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Quantitative Subanalysis of Cystoid Spaces and Outer Nuclear Layer Using Optical Coherence Tomography in Age-Related Macular Degeneration

¹From the Doheny Image Reading Center, Doheny Eye Institute, and the ²Statistical Consultation and Research Center, Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.

PURPOSE. To use optical coherence tomography (OCT) to quantify intraretinal cystoid spaces (ICSs) and the outer nuclear layer (ONL) in patients with neovascular age-related macular degeneration (AMD) and to investigate the correlation of these parameters with visual acuity.

METHODS. StratusOCT (Carl Zeiss Meditec, Inc., Dublin, CA) images were collected from 53 patients receiving their initial treatment with intravitreous ranibizumab. Images were analyzed with custom software (OCTOR) that allows accurate manual segmentation of OCT B-scans and provides thickness/volume measurements of ICS, ONL, neurosensory retina, pigment epithelial detachments (PEDs), subretinal fluid (SRF), and subretinal tissue (SRT). Univariate and multivariate analyses were used to correlate OCT parameters with best corrected Snellen visual acuity. Reproducibility was assessed with weighted statistics and intraclass correlation coefficients.

RESULTS. A multivariate linear regression model with adjusted R² showed that ONL volume and SRT thickness significantly correlated with Snellen visual acuity (R² = 0.15, P = 0.002 and R² = 0.19, P = 0.001, respectively) with an overall model R² of 0.34. Adjustment of ONL volume for ICS did not improve correlation with visual acuity, and ICS volume did not independently correlate with visual acuity. Weighted statistics showed excellent intergrader agreement for both ICS and ONL measurements.

CONCLUSIONS. The results suggest that an increased total volume of the ONL is associated with decreased visual acuity in neovascular AMD and that the total volume of ICS does not correlate with visual acuity. Although the correlations detected in this study are modest, quantitative subanalysis of OCT images may be of greater clinical relevance in the context of more advanced OCT technology.

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