Multimodal Imaging, OCT B-Scan Localization, and En Face OCT Detection of Macular Hyperpigmentation in Eyes with Intermediate Age-Related Macular Degeneration

Rita Laiginhas; Jeremy Liu; Mengxi Shen; Yingying Shi; Omer Trivizki; Nadia K Waheed; Giovanni Gregori; Philip J Rosenfeld

doi:10.1016/j.xops.2022.100116

Multimodal Imaging, OCT B-Scan Localization, and En Face OCT Detection of Macular Hyperpigmentation in Eyes with Intermediate Age-Related Macular Degeneration

Ophthalmol Sci. 2022 Jan 24;2(2):100116. doi: 10.1016/j.xops.2022.100116. eCollection 2022 Jun.

Authors

Rita Laiginhas¹, Jeremy Liu¹, Mengxi Shen¹, Yingying Shi¹, Omer Trivizki¹, Nadia K Waheed², Giovanni Gregori¹, Philip J Rosenfeld¹

Affiliations

¹ Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
² New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

Abstract

Purpose: Multimodal imaging was used to identify and characterize the cause of hyperpigmentation seen on color fundus images (CFIs) of eyes with intermediate age-related macular degeneration (iAMD).

Design: Retrospective review of a prospective study.

Participants: Patients with iAMD.

Methods: Color fundus images with macular hyperpigmentation were compared with same-day images obtained using fundus autofluorescence (FAF), near infrared reflectance (NIR), and swept-source (SS) OCT imaging. Two SS OCT en face slabs were generated: a retinal slab to identify hyperreflective foci within the retina and a slab from beneath the retinal pigment epithelium (RPE; the sub-RPE slab) that was used to detect regions that cause decreased light transmission into the choroid, also known as hypotransmission defects. All images were registered to allow for qualitative comparisons by 2 independent graders.

Main outcome measures: Comparison between foci of macular hyperpigmentation seen on CFIs with the detection of these regions on FAF, NIR, and SS OCT en face images.

Results: Compared with CFIs, FAF imaging seemed to be the least sensitive method for the detection of hyperpigmentation, whereas NIR and SS OCT imaging reliably detected these hyperpigmented areas. Although NIR imaging detected most of the hyperpigmentation seen in CFIs, SS OCT imaging detected all the areas of hyperpigmentation and anatomically localized these areas by using both en face and B-scan images. En face OCT slabs of the retina and sub-RPE region were registered to the CFIs, and areas of hyperpigmentation were shown to correspond to hyperreflective foci in the retina and regions of thickened RPE seen on OCT B-scans. Although both hyperpigmentation and early atrophic lesions appeared bright on NIR imaging, en face SS OCT imaging was able to distinguish these lesions because hyperpigmentary changes appeared dark and early atrophic lesions appeared bright on the sub-RPE slab.

Conclusions: En face OCT imaging in conjunction with OCT B-scans were able to identify and localize the hyperpigmentation seen in CFIs reliably. This hyperpigmentation was not only associated with intraretinal hyperreflective foci, but also corresponded to areas with a thickened RPE.

Keywords: AMD, age-related macular degeneration; Age-related macular degeneration; CFI, color fundus image; Color fundus imaging; En face; FAF, fundus autofluorescence; FOV, field of view; Hyperpigmentation; Hyperreflective foci; Hypotransmission; NIR, near infrared; RPE, retinal pigmented epithelium; SS, swept-source; hyperTD, hypertransmission defect; hypoTD, hypotransmission defect; iAMD, intermediate age-related macular degeneration.