Atrophic Lesions Associated with Age-related Macular Degeneration: High-resolution versus Standard Optical Coherence Tomography

The objective of this study was to determine whether high-resolution optical coherence tomography (HR-OCT) could enhance the identification and classification of atrophic features in age-related macular degeneration (AMD) compared to standard resolution OCT. Prospective, observational, cross-sectional study. The study included 60 eyes from 60 patients over the age of 60 with a diagnosis of AMD. The participants underwent volume OCT scanning using HR-OCT and standard resolution OCT devices. Trained graders reviewed and graded the scans, identifying specific regions of interest for subsequent analysis. The study focused on identifying and classifying complete retinal pigment epithelium and outer retinal atrophy (cRORA), incomplete RORA (iRORA), and other non-atrophic AMD features. Additionally, qualitative and quantitative features associated with atrophy were assessed. The agreement among readers for classifying atrophic lesions was substantial to perfect for both HR-OCT (0.88) and standard resolution OCT(0.82). However, HR-OCT showed higher accuracy in identifying iRORA lesions compared to standard OCT. Qualitative assessment of features demonstrated higher agreement for HR-OCT, particularly in identifying ELM (0.95) and EZ disruption (0.94). Quantitative measurements of features such as hypertransmission defects, RPE attenuation/disruption, EZ disruption width, and ELM disruption width showed excellent inter-reader agreement with HR-OCT (> 0.90 for all features) but only moderate agreement with standard OCT (0.51-0.60). The study results suggest that HR-OCT improves the accuracy and reliability of classifying and quantifying atrophic lesions associated with AMD compared to standard resolution OCT. The quantitative findings in particular may have implications for future research and clinical practice, especially with the availability of therapeutic agents for treating geographic atrophy (GA) and the development of commercially available HR-OCT devices.