Early Structure–Function Correlates in Neovascular Age-Related Macular Degeneration Using Artificial Intelligence–Derived OCT Biomarkers

Purpose: To correlate automated artificial intelligence-based retinal fluid quantification with ellipsoid zone (EZ) thickness and loss, macular neovascularization (MNV) type, and visual function. Design: This is a post hoc analysis of a prospective, real-world, multicenter clinical trial. Subjects: Patients with active neovascular age-related macular degeneration (nAMD) were included. Methods: Best-corrected visual acuity (BCVA), measured using the ETDRS chart, OCT, OCT angiography, and microperimetry, were collected by the same certified examiners. Subretinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment (PED) volumes for the central 1- and 6- mm areas were calculated at baseline using the Fluid Monitor (Retinsight) on Spectralis OCT (Heidelberg Engineering). An automated algorithm segmented EZ thickness and loss detectable after fluid resolution at month 1. Main Outcome Measures: Fluid volumes were associated with MNV type, EZ thickness and loss, retinal sensitivity, and BCVA using univariate and multivariate regression models and Wilcoxon rank-sum tests with bootstrapped confidence intervals. Spearman correlation was used to analyze retinal sensitivity and EZ loss. Conclusion: Retinal fluid volumes in nAMD are triggered by MNV types and correlate with photoreceptor integrity and visual function, with the impact depending on the fluid compartment. Although fluid is central to disease monitoring, a more comprehensive approach to structural-functional assessment in nAMD is of interest. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.