AGE-RELATED MACULAR DEGENERATION CURRENT INVESTIGATIONS AND TREATMENTS

agerelatedmaculardeg774enerationkapak

IMAGING BIOMARKERS IN WET AGE-RELATED MACULAR DEGENERATION

Cemal Özsaygılı1
Nurettin Bayram2

1Kayseri City Hospital, Department of Ophthalmology, Kayseri, Türkiye
2Ankara Etlik City Hospital, Department of Ophthalmology, Ankara, Türkiye

Özsaygılı C, Bayram N. Imaging Biomarkers in Wet Age-Related Macular Degeneration. In: Çıtırık M, Şekeryapan Gediz B, editors. AgeRelated Macular Degeneration: Current Investigations and Treatments. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.219-231.

ABSTRACT

The use of optical coherence tomography (OCT) as a standard in retinal examination has enabled detailed characterization of neovascular age-related macular degeneration (nAMD) disease morphology and significant advances have been made in diagnosis. In addition, significant breakthroughs have been made in terms of treatment with the introduction of drug regimens that neutralize vascular endothelial growth factor (VEGF) intravitreally (anti-VEGF) into routine treatment and their benefits.

However, despite this, treatment results are not yet as expected and disease management should become more efficient in real life. This can be solved by identifying biomarkers that are valid for visual acuity, lesion activity and finally prognosis. Identification of biomarkers can guide treatment decisions for both individuals and societies. With advanced OCT devices and technology, quantitative and qualitative data can be obtained regarding the morphological features of the disease and the degeneration stages of nAMD accompanied by exudation and fibrosis. In clinical studies and routine clinical practice, central retinal thickness is used as a biomarker for re-treatment decisions, while fluid localization in different layers of the retina provides more meaningful information on prognosis. In relation to this, intraretinal cystoid fluid has been accepted to have a negative effect on vision and is considered to have a detrimental effect on the retinal structure if it persists during treatment. Subretinal fluid, unlike intraretinal fluid, is known to provide advantages on visual function and reduce the likelihood of progression to geographic atrophy. Retinal pigment epithelium tear has generally been accepted as the most important biomarker responsible for unresponsiveness to treatment and decreased visual acuity during pro-re-nata (PRN) treatment regimen. Changes in neuroretinal structure are closely related to irreversible damage to cellular elements responsible for visual function and negative visual prognosis. New OCT technologies provide important prognostic data by providing detailed imaging of changes at the photoreceptor-RPE-choriocapillary unit level. Retinal biomarkers obtained with the help of high-resolution imaging can be used for effective personalized treatment for the individual, disease prediction for the population, development of new therapeutic strategies and new targets.

Keywords: Imaging biomarkers; Neovascular age related macular degeneration; Optic coherence tomography; Optic coherence tomography angiography

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