Dados do Trabalho

Título

Assessing different Techniques for Measuring Geographic Atrophy: A Systematic Review and Network Meta-Analysis

Introdução

Age-related macular degeneration (AMD) is a leading cause of severe vision loss in developed nations, with geographic atrophy (GA) characterizing its atrophic late stage. The recent FDA approval of treatments for GA, aimed at slowing disease progression, underscores the need for precise and reliable GA measurement techniques. This study aims to assess and compare various GA area measurements, using autofluorescence blue (AF-Blue) as a gold standard.

Métodos

We searched PubMed, Scopus, and Cochrane to identify studies that compared different imaging techniques to measure GA. The primary outcome of interest was the mean difference (MD) on GA areas. We conducted a network-meta-analysis (NMA) within a Bayesian framework to compare the differences in the GA area. Consistency was evaluated using the node-splitting method. Serial sensitivity, subgroup analyses and pairwise meta-analyses were performed to validate the robustness and generalizability of our findings.

Resultados

Our NMA included 2001 eyes from 18 studies, comprising 2 post hoc analyses of randomized controlled trials (RCTs) and 16 observational studies. We evaluated 10 different imaging techniques for measuring GA: AF-Blue, autofluorescence green (AF-Green), autofluorescence infrared (AF-Infrared), near-infrared reflectance (NIR), multicolor autofluorescence (MC-AF), en face sub-retinal pigment epithelium slab (subRPE slab), en face fundus optical coherence tomography (en face OCT), OCT Angiography (OCTA), color fundus photography(CFP), and fluorescein angiography(FA). AF-Blue was the primary comparator in 97% direct comparisons. We found no significant differences in GA measurements among these techniques, even when compared with the gold standard AF-Blue. AF-Infrared showest the largest GA area mean and MC-AF the smallest when compared to the other techniques considering the rankogram and Surface Under the Cumulative Ranking (SUCRA) values, which ranged from 0.143 to 0.819.

Conclusões

Our NMA revealed no statistically significant differences in the measurement of GA area between different imaging techniques, including the reference standard AF Blue. We also found that AF-IR tends to present with greater GA area measurements, and MC-AF tends to present with smaller GA areas according to SUCRA values. These results underscore the reliability of the current imaging modalities and also help us better understand the area relationship between these different modalities.

Palavras Chave

Geographic Atrophy, Age-related Macular Degeneration, Imaging Techniques, Autofluorescence Imaging, Optical Coherence Tomography, Network Meta-Analysis, Diagnostic Imaging, Retinal Imaging Modalities, Disease Progression Measurement, Ophthalmic Diagnosis

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