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Purpose: Spectral-domain OCT angiography (SD-OCTA) scans were tested in an algorithm developed for use with swept-source OCT angiography (SS-OCTA) scans to determine if SD-OCTA scans yielded similar results for the detection and measurement of persistent choroidal hypertransmission defects (hyperTDs)., Design: Retrospective study., Participants: Forty pairs of scans from 32 patients with late-stage nonexudative age-related macular degeneration (AMD)., Methods: Patients underwent both SD-OCTA and SS-OCTA imaging at the same visit using the 6 × 6 mm OCTA scan patterns. Using a semiautomatic algorithm that helped with outlining the hyperTDs, 2 graders independently validated persistent hyperTDs, which are defined as having a greatest linear dimension ≥250 μm on the en face images generated using a slab extending from 64 to 400 μm beneath Bruch's membrane. The number of lesions and square root (sqrt) total area of the hyperTDs were obtained from the algorithm using each imaging method., Main Outcome Measures: The mean sqrt area measurements and the number of hyperTDs were compared., Results: The number of lesions and sqrt total area of the hyperTDs were highly concordant between the 2 instruments (r c  = 0.969 and r c  = 0.999, respectively). The mean number of hyperTDs was 4.3 ± 3.1 for SD-OCTA scans and 4.5 ± 3.3 for SS-OCTA scans ( P  = 0.06). The mean sqrt total area measurements were 1.16 ± 0.64 mm for the SD-OCTA scans and 1.17 ± 0.65 mm for the SS-OCTA scans ( P < 0.001). Because of the small standard error of the differences, the mean difference between the scans was statistically significant but not clinically significant., Conclusions: Spectral-domain OCTA scans provide similar results to SS-OCTA scans when used to obtain the number and area measurements of persistent hyperTDs through a semiautomated algorithm previously developed for SS-OCTA. This facilitates the detection of atrophy with a more widely available scan pattern and the longitudinal study of early to late-stage AMD., Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (© 2024 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology.)

Purpose: En face OCT imaging was investigated as a method for the detection and monitoring of calcified drusen in eyes with nonexudative age-related macular degeneration (AMD)., Design: Retrospective case series of a prospective study., Participants: Patients with nonexudative AMD., Methods: A retrospective review was performed of same-day color fundus (CF), fundus autofluorescence (FAF), near-infrared (NIR), and en face swept-source (SS) OCT images to identify eyes with nonexudative AMD and calcified drusen. The appearance and progression of these lesions were compared using the different imaging methods., Main Outcome Measures: Comparison between the presence of calcified drusen observed on CF images with the detection of these lesions on FAF, NIR, and en face SS OCT images., Results: Two hundred twenty eyes from 139 patients with nonexudative AMD were studied, with 42.7% of eyes containing calcified drusen either at baseline or during follow-up visits. On the en face SS OCT images, calcified drusen appeared as dark focal lesions referred to as choroidal hypotransmission defects (hypoTDs) that were detected in the choroid using a sub-retinal pigment epithelium (RPE) slab. The corresponding B-scans showed drusen with heterogenous internal reflectivity, hyporeflective cores, and hyperreflective caps. In most calcified drusen, choroidal hypertransmission defects (hyperTDs) were observed to develop over time around the periphery of the hypoTDs, giving them the appearance of a donut lesion on the en face SS OCT images. These donut lesions were associated with significant attenuation of the overlying retina, and the corresponding FAF images showed hypoautofluorescence at the location of these lesions. The donut lesions fulfilled the requirement for a persistent hyperTD, which is synonymous with complete RPE and outer retinal atrophy (cRORA). Six eyes displayed regression of the calcified drusen without cRORA developing. B-scans at the location of these regressed calcified drusen showed deposits along the RPE, with outer retinal thinning in the regions where the calcified lesions previously existed., Conclusions: En face OCT imaging is a useful method for the detection and monitoring of calcified drusen and can be used to document the evolution of these drusen as they form donut lesions or foci of cRORA.

Purpose: The impact of cataract surgery on low luminance visual acuity deficit (LLVAD) measurements was investigated by measuring the LLVAD before and after cataract surgery., Design: Prospective, longitudinal study., Participants: Patients undergoing cataract surgery., Methods: Photopic luminance (PL)-best-corrected visual acuity (BCVA) and low luminance (LL)-BCVA were obtained using the ETDRS chart. Low luminance visual acuity deficit scores were calculated by subtracting the LL-BCVA letter score from the PL-BCVA letter score. To demonstrate the reproducibility of these visual acuity measurements, we used data from drusen-only eyes previously published in the Complement Inhibition with Eculizumab for the Treatment of Nonexudative Age-Related Macular Degeneration (COMPLETE) study. The PL-BCVA, LL-BCVA, and LLVAD measurements obtained at an interval of 3 months in this cohort were used for comparison. In the current study, the impact of cataract surgery on LLVAD measurements was analyzed by comparing the PL-BCVA, LL-BCVA, and LLVAD measurements before and after cataract surgery., Main Outcome Measures: The reproducibility of the visual acuity measurements and the changes in LLVAD measurement after cataract surgery., Results: In the COMPLETE study, no clinically significant differences were found in the PL-BCVA, LL-BCVA, or LLVAD measurements between baseline and the 3-month follow-up visits with a change of -1.1 letters, -1.3 letters, and 0.1 letters, respectively ( P  = 0.02, P  = 0.11, and P  = 0.88, respectively). In the current study, significant increases were found in the PL-BCVA and LL-BCVA measurements, with a change of 7.3 letters and 10.2 letters after cataract surgery ( P < 0.001 for both), and a statistically significant decrease in LLVAD measurements was found, with a change of -3.0 letters after cataract surgery ( P  = 0.002)., Conclusions: Because of the variable effect of cataracts on LL-BCVA measurements and the significant change in LLVAD measurements after cataract surgery, investigators should be aware that cataract surgery during a trial will have an unpredictable impact on LLVAD measurements, and pseudophakic and phakic patients should be analyzed separately., (© 2022 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology.)

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., (© 2022 by the American Academy of Ophthalmology.)