Structure-function correlates using high-res OCT images with Karl Csaky, MD, PhD

Karl Csaky, MD, PhD, shared insights into the relationship between retinal structure and function in dry age-related macular degeneration, focusing on patients with geographic atrophy (GA), at the Heidelberg 2025 International SPECTRALIS Symposium — And Beyond, held June 13-14 in Heidelberg, Germany. “There’s been a lot of interest in looking at structure-function relationships,” Csaky explained, especially in the central 1 mm of the retina, where cone function plays a critical role in preserving vision and quality of life.

Using Heidelberg high-resolution OCT, Csaky’s team studied 15 to 17 eyes from patients with GA who maintained 20/80 or better vision. The improved axial resolution “clearly defines certain structures better,” allowing for a more detailed view of the retina. The goal was to identify anatomical features that may correlate more closely with visual performance, since current functional tests like BCVA, contrast sensitivity, and microperimetry often provide variable and subjective results.

“Clearly, the noise tends to come on the functional side,” Csaky noted, highlighting the challenges of relying solely on psychophysical testing. By integrating multiple functional measures with sharper anatomical imaging, the team hopes to uncover more reliable correlations between retinal structure and visual capacity.

He also discussed the increasing role of artificial intelligence in analyzing OCT data. “We are on the cusp of using AI on a more frequent basis to analyze normal OCT images,” he said. As high-resolution imaging adds complexity, AI may offer a valuable tool for managing and interpreting the larger and more detailed datasets, though validation remains essential.

Reflecting on current anti-GA treatments, Csaky noted that while anatomical benefits are evident, “many of those benefits did not translate to the types of visual function benefits that we were expecting.” He suggested that advancing imaging capabilities may offer new opportunities to better align therapeutic strategies with both structural and functional outcomes.