German investigators performed a prospective interventional case series in which they applied different tests to assess the sensitivity of patient self-control; Amsler grid and visual acuity (VA) assessment, as well as fundus examinations to reveal recurrent choroidal neovascularization (CNV) activity in age-related macular degeneration as detected by spectral domain optical coherence tomography (SD-OCT) in monthly controls.

They examined a series of patients with exudative age-related macular degeneration (AMD) that received ranibizumab injections until complete resolution of fluid in SD-OCT. They conducted an analysis of changes in subjective perception, Amsler grid, early treatment diabetic retinopathy study (ETDRS) VA, Radner reading VA and fundus examination in the case of OCT-confirmed CNV recurrences.

Out of 40 morphological recurrences determined by SD-OCT, six (15%) were noticed by subjective patient perception. According to the investigators, Amsler grid testing revealed deterioration in 12 cases (30%); 11 recurrences (28%) were accompanied by loss of ≥5 letters in ETDRS VA and/or ≥1 line in Radner VA; fundus examination showed signs of novel CNV activity in 10 out of 40 recurrences (25%). They reported that the combined sensitivity of all diagnostic methods compared to SD-OCT for recurrence detection was 67.5% (27 out of 40 recurrences).

Subjective patient perception, Amsler grid, VA and fundus examination lead to pronounced underestimations of CNV recurrences, the investigators determined. They concluded that morphologic recurrences can be detected prior to functional deterioration and as any delay of treatment can result in irreversible vision loss, attempts should be made to provide monthly OCT controls to detect recurrences as early as possible.

An Italian observational, cross-sectional evaluation of diagnostic tests explored and compared the influence of optic size on the diagnostic accuracy of retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) quantitative assessment.

Included were 120 eyes of 50 normal subjects and 70 glaucomatous patients classified by the presence of a repeatable visual field defect for the analysis. The RNFL thickness was measured by scanning laser polarimetry with variable corneal compensator (GDx-VCC, Carl-Zeiss Meditec) and spectral-domain optical coherence tomography (Cirrus HD-OCT). Imaging was obtained by means of confocal scanning laser ophthalmoscopy (HRT3; Heidelberg Engineering, GmbH). Main outcome measures were sensitivity and specificity for normative classifications, sensitivity at fixed specificity and area under the receiving operating characteristics curve (AUC) for continuous parameters. A logistic marginal regression model and coefficients of variation (CoV) have been used to test and quantify the influence of optic disc size on the diagnostic accuracy of the 3 technologies under investigation.

Among continuous parameters average RNFL thickness for Cirrus HD-OCT, nerve fiber indicator for GDx-VCC and cup shape measure for the HRT3 showed the best diagnostic accuracy with an AUC of 0.97, 0.94 and 0.94, respectively. Among normative classifications, the highest sensitivity and specificity were found for OCT average RNFL thickness (75.8% and 94.7%), for GDx superior thickness (77.1% and 97.5%), for HRT3 Moorfields regression analysis result (89.4% and 73.7%) and for HRT3 GPS global (92.3% and 76.5%). It was reported that the diagnostic performance of HRT3 parameters seemed to be significantly influenced by optic disc size, although the same was not true for Cirrus HD-OCT and GDx VCC. The most steady performers for each imaging device across disc groups were Cirrus HD-OCT average thickness (CoV, 1.6%), GDx-VCC inferior thickness (CoV, 2.5%) and HRT3 GPS temporal and nasal (CoV, 21.4%).

To conclude, the diagnostic accuracy of quantitative RNFL assessment as performed by Cirrus HD-OCT and GDx-VCC is high and virtually unaffected or only minimally affected by the size of the optic disc and may provide more consistent diagnostic outcomes across small and large discs than ONH assessment as performed by HRT3.

To evaluate the role of the fellow eye status for progression of geographic atrophy (GA) in patients with age-related macular degeneration (AMD), the authors of this study classified 300 eyes with GA of 193 patients from the prospective, longitudinal natural history FAM-Study into 3 groups according to the AMD manifestation of the fellow eye at baseline examination: (1) bilateral GA, (2) early/intermediate AMD, and (3) exudative AMD. They quantified the GA areas based on fundus autofluorescence images using a semi-automated image processing method and estimated progression rates (PR) using 2-level linear mixed effects-models.

Crude GA-PR in the bilateral GA group (mean 1.64mm²/year, 95% CI [1.478;1.803]) was significantly higher compared to the fellow eye early/intermediate group (0.74mm²/year [0.146;1.342]), the authors found. Although there was significant difference in baseline GA-size (p=0.0013, t-test), and there was a significant increase of GA-PR by 0.11mm²/year (95% CI [0.05; 0.17]) per one disc area (1DA=2.54mm²), an additional mean change of –0.79 (95% CI [–1.43, –0.15]) was given to the PR beside the effect of baseline GA size. However, according to the authors, this difference was only significant when GA size was ≥1DA at baseline with a GA-PR of 1.70mm²/year, 95% CI [1.54; 1.85] in the bilateral and 0.95mm²/year [0.37; 1.54] in the early/intermediate group. They determined that there was no significant difference in PR comparing with the fellow-eye exudative group.

The results indicate that the AMD manifestation of the fellow eye at baseline serves as an indicator for disease progression in eyes with GA ≥ 1DA. Predictive characteristics may not only contribute to the understanding of pathophysiological mechanisms, but are also useful for the design of future interventional trials in GA patients.