Theodore Bowe, MD
Ophthalmology Resident
Wills Eye Hospital, Philadelphia PA
Dr. K. Bailey Freund, Clinical Professor of Ophthalmology at the NYU Grossman School of Medicine, was awarded the J. Donald M. Gass Award and Lecture at the Retina Society 2021 Meeting. His lecture was titled “How Understanding the Histologic Basis of Retinal Imaging Findings in Age-Related Macular Degeneration Can Improve Current and Future Patient Outcomes.”
After a warm and memorable introduction by his friend and colleague Dr. David Sarraf, Dr. Freund delivered a presentation that summarized over a decade’s worth of his and his co-investigator, Dr. Christine A. Curcio’s, work to correlate anatomical observations with findings on cutting edge imaging technologies to inform current and future treatments of eye disease broadly, and age-related macular degeneration (AMD) specifically. The focus on using these histologic findings to suggest and support possible treatment targets and strategies was fascinating and lead to numerous audience questions and appreciative comments at the conclusion of the lecture.
Dr. Freund first discussed the histologic features of type 1 neovascularization, which he posits allows for outer retinal structure maintenance even after failure of the native choriocapillaris in AMD. A series of his AMD patients with 10+ years of OCT imaging and autofluorescence photos and sub-foveal type 1 neovascularization in one eye suggested a protective effect of this lesion. Dr. Freund discussed that a type 1 lesion may assume the function of the native choriocapillaris, and thus provide resistance against macular atrophy by restoring nutritional support to the photoreceptors. While other factors may take precedence in treatment decision making, he suggested that at least in theory anti-VEGF therapy could inhibit the naturally protective process of subfoveal type 1 neovascularization formation, which supports the decision to not inject for non-exudative type 1 lesions.
Additionally, he discussed the emerging understanding of the role of basal laminar deposit (BLamD) in various AMD phenotypes. BLamD provide structural support for the RPE in AMD. They can be appreciated on OCT and particularly sensitively on retro-mode near-infrared reflectance. Dr. Freund believes that morphologic features of BLamD will become predictive of AMD phenotype, progression, and severity.
Finally, he turned to the success of OCT angiography in proving that type 3 neovascularization has an origin in the retinal circulation and not from the choriocapillaris. Dr. Freund is optimistic that progress in cutting edge imaging techniques, especially when paired with ex vivo histologic study findings, will allow for continued growth in our ability to diagnose, prognosticate, and treat AMD and other retinal diseases. He finished the lecture by paying homage to Dr. Gass, pointing out that he was truly a pioneer of using clinicopathologic correlation to broaden our understanding of AMD and other retinal diseases.
