Standardizing Measurement of cRORA (Complete Retinal Pigment Epithelial and Outer Retinal Atrophy)- CAM Report 8.

30/01/2026

Ophthalmology. Retina

Authors: David Sarraf, Federico Corvi, Philip J Rosenfeld, Thomas Ach, Barbara Blodi, Ferdinando Bottoni, Mariano Cozzi, Usha Chakravarthy, Emily Y Chew, Karl Csaky, Cathy Cukras, Christine A Curcio, Frederick L Ferris, K Bailey Freund, Juan Grunwald, Robyn H Guymer, Frank G Holz, Glenn J Jaffe, Sandra Liakopoulos, Tock Han Lim, Jordi M Monés, Cynthia Owsley, Sergio Pagliarini, Daniel Pauleikhoff, Steffen Schmitz-Valckenberg, Richard F Spaide, Janet Sparrow, Ramin Tadayoni, Adnan Tufail, Francesco Viola, Scott Fraser, Giovanni Staurenghi, Srinivas R Sadda

PURPOSE: To highlight the role of en face OCT in the measurement of choroidal hypertransmission defects (hyperTDs) in complete retinal pigment epithelial and outer retinal atrophy (cRORA), and to refine the definition of retinal pigment epithelium (RPE)-related alterations associated with cRORA.

DESIGN: Consensus meeting.

PARTICIPANTS: Panel of retina specialists, including retinal imaging experts, reading center leaders, and retinal histologists.

METHODS: As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analyzed and discussed the role of en face OCT in the assessment of cRORA. A structured study was conducted, consisting of an exercise to assess en face OCT cases, reviewed jointly during the 8 CAM meeting, and to explore the utility of this advanced tool for disease staging and progression. Additionally, definitions previously applied to RPE abnormalities were discussed and refined leading to modifications. The current report summarizes the methods employed during the consensus meeting and the outcomes achieved as pertains to the application of en face OCT for cRORA grading and simplification of the RPE assessment criteria.

MAIN OUTCOME MEASURE: Defining the role of en face OCT in the detection and quantification of hyperTDs, improving classification of cRORA, and refining the terminology related to RPE alterations to enhance grading consistency.

RESULTS: During the consensus case discussions, high levels of agreement were achieved for hyperTD detection using en face OCT. The CAM group affirmed the role of en face OCT as a critical adjunct to traditional B-scan analysis, for more precise measurement of the area of cRORA lesions and for distinguishing threshold cRORA from smaller incomplete (iRORA) lesions. Additionally, merger of RPE attenuation and RPE disruption into a unified category termed "abnormal RPE band" significantly reduced inter-reader variability, leading to greater consistency among graders.

CONCLUSIONS: The integration of en face OCT with cross-sectional B-scan imaging enhances the accurate classification and area measurement of early atrophic alterations in AMD, improving diagnostic consistency and lesion assessment. The consensus panel's adoption of the abnormal RPE band term as a unified category for RPE abnormalities may reduce confusion regarding the definition of RPE degeneration and has the potential to improve inter-reader variability.

PMID: 41621805