How, when and why to use AI in the clinical management of nAMD

At this year’s EURETINA in Hamburg, Germany, there were several engaging presentations during the Symposium Session that took place on the Friday, 2nd September on the important topic of artificial intelligence (AI) tools for fluid monitoring in neovascular age-related macular degeneration (nAMD).

In his presentation, “The fluid tool in clinical routine – Data from FRB! In Zurich”, Prof. Daniel Barthelmes, director of the Department of Ophthalmology at University Hospital Zurich, Switzerland, discussed a study that was designed to investigate the feasibility of analysing real-practice optical coherence tomography (OCT) imaging data using an established AI method.

The study aimed to determine the impact of subretinal fluid (SRF), intraretinal fluid (IRF) and pigment epithelium detachment (PED) on visual acuity outcomes at 12 and 48 months after starting anti-VEGF treatment.

The patients enrolled onto the study were treatment naïve and had nAMD, an average age of 78.9 years, and had had no prior treatment. A total of 209 eyes were analysed during the trial.

The Vienna Fluid monitor, an AI-based method for detecting and quantifying retinal fluid, was used to analyse OCT volume scans for SRF, IRF and PED from routine clinical practice and the effect of post-loading phase fluid volumes on visual acuity outcomes.

The study determined that the volume of fluids present was correlated with visual acuity outcomes and that the Vienna Fluid monitor is a more accurate method of assessing the volume of fluid present. Prof. Barthelmes explained that it is imperative to control the volume of fluid to improve patient outcomes, and this should be reflected in a change to the treatment paradigm.

He concluded by stating that the AI tool allows for more precise measurements in real time which can be utilised to improve treatment benefits in daily clinical practice. Patients with high IRF volumes after the loading phase are at risk of losing vision during the maintenance phase. Patients with high macular fluid volumes receive more injections compared to those with low volumes. For SRF and PED, this increased number of injections can prevent vision loss, however, for IRF the increase in injections does not compensate for loss in visual acuity.