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

Abstract

<strong>Objective</strong> 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.<br /> <strong>Methods and analysis</strong> 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.<br /> <strong>Results</strong> 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.<br /> <strong>Conclusion</strong> We demonstrated that iRORA lesions are associated with a severe impairment in retinal sensitivity. Larger cohort studies will be necessary to validate our findings.