CHARACTERISTICS OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION DETERMINED IN-VIVO WITH CONFOCAL AND INDIRECT INFRARED IMAGING

Purpose: To evaluate the current and future interventions in age-relat ed macular degeneration (AMD), it is essential to delineate the early clinical features associated with later visual loss. The authors descr ibe the retinal pigment epithelium (RPE)/Bruch membrane region in ten patients with advanced exudative AMD using current angiographic techni ques and a noninvasive method: infrared (IR) imaging with the scanning laser ophthalmoscope. Methods: Ten patients with exudative AMD, evide nced by choroidal neovascularization (CNV), fibrovascular scar formati on, pigment epithelial detachment, or serous subretinal fluid, were ex amined using IR imaging, fluorescein angiography, indocyanine green an giography, and stereoscopic viewing of fundus slides. The authors dete rmined the number and size of drusen and subretinal deposits and the t opographic character of the RPE/Bruch membrane area and of CNV. Result s: In all patients, IR imaging yielded the greatest number of drusen a nd subretinal deposits. Sheets of subretinal material, but few lesions consistent with soft drusen, were seen. Infrared imaging provided top ographic information of evolving CNV. Choroidal neovascularization app eared as a complex with a dark central core, an enveloping reflective structure which created a halo-like appearance in the plane of focus, and outer retinal/subretinal striae. Conclusions: Infrared imaging pro vides a noninvasive, in vivo method to image early changes in the RPE/ Bruch membrane. It offers advantages over current imaging techniques b y minimizing light scatter through cloudy media and enhancing the abil ity to image through small pupils, retinal hyperpigmentation, blood, h eavy exudation, or subretinal fluid. It provides additional informatio n regarding early CNV, and the character of drusen and subretinal depo sits.