Purpose of review Geographic atrophy, the advanced form of dry age-related macular degeneration (AMD), has historically been evaluated using structural endpoints and best-corrected visual acuity (BCVA). This review examines the growing rationale for a function-first approach. Recent findings Emerging data demonstrate that functional deficits often decline earlier and more profoundly than BCVA. Recently approved complement inhibitors have shown slowing of geographic atrophy lesion growth but without consistent improvements in traditional visual acuity endpoints. Extension studies and post hoc analyses suggest some functional benefits. Next-generation therapies are increasingly incorporating functional endpoints into trial design. Summary Structural slowing alone does not fully capture therapeutic value in geographic atrophy. Functional measures provide a more sensitive and patient-centered assessment of disease progression and treatment impact.
PURPOSE:To describe a novel optical coherence tomography finding called "scolex sign" in cases of central serous chorioretinopathy. METHODS:This retrospective multicenter study included patients with central serous chorioretinopathy with serous pigment epithelial detachments (PEDs) greater than 100 µ m, with or without subretinal fluid. Eyes showing a distinct hyperreflective focus on the PED wall (scolex sign) were analyzed. An equal number of age-matched controls with PEDs but without the scolex sign were included. Multimodal imaging data were reviewed. A subgroup analysis based on subretinal fluid status was also performed. RESULTS:Of 291 eyes with large serous PEDs, 52 eyes exhibited the "scolex sign" and were compared with 52 age-matched controls. Baseline characteristics including sex, systemic comorbidities, best-recorded visual acuity and optical coherence tomography parameters were similar in both the groups. However, eyes with the "scolex" sign exhibited a greater number of central PEDs and shorter distance from the foveal center. On follow-up, eyes with the "scolex" sign showed a higher rate of PED flattening and subretinal fluid resolution trended to be higher compared with controls. CONCLUSION:The "scolex" sign represents a novel, benign optical coherence tomography feature seen in a subset of central serous chorioretinopathy cases. While not associated with poorer outcomes or adverse sequelae, it may reflect ongoing reparative changes, indicating a resolving stage of the disease.
Aflibercept 8 mg demonstrated comparable visual and anatomic improvements versus 2 mg in patients with diabetic macular edema at week 96, regardless of baseline best-corrected visual acuity ≤20/50 versus ≥20/40.
