Choroidal Sublayer Thickness May Predict AMD Progression

Age Related Macular Degeneration, Also Called Senile Macular Degeneration. Choroidal Neovascularization. Photograph Of The Back Of Eye. (Photo By BSIP/UIG Via Getty Images)
Evidence suggests the thickness of the Sattler layer-choriocapillaris complex can act as a biomarker for age-related macular degeneration progression.

Reduced Sattler layer-choriocapillaris complex thickness (SLCCT) may be a biomarker for disease progression among patients with age-related macular degeneration (AMD), according to results of a prospective, observational case series, published in the journal Retina.

This study was conducted at the IRCCS San Raffaele Hospital in Italy. Patients (N=253) with AMD underwent complete ophthalmologic examination every 6 months. The relationship between AMD progression and choroidal thickness changes spanning 3 to 7 years were evaluated.

Patients had a mean age of 79±7 years, 56% were men, 69% had arterial hypertension, and 34% had type 2 diabetes mellitus.

At baseline and final follow-up (mean, 5 years) best corrected visual acuity (BCVA; mean, 0.41 vs 0.47 logMAR; P <.001), choroidal thickness (CT; mean, 216 vs 197 μm; P <.001), Haller layer thickness (HLT; mean, 184 vs 168 μm; P <.001), and SLCCT (mean, 32 vs 28 μm; P <.001) had declined. Central macular thickness (CMT; mean, 316 vs 309 μm; P >.05) remained unchanged.

Stratified by early (n=30), intermediate (n=97), and late (n=126) AMD at baseline, early and intermediate eyes differed by SLCCT; early and late eyes by BCVA, CMT, and SLCCT; and intermediate and late eyes by BCVA, CMT, and SLCCT (all P <.001).

In the early AMD cohort, at baseline eyes that did not progress had increased SLCCT than eyes that progressed (both P <.01) and between the evaluations, SLCCT remained unchanged in nonprogressing eyes (mean, 60 vs 51 μm; P >.05) but declined in progressing eyes (mean, 37 vs 32 μm; P <.01).

In intermediate AMD, eyes that progressed had lower SLCCT at both baseline and follow-up (both P <.01) but within subgroups, no significant differences were observed longitudinally (both P >.05).

In late AMD, no significant changes in SLCCT were observed between baseline and follow-up or between eyes with geographic atrophy or macular neovascularization (all P >.05).

SLCCT was used to predict AMD stage progression, an SLCCT cutoff of <10.5 μm had an area under the receiver operating characteristic curve (AUC ROC) of 0.875 (P <.001) for the prediction of AMD progression with a sensitivity of 0.89 and specificity of 0.86.

An SLCCT cutoff thinner than 8.5 μm had an AUC ROC of 0.728 (P <.001) for predicting progression to macular neovascularization with a sensitivity of 0.97 and specificity of 0.88.

This study was limited by the small sample sizes within AMD stages, especially in the early AMD cohort, which likely limited power.

This study observed progressive choroidal impairment in AMD progression among all disease stages and found quantitative SLCCT cuttoffs which may be biomarkers for disease progression.


Amato A, Arrigo A, Borghesan F, et al. Baseline Sattler layer-choriocapillaris complex thickness cutoffs associated with age-related macular degeneration progression. Retina. Published online May 12, 2022. doi:10.1097/IAE.0000000000003530