Late (neovascular) AMD

Fundus photo (1) and red free image (2) - left macula

Fundus photography shows drusen and pigmentary changes within the left macula. There is also a retinal haemorrhage inferotemporal to the fovea.

Spectralis OCT volume (1) and line (2) scans - left macula

OCT images show retinal thickening extending inferiorly as well as a large RPE detachment with mixed internal reflectivity, subretinal and intraretinal fluid accumulation. This is also accompanied by drusen, reticular pseudodrusen and hyper-reflective foci.

Fundus photo (1), red-free (2) and fundus autofluorescence (3) images - right eye

Fundus photography shows extensive medium to large drusen within the macula region of the right eye. On funduscopic examination, the central macula appeared elevated.

A mottled hyper- and hypo-autofluorescence is seen at the macula on autofluorescence imaging.

Spectralis OCT line scans - right macula

OCT scans show a region of subretinal fluid overlying a shallow, irregular PED. There is also surrounding drusen.

Fundus photo (1), red-free (2) and fundus autofluorescence (3) images - right eye

Fundus photography shows a large white, disciform scar spanning approximately 3 disc diameters along the longest diameter and encompassing the macula. FAF showed uneven hypo-autofluorescence with regions of internal hyper-autofluorescence.

These findings are consistent with a diagnosis of disciform scarring. Disciform scars represent the end-stage of neovascular AMD where vascularised scar tissue replaces the normal retinal tissue. This finding is associated with significant vision loss.

Spectralis OCT volume scan (right macula)

OCT imaging shows a large, elevated disciform scar with intraretinal cystic spaces as well as surrounding atrophy of the retinal and RPE layers.

Spectralis line scans (left macula)

OCT imaging shows a large disciform scar with intraretinal cystic spaces as well as surrounding atrophy of the retinal and RPE layers.

Cirrus OCT Angiography (OCT-A)

OCT-A shows a network of large vessels with fewer smaller branches - a presentation described in the literature as a "dead tree" appearance.

This appearance is typical of a chronic or previously treated CNV lesion as opposed to an active 'sea-fan' or 'lacy-wheel' presentation on OCT-A.

Fundus photos (right eye) - at baseline and follow-up

Baseline: Medium to large drusen can be seen at the right macula.

Follow up: The drusen at the central macula appear to have regressed. Instead, on funduscopic examination, the foveal region appears to be raised. There are no haemorrhages or exudates visible.

Spectralis OCT line scans (baseline- left and follow up- right) - right eye

Baseline: OCT scans show medium to large drusen with no subretinal or intraretinal fluid present. Hyper-reflective foci are visible above the drusen in the second scan - a structural change that may precede the development of late AMD (refer to the page "Prognostic Biomarkers in AMD" for more information).

Follow up: A large PED with mixed internal reflectivity is present at the central macula. There is also intraretinal fluid present. This presentation is consistent with neovascular AMD and this patient was referred to an ophthalmologist for further assessment.