PurposeTo evaluate real-world agreement between a CE-marked OCT-based AI decision-support system and routine retreatment decisions for neovascular AMD within a teleophthalmology workflow.MethodsRetrospective clinical study including 429 OCT examinations from 247 patients (306 treated eyes) with neovascular AMD. Retinal specialists made routine retreatment decisions (“inject” vs “watch-and-wait”) using full clinical context. Independently, the AI system (deepeye® TPS, version 1.2) analyzed the current OCT volume only (no prior OCT, visual acuity, treatment interval, or clinical notes) and generated a Disease Activity Score (DAS; 0–100) used to derive an “inject” vs “watch-and-wait” recommendation. Discrepant cases were re-evaluated by senior graders to establish a double-senior-graded (DSG) reference standard. Implementation analyses assessed a deferral (“safety zone”) strategy. Main outcome measures included agreement/accuracy, sensitivity, and specificity versus real-world decisions and the double-senior-graded (DSG) reference standard, as well as decision coverage under deferral.ResultsAgreement between real-world decisions and AI recommendations was 83.2% (sensitivity 74.7%, specificity 88.0%). Against the double-senior-graded reference standard (DSG), accuracy in the full analysis set (FAS), analyzed at the examination level, was 85.5% (sensitivity 77.2%, specificity 90.4%). Using an empirically optimized DAS threshold, accuracy increased to 88.6% (sensitivity 78.5%, specificity 94.9%) in the eligible retreatment-decision set (ERDS). Application of a deferral policy (“safety zone”, DAS 33–64) resulted in automated recommendations for 78.4% of eligible examinations, while 21.6% were deferred due to intermediate DAS values; among examinations with an automated recommendation, accuracy was 92.3% (sensitivity 83.2%, specificity 97.5%). Most misclassifications involved subtle IRF/SRF and SHRM as identified by the reading center and tended to be underestimated by the AI.ConclusionThe evaluated OCT-only AI decision-support output showed substantial agreement with routine retinal-specialist retreatment decisions in a real-world teleophthalmology workflow, particularly when intermediate Disease Activity Scores were deferred to human review. However, false-negative cases and context-dependent discrepancies highlight that the system should support, not replace, clinician judgement. Prospective multicenter validation using longitudinal and multimodal input data is required before broader workflow integration can be recommended.
Purpose: Macular atrophy (MA) can develop during long-term anti-angiogenic therapy in neovascular AMD (nAMD). This study characterizes the development of MA, associated changes in macular neovascularization (MNV), and the functional consequences. Patients and methods: MNV and MA size were analyzed in 143 eyes from 94 patients with nAMD (31 male, 63 female; mean age: 75.9 ± 7.5 years; mean follow-up: 5.23 ± 2.34 years; mean 7.0 ± 2.3 injections/year). MNV and MA areas were delineated on optical coherence tomography (OCT) B-scans, transposed onto near-infrared images, and quantified at baseline and annually. Best-corrected visual acuity (BCVA) and additional features, including serous pigment epithelial detachment (PED) and subretinal drusenoid deposits (SDD), were also recorded. Results: MA was present at baseline in 10.5% of eyes and developed in an additional 54.7% during follow-up, with a mean onset at 2.44 ± 1.51 years. Larger MNV size (p = .001) and faster MNV growth (p = .03) were significantly associated with MA development, as well as the presence of SDD (p = .001) and PED (p = .02). MA was linked to significantly reduced BCVA (p = .0024) especially after subfoveal involvement. Conclusion: MA commonly emerges during long-term anti-angiogenic therapy in nAMD and is functionally relevant, especially when the fovea is involved. Its development appears primarily associated with MNV size and progression resulting from MNV transformation. These findings suggest that MA and MNV transformation (“fibrosis”) represent two facets of the same pathological process contributing to vision loss. Consequently, preventing MA in nAMD could become an important target for future therapeutic strategies.
PURPOSE:To highlight the role of en face OCT in the measurement of choroidal hypertransmission defects (hyperTDs) in complete retinal pigment epithelial and outer retinal atrophy (cRORA), and to refine the definition of retinal pigment epithelium (RPE)-related alterations associated with cRORA. DESIGN:Consensus meeting. PARTICIPANTS:Panel of retina specialists, including retinal imaging experts, reading center leaders, and retinal histologists. METHODS:As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analyzed and discussed the role of en face OCT in the assessment of cRORA. A structured study was conducted, consisting of an exercise to assess en face OCT cases, reviewed jointly during the eighth CAM meeting, and to explore the utility of this advanced tool for disease staging and progression. Additionally, definitions previously applied to RPE abnormalities were discussed and refined leading to modifications. The current report summarizes the methods used during the consensus meeting and the outcomes achieved as pertains to the application of en face OCT for cRORA grading and simplification of the RPE assessment criteria. MAIN OUTCOME MEASURES:Defining the role of en face OCT in the detection and quantification of hyperTDs, improving classification of cRORA, and refining the terminology related to RPE alterations to enhance grading consistency. RESULTS:During the consensus case discussions, high levels of agreement were achieved for hyperTD detection using en face OCT. The CAM group affirmed the role of en face OCT as a critical adjunct to traditional B-scan analysis, for more precise measurement of the area of cRORA lesions and for distinguishing threshold cRORA from smaller incomplete retinal pigment epithelial and outer retinal atrophy lesions. Additionally, merger of RPE attenuation and RPE disruption into a unified category termed "abnormal RPE band" significantly reduced interreader variability, leading to greater consistency among graders. CONCLUSIONS:The integration of en face OCT with cross sectional B-scan imaging enhances the accurate classification and area measurement of early atrophic alterations in age-related macular degeneration, improving diagnostic consistency and lesion assessment. The consensus panel's adoption of the abnormal RPE band term as a unified category for RPE abnormalities may reduce confusion regarding the definition of RPE degeneration and has the potential to improve interreader variability. FINANCIAL DISCLOSURE(S):The authors have no proprietary or commercial interest in any materials discussed in this article.
