The authors are commenting on the study entitled :“Spectral-domain OCT analysis of risk factors for macular atrophy development in the Harbor study for neovascular age-related macular degeneration” published by Sadda et al. in Ophthalmology 2020;127(10):1360-1370,which identified the baseline risk factors for macular atrophy development in patients with neovascular age-related macular degeneration treated with ranibizumab over 24 months of follow-up. The following baseline risk factors for macular atrophy were confirmed from prior analyses that used color fundus photography and fluorescein angiography data: absence of subretinal fluid, presence of intraretinal cysts, presence of Type 3 neovascularization, and presence of atrophy in the fellow eye. This analysis using Spectral-domain optical tomography data revealed new baseline risk factors for macular atrophy: higher central drusen volume, lower choroidal thickness, presence of nascent atrophy, presence of reticular pseudodrusen, and increased central foveal thickness. Ranibizumab treatment regimen and dose level were not found to be risk factors for macular atrophy development. However, the validation, extrapolation, and generalizability of the authors’ conclusions can be made only by statistical analyses including all the missing baseline potential risk factors referred by us in addition to the new risk factors identified in this study, which serve as putative biomarkers predicting the occurrence and progression of macular atrophy in neovascular age-related macular degeneration patients.
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