature-extraction platform for retinal layer, SHRM, and sub-RPE boundary lines, which were evaluated and corrected as needed by masked trained graders. The current analysis focused only on patients evaluated with the Cirrus (Zeiss) platform (n = 28). Main Outcome Measures: Outcome measures included change from baseline in EZ-RPE (i.e., photoreceptor outer segment) volume, EZ-RPE central subfield thickness (CST), total EZ attenuation, SHRM volume, SHRM CST, and total sub-RPE volume. The correlation between each of these measures and best-corrected visual acuity (BCVA) at each visit was evaluated. Results: EZ-RPE volume and EZ-RPE CST showed significant increases, and total EZ attenuation, SHRM volume, SHRM CST, and total sub-RPE volume showed significant decreases from baseline at each visit from weeks 4 through 56 (P < 0.05 at each visit). Ellipsoid zone integrity measures and SHRM volume correlated significantly with BCVA at most visits (P < 0.05). No significant correlation was found between total sub-RPE volume and BCVA. Conclusions: EZ integrity, SHRM, and sub-RPE disease features in eyes with nAMD showed improvement as early as week 4 of anti-VEGF treatment. EZ integrity measures and SHRM volume were predictors of visual acuity over the first year of treatment.

Original languageEnglish (US)
Pages (from-to)1204-1213
Number of pages10
JournalOphthalmology Retina
Volume5
Issue number12
DOIs
StatePublished - Dec 2021

Keywords

  • Ellipsoid zone
  • OCT
  • neovascular age-related macular degeneration
  • subretinal hyperreflective material
  • sub–retinal pigment epithelium

ASJC Scopus subject areas

  • Ophthalmology

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