Relationship Between Presumptive Inner Nuclear Layer Thickness and Geographic Atrophy Progression in Age-Related Macular Degeneration

Abstract

PURPOSE To analyze inner retinal changes in patients with geographic atrophy (GA) secondary to age-related macular degeneration and identify morphological cues for progression. METHODS A total of 100 eyes with GA were assessed in this longitudinal, observational case series. Patients with GA and absent confounding pathology were compared with age-matched controls. The retinal layers on spectral-domain optical coherence tomography, acquired in tracking mode, were segmented manually on central scans through the fixation point. Zones of GA were defined based on choroidal signal enhancement from retinal pigment epithelium loss. An area of unaffected temporal retina was used for comparison. Progression of GA was quantified with fundus autofluorescence. RESULTS We analyzed 41 eyes of 41 patients (mean age 79.2 ± 6.7 years). In areas of GA, the layer representing the inner nuclear layer (INL) in healthy retina was increased in thickness. Thickness of this presumptive INL was inversely correlated with best-corrected visual acuity (r = -0.48, P < 0.01). The presumptive INL thickness increase in atrophic areas was less marked in eyes with foveal sparing. Increased INL thickness in areas adjacent to GA was associated with a higher progression rate. CONCLUSIONS Optical coherence tomography findings demonstrate that atrophy of the retinal pigment epithelium-photoreceptor complex in GA is associated with an increase of thickness of the presumptive INL, presumably caused by remodeling of the degenerating retina. Similar alterations in the retina adjacent to areas clinically affected by GA were associated with higher atrophy progression rates