I-RORA is defined as 1) a regional of signal hypertransmission into the choroid, 2) a corresponding zone of attenuation or disruption of the RPE, and 3) evidence of overlying photoreceptor degeneration, that is, subsidence of the INL and OPL, presence of a hyporeflective wedge in the Henle fiber layer, thinning of the ONL, disruption of the ELM or, disintegrity of the EZ. On OCT, they appear as “dome-shaped hyperreflective mound bounded posteriorly by the inner aspect of the RPE and anteriorly by the EZ, ELM, or outer aspect of the ONL” (Figure 9).ĬAM Report 6 defined i-RORA and c-RORA and their findings were published in January 2022. Acquired vitelliform lesions can be seen in multiple conditions but there are specific appearances for the ones associated with AMD. Hyperreflective crystalline deposits, also known as sub-RPE plaques, are linear deposits between the sub-RPE and basal lamina (Figure 8). On OCT, they can appear as ribbon or dot pattern and are most commonly seen in the superior macula. Subretinal drusenoid deposits, also known as reticular pseudodrusen, are materials that has accumulated between the RPE and photoreceptors (Figure 7). This can be seen even before outer retinal tissue is lost (Figure 6). Focal changes in drusen, such as thickened or thinned, disintegrated or absent RPE, lead to hypertransmission OCT changes in the choroid. ![]() Specific qualitative drusen and drusenoid pigment epithelial detachment features were described. Intraretinal hyperreflective foci are described as “discrete, well-circumscribed, punctate lesions in a single or clustered distribution that are of equal or greater reflectivity than that of the retinal pigment epithelium (RPE)” (Figure 5). ![]() First, inner and outer retinal abnormalities were described as “inner nuclear layer (INL) and outer plexiform layer (OPL) subsidence, hyporeflective wedges, external limiting membrane (ELM) descent, outer nuclear layer (ONL) thinning, ELM and ellipsoid zone (EZ) integrity loss, and hyper-transmission of the OCT signal into the choroid”. There were six main features highlighted in this report. The Classification of Atrophy Meeting (CAM) Report 5 (published in September 2021) provided image-based descriptions associated with the development of geographic atrophy.
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