Diagnostic Performance of Ring Aperture Retro Mode Imaging for Detecting Pigment Migration in Age-Related Macular Degeneration

Sep 30, 2026

Uploaded by James

This retrospective diagnostic study evaluates ring aperture Retro mode (RAR) imaging for detecting pigment migration in age-related macular degeneration (AMD) and compares it with multimodal imaging, including color fundus images, fundus autofluorescence, and en face optical coherence tomography (OCT). Eighty eyes from 61 consecutive AMD patients underwent masked grading of AMD stage and pigment migration. Using en face OCT as reference, RAR achieved 94.7% sensitivity and 93.4% PPV, revealing early and subtle migration patterns.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

Article Diagnostic Performance of Ring Aperture Retro Mode Imaging for Detecting Pigment Migration in Age-Related Macular Degeneration Thomas Desmettre 1,2, *, Gerardo Ledesma-Gil 3 and Michel Paques 4 Academic Editor: AssafKratz Received: 19 November 2025 Revised: 16 December 2025 Accepted: 20 December 2025 Published: 23 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Centre de Rétine Médicale, 187 Rue de Menin, 59520 Marquette-Lez-Lille, France 2 Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, KS 66208, USA 3 Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City 06800, Mexico; [gerardo.ledesma.md@gmail.com](gerardo.ledesma.md@gmail.com) 4 Paris Eye Imaging Group, Clinical Investigation Center 1423, Quinze-Vingts Hospital, National Institute of Health and Medical Research-Directorate of Hospitalization and Healthcare Organization, 75012 Paris, France; [michel.paques@protonmail.com](michel.paques@protonmail.com) * Correspondence: [thomas@desmettre.org](thomas@desmettre.org); Tel.: +33-(0)-320-22-11-77 Abstract Background/Objectives: Pigment migration is a key biomarker of progression in agerelated macular degeneration (AMD) . This study assessed the diagnostic performance of ring aperture Retro mode (RAR) imaging for detecting pigment migration and compared its performance with established multimodal imaging techniques. Methods: This retrospective study included 80 eyes from 61 consecutive patients with AMD who underwent multimodal imaging with color fundus images (CFIs), fundus autofluorescence (FAF), RAR imaging (Mirante, NIDEK), and en face optical coherence tomography (OCT) with B-scans (Cirrus HD-OCT 5000, Zeiss) . Two independent retina specialists graded the AMD stage and the presence of pigment migration across modalities. Sensitivity and positive predictive value (PPV) of RAR were calculated using en face OCT as the reference standard. Results: RAR demonstrated high diagnostic performance, with a sensitivity of 94.7% and a PPV of 93.4% relative to en face OCT. RAR frequently identified pigment migration that was not visible on CFI or FAF, particularly in early AMD and in eyes with media opacity. Distinct morphologic patterns—including hyperreflective foci, thickened retinal pigment epithelium, refractiledrusen, and cuticular drusen—were consistently identifiable on RAR. In four eyes with geographic atrophy, RAR detected perifoveal pigment redistribution at least six months before foveal involvement was confirmed by OCT and FAF. Conclusions: RAR imaging is a rapid, sensitive, and clinically practical technique for detecting pigment migration in AMD. By complementing en face OCT and enhancing visualization in cases where standard imaging is limited, RAR may strengthen early disease surveillance, support prognostic assessment, and improve multimodal diagnostic workflows in routine practice. Keywords: age-related macular degeneration; geographic atrophy; retinal imaging; diagnostic performance; en face OCT; retro mode imaging; pigment migration; hyperreflective foci; thickened RPE; refractile drusen 1. Introduction Pigment migration in age-related macular degeneration (AMD) is an important clinical finding, reflecting retinal pigment epithelium (RPE) dysfunction and signaling risk of progression toward geographic atrophy (GA) and vision loss [1] . Along with drusen, pigmentary changes are a central criterion for upgrading disease classification from early to intermediate AMD (iAMD) [1] . According to the Beckman/AREDS2 consensus classification, iAMD is defined by the presence of large drusen (>125 µm) and/or any AMD-related pigmentary abnormalities in the absence of GA or neovascularization [2] . Pigmentary abnormalities encompass both hype

FAQs

What imaging approach does the study evaluate for pigment migration detection in AMD?

The study evaluates ring aperture Retro mode (RAR) imaging and assesses how well it detects pigment migration in AMD.

How is the diagnostic performance of RAR measured in the study?

RAR sensitivity and positive predictive value (PPV) are calculated using en face OCT as the reference standard.

What advantages does RAR provide compared with other imaging modalities?

RAR frequently identifies pigment migration not visible on color fundus images or fundus autofluorescence, and it can detect perifoveal redistribution before changes are confirmed by OCT and FAF in geographic atrophy cases.

Sep 30, 2026

Uploaded by James