Assessment of local sensitivity in incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) lesions in intermediate age-related macular degeneration (iAMD)

Abstract

Objective Lesions of incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) are associated with disease progression in intermediate age-related macular degeneration (AMD). However, the corresponding functional impact of these precursor lesions is unknown and needs to be established.Methods and analysis We present a cross-sectional study of four patients with intermediate AMD employing clinical-grade MAIA (stimulus size: 0.43°, ~125 µm) and adaptive optics scanning light ophthalmoscope (AOSLO, stimulus size 0.07°, ~20 µm) based microperimetry (MP) to assess the specific impact of iRORA lesions on retinal sensitivity.Results AOSLO imaging showed overall reduced photoreceptor reflectivity and patches of hyporeflective regions at drusen with interspersed hyperreflective foci in iRORA regions. MAIA-MP yielded an average retinal sensitivity loss of -7.3 ±3.1 dB at iRORA lesions compared to the in-eye control. With AOSLO-MP, the corresponding sensitivity loss was -20.1 ±4.8 dB.Conclusion We demonstrated that iRORA lesions are associated with a severe impairment in retinal sensitivity. Larger cohort studies will be necessary to validate our findings.