Angiogenesis 2024: Precursor lesions for development of atrophy and AMD

SriniVas R. Sadda, MD, sat down with David Hutton of Ophthalmology Times to discuss his presentation about precursor lesions for development of atrophy and AMD from the Angiogenesis Exudation and Degeneration 2024 event.

Video Transcript

Editor's note - This transcript has been edited for clarity.

David Hutton:

I'm David Hutton of Ophthalmology Times, the Angiogenesis Exudation and Degeneration 2024 event is being held virtually on February 3. Dr. SriniVas Sadda is making a presentation titled "Precursor lesions for development of atrophy and AMD." Dr. Sadda thank you so much for joining us. Tell us about this presentation.

SriniVas R. Sadda, MD:

Thanks very much pleasure to be here. So yes. So, you know, one of the things that's become a topic of interest, because now we have two FDA approved treatments for atrophy associated with AMD, is that we all think that if we could actually intervene earlier, for these patients, before atrophy actually develops we'd have better visual outcomes. So there's been a real focus, topic of interest for myself as many as well as many others, to try to identify risk factors for the development of atrophy. So maybe we could intervene before atrophy actually occurs. And so we and others have published a number of papers where we've looked at a variety of different eyes with AMD, before they progress to atrophy and said, "Aha!, If these features are present in the eyes, they're more likely to develop atrophy."

So what was unique about the present project that I'm presenting at the Angiogenesis meetings, we said, "Well, it's not enough to know what else was in the eye, we'd like to actually know what preceded the development of atrophy at that location." So this is a location specific analysis. And the potential benefit of looking at it that way is that we may get further insight into how atrophy actually develops in these eyes. And so that's what we did, we looked at a large cohort of patients with intermediate AMD. It was a retrospective study, where we had several years of follow up. In fact, in this case, four years of follow up data. And we looked at where does atrophy develop, and then we looked back several years earlier, four years earlier, to see, well what was there before. And we compared that to regions that didn't develop atrophy, and we identify a couple of interesting features.

And this was an OCT-based analysis, one of which was the presence of Hyper-reflective foci, which we believe are RPE cells that have migrated into the retina, it's sort of a sign of RP distress. And it kind of makes sense that area may evolve into atrophy. But we also uncovered another independent risk factor as being something we call a thin double layer sign, which is actually an area of thickened basal laminar deposit. And so we identify that these areas alone could increase the risk for development of atrophy. And so I think that's something that's somewhat novel, and may open the pathway to study these lesions specifically. So maybe we can design a treatment that might be focused on that specific entity, because we certainly see that atrophy can develop in that setting.

David Hutton:

What's the next step for this research?

SriniVas R. Sadda, MD:

I think the next step is to look at this in a prospective fashion. This was a retrospective study, as I said. You know, whenever you have these kinds of findings, I believe it's very important to replicate them. So to replicate them in a larger prospective study, I think would be important. And then I think we'd want to do further histopathologic correlation of these thin double layer signs are they always thickened basal laminar deposit, how does thickened basal laminar deposit, how does that differ in terms of the atrophy that evolves in that setting, compared to atrophy and other settings? I think that those would be the logical next steps.