Age-Related Macular Degeneration Diagnostics

Imaging

Retinal Imaging  

Fundus Autofluorescence  

Fundus autofluorescence helps demonstrate areas of geographic atrophy and monitor their progression. It may be used to quantify lipofuscin in the RPE.  

Fundus Fluorescein Angiography (FFA)  

Fundus fluorescein angiography is the gold standard for diagnosing CNV and AMD as it confirms the presence of CNV and its extent type, size, and location. It detects persistent or recurrent CNV following treatment. It is recommended to perform when the patient complains of new metamorphopsia with blurring of vision and/or if physical examination reveals elevation of the RPE, or retina, macular edema, subretinal blood, hard exudates or subretinal fibrosis, or if the optical coherence tomography (OCT) manifests evidence of fluid. It helps to determine the cause of visual loss that is not explained by clinical examination. It is also used to guide the treatment using Verteporfin photodynamic therapy (PDT) or laser photocoagulation surgery.  

Fundus Photography  

Once angiography is done, color fundus photography can be done to locate the pathology of the different tissue layers, to evaluate the sensory retina serous detachments, and to identify the cause of the blocked fluorescence. Stereoscopic color photographs record the appearance of the macular retina that can be used as baseline in patients with advanced non-neovascular AMD and in the follow-up of patients that has been treated. 

Indocyanine Green (ICG) Angiography  

The alternative dye, indocyanine green, is used to delineate choroidal vessel morphology and circulation. It penetrates hemorrhage and RPE better than FFA. It is useful in the assessment of specific forms of AMD such as pigment epithelium detachment (PED), poorly defined CNV, occult CNV, and lesions including retinal angiomatous proliferation or idiopathic PCV.  

Optic Coherence Tomography (OCT)  

Optic coherence tomography provides a cross-sectional view of the retina that can identify soft drusen, RPE detachments, subretinal and intraretinal fluid, CNV, cystoid macular edema, as well as the integrity of the photoreceptor and RPE layers. It helps to distinguish the causes of visual loss that are not directly associated with AMD (eg subtle epiretinal membrane or vitreomacular traction). It also allows the evaluation of the RPE and photoreceptor layer to identify the anatomic causes of metamorphopsia and visual acuity loss. It helps determine the presence of subretinal fluid and degree of retinal thickening which are the earliest manifestations of neovascularization. Lastly, it accurately follows the structural changes that can be used in evaluating the retina and RPE response to therapy.  

Optical Coherence Tomography Angiography (OCTA)  

Optical coherence tomography angiography provides non-invasive assessment of the retinal and choroidal vasculature. It is a useful test to detect new or recurrent neovascular disease activity and helps guide therapy.

Age-Related Macular Degeneration_Diagnostics