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New Clinical Advances in Macular Degeneration

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Special Issue Editors

Dr. Alaa Din Abdin

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Guest Editor

Department of Ophthalmology, Saarland University Medical Center (UKS), 66421 Homburg, Germany
Interests: macular degeneration

Prof. Dr. Berthold Seitz

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Guest Editor

Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, 66421 Homburg, Germany
Interests: cornea

Special Issue Information

Dear Colleagues,

Age-related macular degeneration (AMD) is a progressive macular disease that represents an increasing burden for both patients and healthcare systems worldwide. The clinical manifestations of AMD range from drusen to geographic atrophy and macular neovascularization.

Many attempts have been undertaken to improve disease classification and characterize biomarkers based on spectral-domain optical coherence tomography (SD OCT) and, more recently, OCT angiography. These validated biomarkers can be combined with clinical findings to create promising therapies.

Until a few years ago, there was no proven treatment for dry AMD. However, early and intermediate AMD have recently been recognized as multifactorial entities that respond to various therapies, including complement factors and statins. In addition, several studies have supported the use of anti-complement therapies to reduce the progression of geographic atrophy. On the other hand, many new agents against the vascular endothelial growth factor have recently been approved for the treatment of neovascular AMD. Nevertheless, we still have limited knowledge of the indication criteria and outcomes of these new treatment agents following different treatment protocols.

This Special Issue of the Journal of Clinical Medicine focuses on clinical advances in macular degeneration in terms of diagnostic methods, biomarkers, new therapeutic concepts, agents, and protocols.

Dr. Alaa Din Abdin
Prof. Dr. Berthold Seitz
Guest Editors

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Research

10 pages, 4621 KiB

Open AccessArticle

Evaluation of Retinal Sensitivity in Complete Retinal-Pigment-Epithelium and Outer Retinal Atrophy (cRORA) Lesions in Intermediate Age-Related Macular Degeneration (iAMD) by High-Resolution Microperimetry

by Marlene Saßmannshausen, Julius Ameln, Leon von der Emde, Frank G. Holz, Thomas Ach and Wolf M. Harmening

J. Clin. Med. 2024, 13(24), 7785; https://doi.org/10.3390/jcm13247785 - 20 Dec 2024

Viewed by 718

Abstract

Objective: Lesions characterized as complete retinal pigment epithelium and outer retinal atrophy (cRORA) are linked to the progression of intermediate age-related macular degeneration (iAMD). However, the extent of functional impairment of such precursor lesions remains uncertain. Methods: In this cross-sectional study, 4 participants (mean age ± standard deviation: 71.5 ± 2.1 years) underwent extensive multimodal imaging and psychophysical testing of cRORA lesions secondary to iAMD. Lesion-specific functional testing was performed using patient individualized testing grids with clinical conventional available (Stimulus size: 0.43°, ~125 µm) and experimental adaptive optics scanning light ophthalmoscope (AOSLO, stimulus size 0.07°, ~20 µm) based microperimetry (MP). One cRORA lesion site and one in-eye control region were tested per patient, respectively. Results: AOSLO imaging revealed an overall decrease in photoreceptor reflectivity, areas of hyporeflectivity over drusen, interspersed with hyperreflective foci, and disrupted photoreceptor mosaic in regions of cRORA. Localized retinal sensitivity assessment with clinical conventional MP yielded an average loss of −14.0 ± 3.3 dB at cRORA lesions compared to the in-eye control regions. In contrast, localized visual impairment assessed by high-resolution AOSLO-MP with smaller test stimuli (20 µm) revealed a sensitivity loss of −15.1 ± 5.1 dB at cRORA lesions (p < 0.01). Notably, also the area surrounding cRORA lesions can be impacted. Conclusions: We demonstrated that cRORA lesions are associated with severe localized functional impairment. cRORA precursor lesions may thus be considered as a surrogate outcome measure in future interventional iAMD trials. Full article

(This article belongs to the Special Issue New Clinical Advances in Macular Degeneration)

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15 pages, 5569 KiB

Open AccessArticle

Natural History of Visual Acuity and Microperimetry-Based Functional Outcome Measures of the Macula in Patients with Geographic Atrophy: A Retrospective Chart Review Study in Germany

by Paul Kohlhas, Alaa Din Abdin, Wissam Aljundi, Ann-Isabel Mattern, Machteld Devenijn, Kathrin Borchert, Andreas Fricke, Tammo Viering, Jürgen Wasem, Berthold Seitz and Hakan Kaymak

J. Clin. Med. 2024, 13(13), 3959; https://doi.org/10.3390/jcm13133959 - 6 Jul 2024

Viewed by 1602

Abstract

Background/Objectives: Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) leading to the progressive and irreversible loss of visual function. Characteristics of GA include atrophic lesions resulting from the loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. During GA progression, atrophic lesions typically advance from the macular periphery to the center, affecting foveal light sensitivity and visual acuity. This study analyzed changes in light sensitivity and visual acuity during the natural course of GA progression using the topographic analysis of structural and functional changes based on Early Treatment Diabetic Retinopathy Study (ETDRS) charts, multimodal imaging, and microperimetry assessment. Methods: Medical chart data of GA patients between 2014 and 2022 from the Internationale Innovative Ophthalmochirurgie GbR (I.I.O.) research center (Düsseldorf, Germany) were retrospectively analyzed. All patient eyes fulfilling the phase 3 OAKS study inclusion criteria were included and followed up for 60 months. The imputation of missing measurements and dropouts was performed by linear mixed models. Results: A total of 20 GA eyes from 13 GA patients were included in the study. At the index, 53.8% of patients had bilateral GA, with 70.0% of the eyes showing multifocal GA and 30.0% subfoveal encroachment (SFE). A total of 35.0% of the eyes had 2–5, and 15.0% over 20, areas of atrophy. Over time, the GA lesion size increased from 6.4 mm² to 11.8 mm² (1.08 mm²/year). After an average observation time of 2.9 years, 78.6% of the initially unaffected study eyes developed SFE. The percentage of study eyes without visual impairment decreased from 55.0% to 30.0%, with mean normal-luminance best-corrected visual acuity (NL-BCVA) reducing from 63.7 to 55.7 ETDRS letters. The share of absolute scotoma points in microperimetry assessment increased from 15.7% to 43.5% while overall average macular sensitivity declined from 15.7 dB to 7.4 dB. Conclusions: The substantial deterioration of macular outcomes and visual function was comprehensively detected. The results were a documentation of structural and functional aspects of the natural progression of GA for a 60-month follow-up, providing a typical outline for AMD patients with GA. Full article

(This article belongs to the Special Issue New Clinical Advances in Macular Degeneration)

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