Swept-source optical coherence tomography angiography features of sub-retinal fibrosis in neovascular age-related macular degeneration

ImportanceThe study highlights the role of optical coherence angiography in the management of patients with neovascular age-related macular degeneration (nAMD) who have developed sub-retinal fibrosis. BackgroundDevelopment of sub-retinal fibrosis in the context of nAMD is known to adversely affect visual function. The aim of this study is to assess structure and flow features obtained through swept-source optical coherence tomography angiography (OCTA) in patients with sub-retinal fibrosis and associate these with visual acuity (VA). DesignInstitutional retrospective cohort study. ParticipantsA total 39 eyes of 39 patients with nAMD with sub-retinal fibrosis imaged with OCTA were included in this study. MethodsPatients underwent swept-source OCTA. Thickness of sub-retinal hyper-reflective material (SHRM) and presence and configuration of a choroidal neovascular membrane were recorded in each case. Main Outcome MeasuresA univariate multiple regression was performed seeking associations between VA and structural and flow OCTA features. ResultsAverage VA on the date of OCTA was 5322 ETDRS letters. Average thickness of centre-involving SHRM was 157 +/- 73m. A choroidal neovascular membrane was detectable in 26 cases and not detectable in 13. VA was independently influenced by thickness of SHRM (P=0.034) and presence of a detectable choroidal neovascular membrane (P=0.02) on OCTA. Conclusions and RelevancePoorer VA in patients with nAMD and sub-retinal fibrosis is associated with presence of a detectable neovascular membrane on OCTA. The role of OCTA to guide nuanced management decisions in this patient population may be significant.