Age-Related Hypofluorescent Indocyanine Green Angiography Spots: Prevalence, Characteristics, and Associated Features in Age-Related Macular Degeneration.

PURPOSE: To evaluate the frequency and associated features of detecting age-related scattered hypofluorescent spots (ASHS) on indocyanine green angiography (ICGA) among fellow eyes of patients with unilateral neovascular age-related macular degeneration (nAMD).

DESIGN

Imaging analysis.

PARTICIPANTS

Prospectively recruited cohort with treatment-naive nAMD.

METHODS

Patients underwent protocolized examination. Indocyanine green angiography was used to evaluate the presence of ASHS. Choriocapillaris vessel density was determined using OCT angiography (OCTA). The development of incident exudative age-related macular degeneration over 12 months was recorded.

MAIN OUTCOME MEASURES: Prevalence and associated features of ASHS.

RESULTS

We included 142 patients. Macular neovascularization (MNV)-subtype in the fellow eye was polypoidal choroidal vasculopathy (PCV; 60.5%), type I/mixed MNV (26.1%), type II (9.9%), and type III (3.5%). According to ICGA, eyes were categorized into homogeneous (n = 48, 33.8%), ASHS (n = 46, 32.3%), and drusen/reticular pseudodrusen (RPD) groups (n = 48, 33.8%). The ASHS group was significantly younger than the drusen/RPD group (68.4 vs. 75.5 years; P < 0.001). The ASHS group had shorter axial length (23.52 vs. 24.32; P = 0.047) than the homogeneous group and had better vision (0.17 vs. 0.29; P = 0.012) and greater subfoveal choroidal thickness (262.28 vs. 183.04 μm; P = 0.006) than the drusen/RPD group. Choriocapillaris vessel density was similar between the ASHS group and the homogeneous group (71.1% vs. 71.2%; P = 0.934), but lower in the drusen/RPD group (64.6%; P = 0.002). Fellow eye MNV-subtype was predominantly PCV in the ASHS and homogeneous groups (78.26% and 75.00%; P = 0.78) but lower in the drusen/RPD group (29.2%; P < 0.001). The ASHS group had lower total cholesterol than the homogeneous group (4.31 vs. 4.56mmol/L; P = 0.039) and the drusen/RPD group (4.84 mmol/L; P = 0.028).

CONCLUSIONS

One in 3 fellow eyes of patients with unilateral nAMD in this Asian population exhibited ASHS lesions. Choriocapillaris vessel density based on OCTA was similar between the ASHS and the homogeneous groups, supporting the hypothesis for reduced transit of indocyanine green-laden lipoproteins across the Bruch membrane.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.