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High-Resolution OCT of Basal Laminar Deposit Phenotypes and Retinal Pigment Epithelium Morphologic Changes in Age-Related Macular Degeneration

Year: 2026

Type: article

Abstract: Purpose: To characterize the high-resolution OCT phenotype of basal laminar deposit (BLamD) and the codistribution of retinal pigment epithelium (RPE) morphologic changes in patients with age-related macular degeneration (AMD). Design: Cross-sectional observational study. Participants: Thirty-one eyes from 19 patients (10 female, 9 male; mean age 85.6 ± 5.5 years) with AMD and OCT-visible BLamD. Methods: Structural high-resolution OCT B-scans were systematically graded for BLamD phenotype (persistent, scalloped, and outer retinal corrugations), RPE morphologic changes (spiky RPE and intraretinal hyperreflective foci [IHRF]), foveal involvement, and additional features (hypocore drusen, subretinal drusenoid deposits [SDDs], and soft drusen), including geographic atrophy (GA), complete RPE and outer retinal atrophy (cRORA), and incomplete RPE and outer retinal atrophy. Main Outcome Measures: Prevalence and co-occurrence of BLamD and RPE phenotypic features stratified by foveal status. Results: Of the 117 screened patients with AMD, 19 (16.2%) had OCT-visible BLamD, contributing 31 eyes: 28 with cRORA, 1 with incomplete RPE and outer retinal atrophy, and 2 without OCT-defined atrophy. Persistent BLamD was the most prevalent finding (28/31, 90.3%), followed by scalloped BLamD and IHRF (both 21/31, 67.7%) and spiky RPE (18/31, 58.1%). All 31 eyes exhibited ≥1 RPE-BLamD complex abnormality, and 27/31 eyes (87.1%) demonstrated ≥2 concurrent features. Outer retinal corrugations were identified in 4/31 eyes (12.9%) and were exclusively present in eyes without spiky RPE (4/13, 30.8% vs. 0/18, 0%). Foveal-spared GA eyes showed higher prevalences of spiky RPE (9/14, 64.3% vs. 6/14, 42.9%) and IHRF (11/14, 78.6% vs. 7/14, 50.0%) compared with foveal-involved eyes. Eyes lacking persistent BLamD (3/31, 9.7%) paradoxically showed all spiky RPE, scalloped BLamD, and IHRF. Additional findings included hypocore drusen in 8/31 eyes (25.8%), SDD in 31/31 eyes (100%), and soft drusen in 4/31 eyes (12.9%). Conclusions: In BLamD-associated GA, persistent and scalloped BLamD, spiky RPE, IHRF, and outer retinal corrugations showed variable patterns of co-occurrence. Spiky RPE and IHRF were more frequent in foveal-sparing than in foveal-involved eyes, although the significance of this observation requires longitudinal validation. These findings support the integration of BLamD morphologic subtyping and RPE phenotyping into clinical and trial-based assessments of advanced AMD, with potential implications for patient selection and monitoring in the era of approved complement inhibition therapies. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2026.101415