The better definition achieved with the OCT devices that include SD technology allows more detailed study of the outer retinal layers and RPE, which are important structures in the development of dry AMD. Thus, new SD-OCT instruments can accurately distinguish the presence and size of drusen and RPE changes, making it possible to differentiate the different retinal layers to identify changes at that level.⁴⁸ Thus, in a group of patients with dry AMD, Schuman and colleagues⁴⁹ found localized thinning of the photoreceptor layer immediately above the drusen compared to healthy controls, suggesting a degenerative process with cell loss to explain the decreased visual function in this group (Figure 16).

Bearelly and colleagues¹⁷ studied the thinning at the edges of the plaques of GA to establish a gradient in the thickness of the photoreceptors layer from the healthy retina to the atrophic plaque. Although they had a small sample size in their study (n = 17), they concluded that SD-OCT allows quantitative measurement of disease progression and postponed for future study the application of the technique. Moreover, to study progression of the dry forms, other studies have been designed to correlate the findings with the SD-OCT scans with other techniques such as the autofluorescence mentioned previously. To this end, Stopa and colleagues⁴⁷ analyzed a series of patients with dry AMD and correlated SD-OCT images of areas of GA, and isolated hard drusen and soft coalescing drusen with retinographies and images with autofluorescence. Thus, in addition to finding different patterns of reflectivity for each type of drusen, they observed that certain patterns of hyperreflectivity in some drusen and the overlying retina corresponded to increased or decreased autofluorescence at these points. This established a certain morphology-function relationship with both scans (Figure 17).

Finally, in some cases Stopa and colleagues identified small hyporeflective spots in retinas with soft coalescent drusen and drusenoid PEDs corresponding to subretinal fluid, which were not found in other examinations. In conclusion, it appears that the study of dry AMD need a combined approach with different and complementary techniques, with autofluorescence highlighted. OCT plays an important role both from a descriptive and clinical standpoint and provides anatomic information on retinal structures as a primary exploration and a complementary test.⁵⁰