Prior Exudative AMD Markers Can Help Distinguish It from De Novo GA

Eyes with prior neovascular activity are at increased risk of macular atrophy incidence and progression. These eyes are also prone to neovascular reactivation following new GA treatments. Therefore, researchers based at the University of Pittsburgh sought to identify OCT biomarkers that distinguish macular atrophy secondary to neovascular AMD (wet AMD) from de novo geographic atrophy (GA), improving risk stratification and comparing atrophy progression between the two groups.Their study demonstrated that eyes with prior exudative activity exhibited higher prevalence of epiretinal membrane (ERM), hyperreflective dots and foci, subretinal hyperreflective material, double layer sign, intraretinal fluid, and outer retinal tubulation at the time of GA presentation, as well as more frequent epiretinal membrane, subretinal hyperreflective material, and intraretinal fluid after two years of follow-up. OCT biomarkers may detect previous exudation, helping identify cases where recently FDA-approved GA therapies may be relatively contraindicated due to prior disease. These images from the study show (A) multiple pigment epithelial detachments (PEDs) (arrows) in an eye with intermediate AMD, (B) serous PED (star) accompanied by subretinal hyperreflective material (arrow) and intraretinal fluid, indicating active neovascularization and (C) hypertransmission defects (arrows) consistent with GA observed 12 months after the onset of neovascular activity and following eight anti-VEGF injections. Photo: Sadeghi, et al. Eye; Feb. 2026. Click image to enlarge. This study, which was published in Eye, analyzed 60 eyes from 44 patients: 30 eyes with de novo GA and 30 with macular atrophy secondary to wet AMD. All patients had monthly follow-ups before GA onset and continued for at least two years after. GA was defined as complete retinal pigment epithelium atrophy ≥250μm using OCT scans. The mean age was 80.06 years, with 50.0% men. Eyes with wet AMD progressed to macular atrophy after 31.38 months and 8.86 anti-vascular endothelial growth factor (VEGF) injections.Compared to de novo GA, eyes with macular atrophy following wet AMD had a larger baseline atrophic area (3.79mm² vs. 1.12mm²) and greater atrophy growth (2.65mm² vs. 0.652mm²), with more frequent ERM, double layer sign, hyperreflective foci, subretinal hyperreflective material, outer retinal tubulation and intraretinal fluid. The researchers proposed that the observed accelerated progression may be attributable to the larger baseline GA area. Atrophy growth correlated with baseline subretinal hyperreflective material and GA area but not with the number of anti-VEGF injections.“The greater baseline atrophic area may be attributed to the inflammatory process, effects of anti-VEGF therapy or the impact of macular neovascularization on the retinal pigment epithelium and choriocapillaris, which leads to compression or affects nutrition,” the study authors suggested.“These findings can help recognize prior exudative disease, which may represent a relative contraindication for the use of newly FDA-approved therapies,” the team concluded. “More clinical studies are needed to determine the optimal approach for eyes with GA that present after neovascular activity and anti-VEGF injections.”Click here for the journal source. Sadeghi E, DeCicco J, Gandhi P, et al. Differentiation of macular atrophy secondary to neovascular age-related macular degeneration vs. de novo geographic atrophy: a multimodal analysis. Eye (Lond). February 19, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.