Automated Quantitative Assessment of Retinal Fluid Volumes as Important Biomarkers in Neovascular Age-Related Macular Degeneration

• Published in: American journal of ophthalmology Vol. 224; pp. 267 - 281
• Main Authors: Keenan, Tiarnan D.L., Chakravarthy, Usha, Loewenstein, Anat, Chew, Emily Y., Schmidt-Erfurth, Ursula
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021; Elsevier Limited
• Subjects: Aged; Algorithms; Angiogenesis Inhibitors - therapeutic use; Artificial Intelligence; Automation; Biomarkers; Biomarkers - metabolism; Choroidal Neovascularization - diagnostic imaging; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - metabolism; Clinical medicine; Clinical Trials as Topic; Datasets; Datasets as Topic; Diabetes; Diabetic retinopathy; Dimensional analysis; Disease; Female; Humans; Intravitreal Injections; Localization; Macular degeneration; Male; Middle Aged; Prospective Studies; Ranibizumab - therapeutic use; Software; Subretinal Fluid - metabolism; Tomography, Optical Coherence; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity; Wet Macular Degeneration - diagnostic imaging; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - metabolism; United States > US
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2020.12.012

To evaluate retinal fluid volume data extracted from optical coherence tomography (OCT) scans by artificial intelligence algorithms in the treatment of neovascular age-related macular degeneration (NV-AMD).
Perspective.
A review was performed of retinal image repository datasets from diverse clinical settings. Settings: Clinical trial (HARBOR) and trial follow-on (Age-Related Eye Disease Study 2 10-year Follow-On); real-world (Belfast and Tel-Aviv tertiary centers). Patients: 24,362 scans of 1,095 eyes (HARBOR); 4,673 of 880 (Belfast); 1,470 of 132 (Tel-Aviv); 511 of 511 (Age-Related Eye Disease Study 2 10-year Follow-On). ObservationProcedures: Vienna Fluid Monitor or Notal OCT Analyzer applied to macular cube scans. OutcomeMeasures: Intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED) volumes.
The fluid volumes measured in neovascular AMD were expressed efficiently in nanoliters. Large ranges that differed by population were observed at the treatment-naïve stage: 0-3,435 nL (IRF), 0-5,018 nL (SRF), and 0-10,022 nL (PED). Mean volumes decreased rapidly and consistently with anti-vascular endothelial growth factor therapy. During maintenance therapy, mean IRF volumes were highest in Tel-Aviv (100 nL), lower in Belfast and HARBOR-Pro Re Nata, and lowest in HARBOR-monthly (21 nL). Mean SRF volumes were low in all: 30 nL (HARBOR-monthly) and 48-49 nL (others).
Quantitative measures of IRF, SRF, and PED are important biomarkers in NV-AMD. Accurate volumes can be extracted efficiently from OCT scans by artificial intelligence algorithms to guide the treatment of exudative macular diseases. Automated fluid monitoring identifies fluid characteristics in different NV-AMD populations at baseline and during follow-up. For consistency between studies, we propose the nanoliter as a convenient unit. We explore the advantages of using these quantitative metrics in clinical practice and research.