High-Resolution Adaptive Optics Transscleral Flood Illumination Imaging Allows Phenotyping of Age-Related Macular Degeneration.

Adaptive optics transscleral flood illumination (AO-TFI) enables in vivo imaging of the retinal pigment epithelium (RPE) at near-cellular resolution. In this study, we evaluated its potential as a phenotyping tool in age-related macular degeneration (AMD) by analyzing disease-associated structural patterns and their correlation with optical coherence tomography (OCT) features. We examined AO-TFI images from 120 eyes diagnosed with either early-to-advanced dry AMD (including geographic atrophy, GA) or neovascular AMD (nvAMD). Images were graded by a masked reader, and patterns were matched to corresponding OCT findings. Four consistent morphologic patterns were identified: atrophy, pre-atrophy, soft drusen, and reticular pseudodrusen. Morphometric quantification of hyporeflective regions showed progressive changes in perimeter, diameter, and area from reticular pseudodrusen to soft drusen and pre-atrophy, returning to lower values in atrophy. Distinct nvAMD-specific signatures were not identified. AO-TFI offers a practical, high-resolution complement to OCT, AO-SLO, and AO-OCT for phenotypic characterization of AMD in clinical settings.