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Mauschitz MM, Hochbein BJ, Klinkhammer H, Saßmannshausen M, Terheyden JH, Krawitz P, Finger RP. Prevalence and determinants of subretinal drusenoid deposits in patients' first-degree relatives. Graefes Arch Clin Exp Ophthalmol 2024; 262:53-60. [PMID: 37672102 PMCID: PMC10805990 DOI: 10.1007/s00417-023-06221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE Subretinal drusenoid deposits (SDDs) are distinct extracellular alteration anterior to the retinal pigment epithelium (RPE). Given their commonly uniform phenotype, a hereditary predisposition seems likely. Hence, we aim to investigate prevalence and determinants in patients' first-degree relatives. METHODS We recruited SDD outpatients at their visits to our clinic and invited their relatives. We performed a full ophthalmic examination including spectral domain-optical coherence tomography (SD-OCT) and graded presence, disease stage of SDD as well as percentage of infrared (IR) en face area affected by SDD. Moreover, we performed genetic sequencing and calculated a polygenic risk score (PRS) for AMD. We conducted multivariable regression models to assess potential determinants of SDD and associations of SDD with PRS. RESULTS We included 195 participants, 123 patients (mean age 81.4 ± 7.2 years) and 72 relatives (mean age 52.2 ± 14.2 years), of which 7 presented SDD, resulting in a prevalence of 9.7%. We found older age to be associated with SDD presence and area in the total cohort and a borderline association of higher body mass index (BMI) with SDD presence in the relatives. Individuals with SDD tended to have a higher PRS, which, however, was not statistically significant in the multivariable regression. CONCLUSION Our study indicates a potential hereditary aspect of SDD and confirms the strong association with age. Based on our results, relatives of SDD patients ought to be closely monitored for retinal alterations, particularly at an older age. Further longitudinal studies with larger sample size and older relatives are needed to confirm or refute our findings.
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Affiliation(s)
- Matthias M Mauschitz
- Department of Ophthalmology, University Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany.
| | - Benedikt J Hochbein
- Department of Ophthalmology, University Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Hannah Klinkhammer
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Bonn, Bonn, Germany
| | | | - Jan H Terheyden
- Department of Ophthalmology, University Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Peter Krawitz
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
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Krytkowska E, Olejnik-Wojciechowska J, Grabowicz A, Safranow K, Machalińska A. Association between Subretinal Drusenoid Deposits and Age-Related Macular Degeneration in Multimodal Retinal Imaging. J Clin Med 2023; 12:7728. [PMID: 38137797 PMCID: PMC10744131 DOI: 10.3390/jcm12247728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Multimodal retinal imaging enables the detection of subretinal drusenoid deposits (SDD) with significantly greater accuracy compared to fundus photography. The study aimed to analyze a relationship between the presence of SDD, the clinical picture of AMD, and disease progression in a 3 year follow-up. A total of 602 eyes of 339 patients with a diagnosis of AMD, of which 121 (55%) had SDD confirmed in multimodal retinal imaging, were enrolled in the study. SDD was related to a more advanced stage of AMD (p = 0.008), especially with the presence of geographic atrophy (OR = 4.11, 95% CI 2.02-8.38, p < 0.001). Eyes with SDD presented significantly lower choroidal and retinal thickness (ATC: 210.5 μm, CRT: 277 μm, respectively) and volume (AVC: 0.17 mm3, CRV: 8.29 mm3, p < 0.001, respectively) compared to SDD-negative eyes (ATC: 203 μm, CRT: 277 μm; AVC: 7.08 mm3, 8.54 mm3, p < 0.001). Accordingly, the prevalence of pachychoroids and pachyvessels was significantly lower in the SDD present group than in eyes without SDD (p = 0.004; p = 0.04, respectively). Neither demographic factors, lipid profile, genetic predisposition, systemic vascular disease comorbidities, nor parameters of retinal vessels were affected by the presence of SDD. We found no effect of SDD presence on AMD progression (p = 0.12). The presence of SDD appeared to be related to local rather than systemic factors.
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Affiliation(s)
- Elżbieta Krytkowska
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland; (E.K.); (J.O.-W.); (A.G.)
| | - Joanna Olejnik-Wojciechowska
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland; (E.K.); (J.O.-W.); (A.G.)
| | - Aleksandra Grabowicz
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland; (E.K.); (J.O.-W.); (A.G.)
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, 70-111 Szczecin, Poland; (E.K.); (J.O.-W.); (A.G.)
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3
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Wei W, Mazzola M, Otero-Marquez O, Tong Y, Souied E, Querques G, Bailey Freund K, Theodore Smith R. Two potentially distinct pathways to geographic atrophy in age-related macular degeneration characterized by quantitative fundus autofluorescence. Eye (Lond) 2023; 37:2281-2288. [PMID: 36617586 PMCID: PMC10366132 DOI: 10.1038/s41433-022-02332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS To demonstrate two distinct pathways to geographic atrophy (GA) that originate from soft drusen/ pigment epithelial detachments (PEDs) and subretinal drusenoid deposits (SDDs), respectively, and are characterized by their final quantitative autofluorescence (qAF) levels. METHODS 23 eyes of 18 patients with GA underwent spectral-domain optical coherence tomography (SD-OCT) and qAF imaging on the qAF-ready Heidelberg Spectralis. 52 GA Regions-of-interest (ROIs), or clusters of adjacent lesions, were selected, and the ROIs were divided into groups by the dominant iAMD precursors on prior serial tracked SD-OCT scans. Mean qAF values and structural SD-OCT findings of groups were compared. RESULTS Group 1 lesions (soft drusen/PED precursors, 18/52) were isolated, with lower mean qAF (35.88 ± 12.75 units); group 3 lesions (SDD precursors, 12/52) were multilobular, with significantly higher mean qAF (71.62 ± 12.12 units, p < 0.05). Group 2 lesions, (mixed precursors, 22/52) had intermediate mean qAF (58.13 ± 67.92 units). Significantly greater prevalence of split RPE/ Bruch's membrane complex in SDD-associated GA, suggesting basal laminar deposit (BLamD), than in drusen-associated lesions was the major structural difference. CONCLUSION Quantitative autofluorescence (qAF) of GA lesions may reflect two distinct pathogenic pathways and structural outcomes, originating from soft drusen/PED and subretinal drusenoid deposits (SDDs), with the final qAF values lower or higher, respectively. Basal laminar deposit specifically in and adjacent to SDD-associated lesions may account for their greater autofluorescence. The potential importance of this paradigm is that it could direct, simplify and facilitate research on geographic atrophy by dividing the disease into two components that may be studied separately.
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Affiliation(s)
- Wei Wei
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Marco Mazzola
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ophthalmology, University of Insubria Varese-Como, Viale Luigi Borri, Varese, Italy
| | | | - Yuehong Tong
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Souied
- Department of Ophthalmology, Hôpital Intercommunal de Créteil Université, Créteil, France
| | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - R Theodore Smith
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Huang BB, Fawzi AA. Disentangling the Impact of Reticular Pseudodrusen Phenotype and the ARMS2/HTRA1 Risk Allele in Geographic Atrophy: The AREDS 2 Study Report 32. Ophthalmology 2023; 130:460-461. [PMID: 37085233 DOI: 10.1016/j.ophtha.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 04/23/2023] Open
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Bhuiyan A, Souied E, Allikmets RL, Smith RT. Re: Agrón et al.: Reticular pseudodrusen status, ARMS2/HTRA1 genotype, and geographic atrophy enlargement: Age-Related Eye Disease Study 2 Report 32. (Ophthalmology. 2022;129:1107-1119). Ophthalmology 2023:S0161-6420(23)00192-6. [PMID: 37115124 DOI: 10.1016/j.ophtha.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Alauddin Bhuiyan
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric Souied
- Department of Ophthalmology, Hopital Intercommunal de Creteil Universite, Créteil, France
| | - Rando L Allikmets
- Department of Ophthalmology, Columbia University, New York, New York
| | - R Theodore Smith
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York.
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Young BK, Shen LL, Del Priore LV. Subretinal Drusenoid Deposit Formation: Insights From Turing Patterns. Transl Vis Sci Technol 2022; 11:5. [PMID: 35254421 PMCID: PMC8914568 DOI: 10.1167/tvst.11.3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to demonstrate that the organized formation of subretinal drusenoid deposits (SDDs) may be a Turing pattern. Methods A Java-based computational model of an inferred reaction-diffusion system using paired partial differential equations was used to create topographic images. Reaction kinetics were varied to illustrate a spectrum of pattern development, which were then compared to dot-like, reticular, and confluent SDD patterns observed clinically. Results A reaction-diffusion system using two agents, one an “activator” that increases its own production, and the other an “inhibitor” that decreases the activator's production, can create patterns that match the spectrum of topographic appearance of organized SDD. By varying a single parameter, the strength of the activator, the full spectrum of clinically observed SDD patterns can be generated. A new pattern, confluence with holes, is predicted and identified in one case example. Conclusions The formation of clinically significant SDD and its different patterns can be explained using Turing patterns obtained by simulating a two-component reaction-diffusion system. Translational Relevance This model may be able to guide future risk stratification for patients with SDD, and provide mechanistic insights into the cause of the disease.
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Affiliation(s)
- Benjamin K Young
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA.,Kellogg Eye Center, Department of Ophthalmology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Liangbo L Shen
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Lucian V Del Priore
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
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Subretinal Drusenoid Deposits and Soft Drusen: Are They Markers for Distinct Retinal Diseases? Retina 2022; 42:1311-1318. [PMID: 35213528 DOI: 10.1097/iae.0000000000003460] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Soft drusen and subretinal drusenoid deposits (SDDs) characterize two pathways to advanced age-related macular degeneration (AMD), with distinct genetic risks, serum risks and associated systemic diseases. METHODS 126 Subjects with AMD were classified as SDD (with or without soft drusen), or non-SDD (drusen only) by retinal imaging, with serum risks, genetic testing, and histories of cardiovascular disease (CVD) and stroke. RESULTS There were 62 SDD subjects and 64 non-SDD subjects, 51 total had CVD or stroke.SDD correlated significantly with: lower mean serum HDL (61±18 vs. 69±22 mg/dl, p= 0.038, t test); CVD and stroke (34/51 SDD, p= 0.001, chi square); ARMS2 risk allele (p= 0.019, chi square), but not with CFH risk allele (p = 0.66). Non-SDD (drusen only) correlated/trended with: APOE2 (p= 0.032) and CETP (p= 0.072) risk alleles (chi square). Multivariate independent risks for SDD were: CVD and stroke (p= 0.008), and ARMS2 homozygous risk (p= 0.038). CONCLUSION SDD and non-SDD subjects have distinct systemic associations, serum and genetic risks. SDD are associated with CVD and stroke, ARMS2 risk, and lower HDL; non-SDD with higher HDL, CFH risk and two lipid risk genes. These and other distinct associations suggest these lesions are markers for distinct diseases.
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8
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Wu L, Monge M, Araya A. Subretinal drusenoid deposits: An update. Taiwan J Ophthalmol 2022; 12:138-146. [PMID: 35813798 PMCID: PMC9262011 DOI: 10.4103/tjo.tjo_18_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/12/2022] [Indexed: 11/30/2022] Open
Abstract
A wide spectrum of phenotypic manifestations characterizes age-related macular degeneration (AMD). Drusen is considered the hallmark of AMD and is located underneath the retinal pigment epithelium (RPE). In contrast, subretinal drusenoid deposits (SDDs), also known as reticular pseudodrusens, are located in the subretinal space, on top of the RPE. SDDs are poorly detected by clinical examination and color fundus photography. Multimodal imaging is required for their proper diagnosis. SDDs are topographically and functionally related to rods. SDDs cause a deep impairment in retinal sensitivity and dark adaptation. SDDs are dynamic structures that may grow, fuse with each other, or regress over time. An intermediate step in some eyes is the development of an acquired vitelliform lesion. The presence of SDD confers an eye a high risk for the development of late AMD. SDD leads to macular neovascularization, particularly type 3, geographic atrophy, and outer retinal atrophy.
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9
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Farashi S, Ansell BR, Wu Z, Abbott CJ, Pébay A, Fletcher EL, Guymer RH, Bahlo M. Genetics of reticular pseudodrusen in age-related macular degeneration. Trends Genet 2022; 38:312-316. [DOI: 10.1016/j.tig.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
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10
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Altay L, Liakopoulos S, Berghold A, Rosenberger KD, Ernst A, de Breuk A, den Hollander AI, Fauser S, Schick T. Genetic and environmental risk factors for reticular pseudodrusen in the EUGENDA study. Mol Vis 2021; 27:757-767. [PMID: 35136347 PMCID: PMC8763662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/30/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The purpose of this study was to analyze genetic and nongenetic associations with reticular pseudodrusen (RPD) in patients with and without age-related macular degeneration (AMD). METHODS This case-control study included 2,719 consecutive subjects from the prospective multicenter European Genetic Database (EUGENDA). Color fundus photographs and optical coherence tomography (OCT) scans were evaluated for the presence of AMD and RPD. Association of RPD with 39 known AMD polymorphisms and various nongenetic risk factors was evaluated. Stepwise backward variable selection via generalized linear models (GLMs) was performed based on models including the following: a) age, sex, and genetic factors and b) all predictors. Receiver operating characteristic (ROC) curves and the areas under the curve (AUCs) were determined. RESULTS RPD were present in 262 cases (no AMD, n = 9 [0.7%; early/intermediate AMD, n = 75 [12.4%]; late AMD, n = 178 [23.8%]). ROC analysis of the genetic model including age, APOE rs2075650, ARMS2 rs10490924, CFH rs800292, CFH rs12144939, CFI rs10033900, COL8A1 rs13081855, COL10A1 rs3812111, GLI3 rs2049622, and SKIV2L rs4296082 revealed an AUC of 0.871. Considering all possible predictors, backward selection revealed a slightly different set of genetic factors, as well as the following nongenetic risk factors: smoking, rheumatoid arthritis, steroids, antiglaucomatous drugs, and past sunlight exposure; the results showed an AUC of 0.886. CONCLUSIONS RPD share a variety of genetic and nongenetic risk factors with AMD. Future AMD grading systems should integrate RPD as an important risk phenotype.
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Affiliation(s)
- Lebriz Altay
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra Liakopoulos
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Cologne Image Reading Center, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department of Ophthalmology, Goethe University, Frankfurt, Germany
| | - Aileen Berghold
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kerstin-Daniela Rosenberger
- Department of Medical Statistics and Computational Biology, Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Angela Ernst
- Department of Medical Statistics and Computational Biology, Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Anita de Breuk
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands,Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Anneke I. den Hollander
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands,Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Sascha Fauser
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,F. Hoffmann - La Roche AG, Basel Switzerland
| | - Tina Schick
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Cologne Image Reading Center, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,AugenZentrum Siegburg, MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH, Siegburg, Germany
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11
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Wu Z, Fletcher EL, Kumar H, Greferath U, Guymer RH. Reticular pseudodrusen: A critical phenotype in age-related macular degeneration. Prog Retin Eye Res 2021; 88:101017. [PMID: 34752916 DOI: 10.1016/j.preteyeres.2021.101017] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/07/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022]
Abstract
Reticular pseudodrusen (RPD), or subretinal drusenoid deposits (SDD), refer to distinct lesions that occur in the subretinal space. Over the past three decades, their presence in association with age-related macular degeneration (AMD) has become increasingly recognized, especially as RPD have become more easily distinguished with newer clinical imaging modalities. There is also an increasing appreciation that RPD appear to be a critical AMD phenotype, where understanding their pathogenesis will provide further insights into the processes driving vision loss in AMD. However, key barriers to understanding the current evidence related to the independent impact of RPD include the heterogeneity in defining their presence, and failure to account for the confounding impact of the concurrent presence and severity of AMD pathology. This review thus critically discusses the current evidence on the prevalence and clinical significance of RPD and proposes a clinical imaging definition of RPD that will help move the field forward in gathering further key knowledge about this critical phenotype. It also proposes a putative mechanism for RPD formation and how they may drive progression to vision loss in AMD, through examining current evidence and presenting novel findings from preclinical and clinical studies.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Erica L Fletcher
- Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Himeesh Kumar
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Ursula Greferath
- Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
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Tzoumas N, Hallam D, Harris CL, Lako M, Kavanagh D, Steel DHW. Revisiting the role of factor H in age-related macular degeneration: Insights from complement-mediated renal disease and rare genetic variants. Surv Ophthalmol 2020; 66:378-401. [PMID: 33157112 DOI: 10.1016/j.survophthal.2020.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022]
Abstract
Ophthalmologists are long familiar with the eye showing signs of systemic disease, but the association between age-related macular degeneration and abnormal complement activation, common to several renal disorders, has only recently been elucidated. Although complement activation products were identified in drusen almost three decades ago, it was not until the early 21st century that a single-nucleotide polymorphism in the complement factor H gene was identified as a major heritable determinant of age-related macular degeneration, galvanizing global efforts to unravel the pathogenesis of this common disease. Advances in proteomic analyses and familial aggregation studies have revealed distinctive clinical phenotypes segregated by the functional effects of common and rare genetic variants on the mature protein and its splice variant, factor H-like protein 1. The predominance of loss-of-function, N-terminal mutations implicate age-related macular degeneration as a disease of general complement dysregulation, offering several therapeutic avenues for its modulation. Here, we explore the molecular impact of these mutations/polymorphisms on the ability of variant factor H/factor H-like protein 1 to localize to polyanions, pentraxins, proinflammatory triggers, and cell surfaces across ocular and renal tissues and exert its multimodal regulatory functions and their clinical implications. Finally, we critically evaluate key therapeutic and diagnostic efforts in this rapidly evolving field.
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Affiliation(s)
- Nikolaos Tzoumas
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Dean Hallam
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Claire L Harris
- Complement Therapeutics Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; National Renal Complement Therapeutics Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Majlinda Lako
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David Kavanagh
- Complement Therapeutics Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; National Renal Complement Therapeutics Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - David H W Steel
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Sunderland Eye Infirmary, Sunderland, United Kingdom
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13
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Lynch AM, Wagner BD, Palestine AG, Janjic N, Patnaik JL, Mathias MT, Siringo FS, Mandava N. Plasma Biomarkers of Reticular Pseudodrusen and the Risk of Progression to Advanced Age-Related Macular Degeneration. Transl Vis Sci Technol 2020; 9:12. [PMID: 32974084 PMCID: PMC7488626 DOI: 10.1167/tvst.9.10.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To determine, using an aptamer-based technology in patients with intermediate age-related macular degeneration (AMD), (1) if there is a difference in plasma levels of 4979 proteins in patients with and without reticular pseudodrusen (RPD), and (2) if plasma levels of proteins are related to time to conversion to advanced AMD. Methods Patients with intermediate AMD and RPD were identified from an AMD registry. Relative concentrations of each protein were log (base 2) transformed and compared between patients with and without RPD using linear regression. A Cox proportional hazards survival model was fit to each aptamer to quantify associations with time to conversion. A pathway analysis was conducted in converters versus non-converters using the Reactome database. Results Of the 109 intermediate AMD patients, 39 had bilateral RPD (36%). Two proteins, TCL1A and CNDP1, were lower in patients in the intermediate AMD group with RPD. Twenty-one patients converted to advanced AMD with a median time to conversion of 25.2 months (range, 2.3-48.5 months) and median follow-up time in non-converters of 26.4 months (range, 0.03-49.7 months). Several proteins (lysozyme C, TFF3, RNAS6, and SAP3) distinguished patients who converted from those who did not convert to advanced AMD. The top conversion pathways included tumor necrosis factors bind their physiological receptors, digestion and absorption, signaling by activin, and signaling by TGF-β family members. Conclusions We identified a protein signature related to RPD, as well as to conversion to advanced AMD. The pathway analysis suggests that dysfunction of critical systemic pathways may have links to conversion to advanced AMD. Translational Relevance Biomarkers identified in plasma likely reflect systemic alterations in protein expression in patients with intermediate AMD.
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Affiliation(s)
- Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marc T Mathias
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Frank S Siringo
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Aydin E, Kazanci L, Balikoglu Yilmaz M, Akyildiz Akcay F, Bayata S. Analysis of central macular thickness and choroidal thickness changes in patients with cardiovascular risk factors. Eye (Lond) 2020; 34:2068-2075. [PMID: 31992862 DOI: 10.1038/s41433-020-0775-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate central macular thickness (CMT) and choroidal thickness (CT) in the eyes of patients with cardiovascular risk factors (CVRF). METHODS A cross-sectional, prospective observational study of 92 patients with CVRF and 21 healthy individuals was conducted. Patients were divided into four groups according to the SCORE system. CMT was evaluated via spectral-domain-optical coherence tomography (SD-OCT). CT at five defined points (subfoveal) [SF] and nasal 500 μm [N0.5] and 1500 μm [N1.5] and 500 μm [T0.5] and temporal 1500 μm [T1.5] from the center of the fovea were measured via enhanced depth imaging (EDI)-OCT. RESULTS Mean SFCT at right eyes (RE) and left eyes (LE) were 311.21 ± 77.7 μm and 303.5 ± 49.6 μm, respectively, in patients with mild CVRF (Group 1); 266.5 ± 63.2 μm and 267.0 ± 62.6 μm, respectively, in patients with moderate CVRF (Group 2); 264.7 ± 57.5 μm and 272.3 ± 64.6 μm, respectively, in patients with high CVRF (Group 3); 272.3 ± 64.6 μm and 271.2 ± 63.4 μm, respectively, in patients with very high-risk CVRF (with coronary arterial disease (CAD) (Group 4); and 352.0 ± 74.4 μm and 363.1 ± 89.0 μm, respectively, in the control group. CT (at both eyes) was significantly lower at the subfoveal location in all study groups (P < 0.05), but at nasal and at temporal quadrants of group 3 and group 4 (P < 0.05). No significant difference in CMT was detected between the study and control groups. CONCLUSIONS This study demonstrated that CVRF might result in a remarkably thinner CT. Furthermore, subretinal drusenoid deposits were detected at a higher rate in the patients with CVRF than controls, and that rate increased in accordance with the severity of CAD. In the future, changes in CT may be used as a promising novel biomarker as part of the SCORE system prior to the development of CAD.
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Affiliation(s)
- Erdinc Aydin
- Department of Ophthalmology, Izmir Katip Celebi University, Faculty of Medicine, Izmir, Turkey. .,Eye Clinic, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Levent Kazanci
- Eye Clinic, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Melike Balikoglu Yilmaz
- Department of Ophthalmology, Izmir Katip Celebi University, Faculty of Medicine, Izmir, Turkey.,Eye Clinic, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Filiz Akyildiz Akcay
- Cardiology Clinic, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Sedar Bayata
- Cardiology Clinic, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
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Lynch AM, Palestine AG, Wagner BD, Patnaik JL, Frazier-Abel AA, Mathias MT, Siringo FS, Holers VM, Mandava N. Complement factors and reticular pseudodrusen in intermediate age-related macular degeneration staged by multimodal imaging. BMJ Open Ophthalmol 2020; 5:e000361. [PMID: 32509962 PMCID: PMC7254108 DOI: 10.1136/bmjophth-2019-000361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/11/2019] [Accepted: 12/17/2019] [Indexed: 12/31/2022] Open
Abstract
Objective Systemic activation of the complement system in intermediate age-related macular degeneration (AMD) is understudied. Moreover, links between the presence of reticular pseudodrusen (RPD) and systemic complement dysregulation have not been studied. The aim of this study was to determine if there is a difference in plasma complement factor levels in intermediate AMD compared with controls, and if complement levels are related to the presence of RPD. Methods and analysis Levels of complement factors C1q (µg/mL), C4 (µg/mL), C2 (µg/mL), Mannose Binding Lectin (ng/mL), C4b (µg/mL), C3 (µg/mL), factor B (µg/mL), factor D (µg/mL), properdin (µg/mL), C3a (ng/mL), iC3b/C3b (ng/mL), Ba (ng/mL), factor H (µg/mL), factor I (µg/mL), C5 (µg/mL), C5a (pg/mL) and SC5b-9 (ng/mL) were measured in plasma. Results 109 cases and 65 controls were included in the study. Thirty-nine (36%) cases had RPD. Significantly lower systemic levels of: C1q (OR 0.96, 95% CI 0.94 to 0.98), factor B (OR 0.98, 95% CI 0.96 to 0.99), iC3b/C3b (OR 0.97, 95% CI 0.95 to 0.98), factor H (OR 0.99, 95% CI 0.98 to 0.99), factor I (OR 0.83, 95% CI 0.77 to 0.89) and C5 (OR 0.94, 95% CI 0.90 to 0.98) were found in cases versus controls. Significantly elevated levels of: C2 (OR 1.29, 95% CI 1.07 to 1.59), C3a (OR 1.03, 95% CI 1.01 to 1.05) Ba (OR 1.03, 95% CI 1.01 to 1.05) and C5a (OR 1.04, 95% CI 1.02 to 1.07) were found in cases versus controls. Systemic levels of complement factors measured were not related to the presence of RPD. Conclusions Levels of several systemic complement pathway factors were found to be altered in intermediate AMD. Systemic levels of complement factors were not related to RPD.
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Affiliation(s)
- Anne M Lynch
- Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | | | - Marc T Mathias
- Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Frank S Siringo
- Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Vernon Michael Holers
- Departments of Medicine and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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16
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Re: Keenan et al.: Progression of geographic atrophy in age-related macular degeneration (Ophthalmology. 2018;125:1913-1928). Ophthalmology 2019; 126:e39-e40. [DOI: 10.1016/j.ophtha.2018.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/30/2018] [Accepted: 11/28/2018] [Indexed: 11/20/2022] Open
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17
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Theodore Smith R. Sub-threshold nanosecond laser (SNL) treatment in intermediate AMD (IAMD). ACTA ACUST UNITED AC 2019; 4. [PMID: 31460493 DOI: 10.21037/aes.2018.12.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The Laser intervention in early stages of age-related macular degeneration (LEAD) study (1) is a 36-month, multicenter, randomized, sham-controlled trial conducted from 2012-2015 of 292 participants with bilateral soft drusen, aka intermediate AMD (iAMD), who underwent q 6-month treatment with sub-threshold nanosecond laser (SNL) or sham treatment to the study eye. The primary efficacy outcome was the time to develop late AMD [geographic atrophy (GA) or choroidal neovascularization (CNV)] defined by multimodal imaging (MMI), which comprised spectral domain optical coherence tomography (SD-OCT), autofluorescence imaging (AF) and near-infrared reflectance imaging (NIR-R). Although progression to late AMD was not significantly slowed with SNL compared to sham for the entire group, posthoc analysis showed a significant benefit to those subjects without reticular pseudodrusen (RPD), and a worse outcome for those subjects with RPD, aka subretinal drusenoid deposits (SDD). SNL treatment may thus have a role in slowing progression for subjects without coexistent RPD/SDD and may be inappropriate in those with RPD/SDD. Further study is clearly warranted.
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Affiliation(s)
- R Theodore Smith
- New York Eye and Ear Infirmary of Mount Sinai, New York City, NY, USA
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18
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Quinn NB, Chakravarthy U, Muldrew KA, Hamill B, McGuinness B, Young IS, Kee F, Hogg RE. Confocal infrared imaging with optical coherence tomography provides superior detection of a number of common macular lesions compared to colour fundus photography. Ophthalmic Physiol Opt 2018; 38:574-583. [PMID: 30575074 DOI: 10.1111/opo.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare diagnostic accuracy of confocal infrared reflectance (IR), with and without optical coherence tomography (OCT), to colour fundus photography (CFP) in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) Study. METHODS Cross-sectional observational study of participants in NICOLA. CFP, IR and IR/OCT of 640 eyes were graded for hard, soft and reticular pseudodrusen; geographic atrophy; choroidal neovascularisation; naevus; epiretinal membrane; and haemorrhages. Test characteristics (sensitivity and specificity) for each imaging modality with respect to each retinal feature were calculated. RESULTS With CFP as the reference standard, sensitivity of IR by itself ranged from 75% for RPD to 93.5% for hard drusen and specificity was above 90% for all features except hard drusen (71.7%). For IR combined with OCT, sensitivity ranged from 80% for choroidal neovascularisation to 96.5% for hard drusen. When IR alone was the reference standard, CFP sensitivity was high for naevi (97.5%) but reduced markedly for epiretinal membrane (48.5%). When the combination of IR and OCT was the reference standard, sensitivity for CFP was least for epiretinal membrane (31.5%), low for geographic atrophy and reticular pseudodrusen (77.8% and 76.2% respectively) and high for all other lesion types. CONCLUSION Our findings support the use of confocal IR with OCT as a screening tool for a variety of features of macular disease in community optometric practice.
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Affiliation(s)
- Nicola B Quinn
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | | | - Barbra Hamill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Ian S Young
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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19
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Mullins RF, McGwin G, Searcey K, Clark ME, Kennedy EL, Curcio CA, Stone EM, Owsley C. The ARMS2 A69S Polymorphism Is Associated with Delayed Rod-Mediated Dark Adaptation in Eyes at Risk for Incident Age-Related Macular Degeneration. Ophthalmology 2018; 126:591-600. [PMID: 30389424 DOI: 10.1016/j.ophtha.2018.10.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To examine the association between sequence variants in genetic risk factors for age-related macular degeneration (AMD) and delayed rod-mediated dark adaptation (RMDA), the first functional biomarker for incident AMD, in older adults with normal macular health and early AMD. DESIGN Cross-sectional. PARTICIPANTS Adults 60 years of age or older showing normal macular health (defined as both eyes at step 1 on the Age-Related Eye Disease Study 9-step AMD classification system) and those with AMD in one or both eyes (defined as steps 2-9). METHODS Single nucleotide polymorphisms were genotyped in the complement factor H (CFH) and ARMS2 genes using a Taqman assay. Rod-mediated dark adaptation was assessed in 1 eye after photobleach with targets centered at 5° on the inferior vertical meridian. Rate of dark adaptation was defined by rod intercept time (RIT), duration (in minutes) required for sensitivity to reach a criterion sensitivity level in the latter half of the second component of rod recovery. Associations between CFH and ARMS2 polymorphisms and RMDA were adjusted for age and smoking. MAIN OUTCOME MEASURE Rod intercept time. RESULTS The sample consisted of 543 participants having both genotype and RIT determination; 408 showed normal macular health and 135 demonstrated AMD, most having early AMD (124 of 135). For the combined sample, higher RIT (slower RMDA) was observed for both the A69S variant in ARMS2 and the Y402H variant in CFH (adjusted P = 0.0001 and P = 0.0023, respectively). For healthy participants, the A69S variant in ARMS2 was associated with higher RIT (adjusted P = 0.0011), whereas the Y402H variant in CFH was not (adjusted P = 0.2175). For AMD patients, the A69S variant of ARMS2 and the Y402H variant of CFH were associated with higher RIT (adjusted P = 0.0182 and P = 0.0222, respectively). Those with a larger number of high-risk ARMS2 and CFH alleles showed higher RIT, in both healthy and AMD groups (adjusted P = 0.0002 and P < 0.0001, respectively). CONCLUSIONS We report a novel association wherein older adults with high-risk ARMS2 and CFH genotypes are more likely to demonstrate delayed RMDA, the first functional biomarker for incident early AMD. Before the AMD clinical phenotype is present, those showing normal macular health with the ARMS2 A69S allele demonstrate delayed RMDA. Understanding ARMS2 function is a research priority.
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Affiliation(s)
- Robert F Mullins
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Searcey
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth L Kennedy
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Edwin M Stone
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama.
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20
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Lin LY, Zhou Q, Hagstrom S, Maguire MG, Daniel E, Grunwald JE, Martin DF, Ying GS. Association of Single-Nucleotide Polymorphisms in Age-Related Macular Degeneration With Pseudodrusen: Secondary Analysis of Data From the Comparison of AMD Treatments Trials. JAMA Ophthalmol 2018; 136:682-688. [PMID: 29801032 PMCID: PMC6145774 DOI: 10.1001/jamaophthalmol.2018.1231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/17/2018] [Indexed: 11/14/2022]
Abstract
Importance Previous studies investigating the association of single-nucleotide polymorphisms (SNPs) that confer increased risk of age-related macular degeneration (AMD) with pseudodrusen have yielded conflicting results and have not evaluated other AMD SNPs or pseudodrusen subtypes. Objective To determine the association of SNPs in the complement factor H (CFH), age-related maculopathy susceptibility 2 (ARMS2), HtrA serine peptidase 1 (HTRA1), complement C2 (C2), complement C3 (C3), lipase C (LIPC), and complement factor B (CFB) genes with the presence of pseudodrusen and pseudodrusen subtypes (ie, dot, reticular, and confluent). Design, Setting, and Participants In this post hoc analysis of cross-sectional data from US participants in the Comparison of AMD Treatments Trials, genotyping was performed in 835 participants with TaqMan assays for the SNPs rs1061170 (Y402H variant in CFH), rs800292 (I62V variant in CFH), rs10490924 (A69S variant in ARMS2), rs11200638 (HTRA1), rs547154 (C2), rs2230199 (R102G variant in C3), rs10468017 (LIPC), and rs4151667 (L9H variant in CFB). Main Outcomes and Measures Presence and subtype of baseline pseudodrusen in either eye determined using color fundus photography, red-free images, and fluorescein angiograms. Results Among 835 participants enrolled for genotyping, 755 (90.4%) were evaluated for pseudodrusen. Of these, 471 (62.4%) were female and 750 (99.3%) were white, and the mean (SD) age was 78.3 (7.5) years. A total of 213 of 755 participants (28.2%) had pseudodrusen (107 [14.2%] had dot pseudodrusen, 180 [23.8%] had reticular pseudodrusen, and 102 [13.5%] had confluent pseudodrusen). After adjusting for age, sex, and smoking status, the ARMS2 risk allele T was associated with higher risk of pseudodrusen (odds ratio [OR], 1.93; 95% CI, 1.19-3.12) for TT vs GG (P = .04). A similar association was found for HTRA1 (OR, 2.04; 95% CI, 1.26-3.31) for AA vs GG (P = .03). The CFH Y402H risk allele C was associated with lower risk of pseudodrusen (OR, 0.61; 95% CI, 0.38-0.97) for CC vs TT but was not statistically significant after correcting for multiple comparison (P = .20). CFH Y402H, ARMS2, HTRA1, and C3 were significantly associated with reticular pseudodrusen. Conclusions and Relevance Among patients with neovascular AMD, the AMD risk alleles ARMS2 and HTRA1 were associated with an increased risk of pseudodrusen and the risk allele CFH Y402H was associated with lower risk of pseudodrusen, supporting findings from previous studies. Understanding the role of these SNPs in the development of pseudodrusen might improve our understanding of the pathogenesis of AMD and help develop future therapies.
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Affiliation(s)
- Lisa Y. Lin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Qiang Zhou
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | - Maureen G. Maguire
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebenezer Daniel
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Juan E. Grunwald
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Gui-shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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21
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Wilde C, Poostchi A, Mehta RL, Hillman JG, MacNab HK, Messina M, Morales M, Vernon SA, Amoaku WM. Prevalence of reticular pseudodrusen in an elderly UK Caucasian population-The Bridlington Eye Assessment Project (BEAP): a cross-sectional study (2002-2006). Eye (Lond) 2018; 32:1130-1137. [PMID: 29491487 PMCID: PMC5997694 DOI: 10.1038/s41433-018-0049-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/07/2017] [Accepted: 12/17/2017] [Indexed: 11/08/2022] Open
Abstract
AIMS To determine prevalence, associations, and risk factors for reticular pseudodrusen (RPD) in a UK population. METHODS Cross-sectional study of Bridlington residents aged ≥65 years. Masked grading of colour fundus photographs from 3549 participants. RPD presence, phenotype, and topography were recorded, demographic details were analysed, and prevalence was calculated. RESULTS RPD was detected in 281 eyes (176 individuals) of 3476 participants (5.06%) with gradable images, and bilateral in 76.6%. Digital enhancement increased detection by 15.7%. Prevalence increased significantly with age from 1.18% (65-69 years) to 27.27% (≥90 years) (mean age 81.1, SD 6.01; OR 1.18, 95% CI 1.15-1.21, p value <0.001), was higher in females (5.9% vs 4.0%; OR 1.52, 95% CI 1.09-2.13, p = 0.014), and associated with diabetes (OR 1.97, CI 1.20-3.17, p = 0.005). History of antihypertension treatment appeared protective (OR 0.64, 95% CI 0.46-0.90, p = 0.009). RPD subtypes were dot in 18.5%, ribbon in 36.7%, and mixed in 36.3%. RPD were located outside the ETDRS grid in 88%, and most commonly in the outer superior subfield. Central grid involvement occurred in 12.1% of right and 14.3% of left eyes. RPD occurred in 25.9% of participants with grade 4 AMD in at least one eye. RPD was associated with visual dissatisfaction after controlling for age (OR 0.63, 95% CI 0.45-0.88, p = 0.007). CONCLUSION RPD occur more commonly than previously reported, most frequently in the upper-outer macular subfield, but also within the central subfield, albeit with reduced frequency and altered morphology. RPD may be associated with visual dissatisfaction and diabetes, but are less frequent in persons receiving antihypertension therapy.
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Affiliation(s)
- Craig Wilde
- Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Ali Poostchi
- Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Rajnikant L Mehta
- Research Design Service, East Midlands (RDS EM), School of Medicine, University of Nottingham, Nottingham Health Science Partners, Room 2107, C Floor South Block, QMC, Nottingham, NG7 2UH, UK
| | | | - Hamish K MacNab
- The Medical Centre, Station Avenue, Bridlington, YO16 4LZ, UK
| | - Marco Messina
- Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Marco Morales
- Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Stephen A Vernon
- University Hospital, Queen's Medical Centre, Nottingham and Honorary Professor of Ophthalmology, University of Nottingham, Nottingham, UK
| | - Winfried M Amoaku
- Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, B Floor, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
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Spaide RF, Ooto S, Curcio CA. Subretinal drusenoid deposits AKA pseudodrusen. Surv Ophthalmol 2018; 63:782-815. [PMID: 29859199 DOI: 10.1016/j.survophthal.2018.05.005] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 01/30/2023]
Abstract
A distinction between conventional drusen and pseudodrusen was first made in 1990, and more recently knowledge of pseudodrusen, more accurately called subretinal drusenoid deposits (SDDs), has expanded. Pseudodrusen have a bluish-white appearance by biomicroscopy and color fundus photography. Using optical coherence tomography, pseudodrusen were found to be accumulations of material internal to the retinal pigment epithelium that could extend internally through the ellipsoid zone. These deposits are more commonly seen in older eyes with thinner choroids. Histologic evaluation of these deposits revealed aggregations of material in the subretinal space between photoreceptors and retinal pigment epithelium. SDDs contain some proteins in common with soft drusen but differ in lipid composition. Many studies reported that SDDs are strong independent risk factors for late age-related macular degeneration. Geographic atrophy and type 3 neovascularization are particularly associated with SDD. Unlike conventional drusen, eyes with SDD show slow dark adaptation and poor contrast sensitivity. Outer retinal atrophy develops in eyes with regression of SDD, a newly recognized form of late age-related macular degeneration. Advances in imaging technology have enabled many insights into this condition, including associated photoreceptor, retinal pigment epithelium, and underlying choroidal changes.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.
| | - Sotaro Ooto
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA; Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Christine A Curcio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabamas, USA
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23
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Jabbarpoor Bonyadi MH, Yaseri M, Nikkhah H, Bonyadi M, Soheilian M. Association of risk genotypes of ARMS2/LOC387715 A69S and CFH Y402H with age-related macular degeneration with and without reticular pseudodrusen: a meta-analysis. Acta Ophthalmol 2018; 96:e105-e110. [PMID: 28593728 DOI: 10.1111/aos.13494] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 04/30/2017] [Indexed: 02/02/2023]
Abstract
To pool the results of published data regarding association of ARMS2/LOC387715 A69S, CFH Y402H and CFH I62V genotypes with age-related macular degeneration (AMD) with and without reticular pseudodrusen (RPD). The results of this pooled data used to estimate the contribution of each of these genes in the pathogenesis of RPD. Heterogeneity of studies was evaluated using Cochran Q-test and I2 index. To modify the heterogeneity in the variables, we used the random effects model. Meta-analysis was performed using STATA. Odds ratio (OR) of genotypes in each study was calculated. Six studies of AMD with RPD and AMD without RPD cases included in this analysis. Analysis of pooled data showed that risk genotypes frequency of ARMS2 A69S was significantly different between AMD with RPD and AMD without RPD [OR = 1.82, 95% confidence interval (CI): 1.26-2.63 for GT versus GG ARMS2 A69S; OR = 2.40, 95% CI: 1.50-3.84 for TT versus GG ARMS2 A69S]. Further analysis also showed that the risk genotype frequency of CFH Y402H was not significantly different between these two groups (OR = 1.02, 95% CI: 0.69-1.50 for CT versus TT CFH Y402H; OR = 1.09, 95% CI: 0.74-1.60 for CC versus TT CFH Y402H). Comparison of above-mentioned ORs revealed statistically higher values for GT and TT genotypes of ARMS2 A69S compared with CFH Y402H genotypes (p = 0.011, p = 0.014, respectively).Our analysis showed stronger contribution of ARMS2 in AMD with RPD group versus AMD without RPD group, in comparison with CFH genotypes.
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Affiliation(s)
| | - Mehdi Yaseri
- Department of biostatistics and epidemiology; Tehran University of Medical Sciences; Tehran Iran
| | - Homayoun Nikkhah
- Ocular Tissue Engineering Research Center; Ophthalmic Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Mortaza Bonyadi
- Center of Excellence for Biodiversity; Faculty of Natural Sciences; University of Tabriz; Tabriz Iran
| | - Masoud Soheilian
- Ocular Tissue Engineering Research Center; Ophthalmic Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
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24
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Yiu G, Tieu E, Munevar C, Wong B, Cunefare D, Farsiu S, Garzel L, Roberts J, Thomasy SM. In Vivo Multimodal Imaging of Drusenoid Lesions in Rhesus Macaques. Sci Rep 2017; 7:15013. [PMID: 29101353 PMCID: PMC5670133 DOI: 10.1038/s41598-017-14715-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/16/2017] [Indexed: 01/19/2023] Open
Abstract
Nonhuman primates are the only mammals to possess a true macula similar to humans, and spontaneously develop drusenoid lesions which are hallmarks of age-related macular degeneration (AMD). Prior studies demonstrated similarities between human and nonhuman primate drusen based on clinical appearance and histopathology. Here, we employed fundus photography, spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), and infrared reflectance (IR) to characterize drusenoid lesions in aged rhesus macaques. Of 65 animals evaluated, we identified lesions in 20 animals (30.7%). Using the Age-Related Eye Disease Study 2 (AREDS2) grading system and multimodal imaging, we identified two distinct drusen phenotypes - 1) soft drusen that are larger and appear as hyperreflective deposits between the retinal pigment epithelium (RPE) and Bruch's membrane on SD-OCT, and 2) hard, punctate lesions that are smaller and undetectable on SD-OCT. Both exhibit variable FAF intensities and are poorly visualized on IR. Eyes with drusen exhibited a slightly thicker RPE compared with control eyes (+3.4 μm, P=0.012). Genetic polymorphisms associated with drusenoid lesions in rhesus monkeys in ARMS2 and HTRA1 were similar in frequency between the two phenotypes. These results refine our understanding of drusen development, and provide insight into the absence of advanced AMD in nonhuman primates.
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Affiliation(s)
- Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, USA.
| | - Eric Tieu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, USA
| | - Christian Munevar
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Brittany Wong
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Laura Garzel
- California National Primate Research Center, Davis, California, USA
| | - Jeffrey Roberts
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA.,California National Primate Research Center, Davis, California, USA
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
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Rabiolo A, Sacconi R, Cicinelli MV, Querques L, Bandello F, Querques G. Spotlight on reticular pseudodrusen. Clin Ophthalmol 2017; 11:1707-1718. [PMID: 29033536 PMCID: PMC5614782 DOI: 10.2147/opth.s130165] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of vision loss in patients >50 years old. The hallmark of the disease is represented by the accumulation of extracellular material between retinal pigment epithelium and the inner collagenous layer of Bruch's membrane, called drusen. Although identified almost 30 years ago, reticular pseudodrusen (RPD) have been recently recognized as a distinctive phenotype. Unlike drusen, they are located in the subretinal space. RPD are strongly associated with late AMD, especially geographic atrophy, type 2 and 3 choroidal neovascularization, which, in turn, are less common in typical AMD. RPD identification is not straightforward at fundus examination, and their identification should employ at least 2 different imaging modalities. In this narrative review, we embrace all aspects of RPD, including history, epidemiology, histology, imaging, functional test, natural history and therapy.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
- Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona
| | | | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
- G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
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26
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McCarter RV, McKay GJ, Quinn NB, Chakravarthy U, MacGillivray TJ, Robertson G, Pellegrini E, Trucco E, Williams MC, Peto T, Dhillon B, van Beek EJ, Newby DE, Kee F, Young IS, Hogg RE. Evaluation of coronary artery disease as a risk factor for reticular pseudodrusen. Br J Ophthalmol 2017; 102:483-489. [PMID: 28822985 DOI: 10.1136/bjophthalmol-2017-310526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE Reticular pseudodrusen (RPD) are a risk factor for late age-related macular degeneration (AMD). Associations between RPD and coronary artery disease (CAD) have been reported from small case-control studies. This study investigated the association of RPD within a predominantly CAD cohort. METHODS A subgroup of subjects from a multicentre randomised controlled trial of CT coronary angiography (CTCA) underwent ultrawide field (UWF) retinal imaging CAD determined by CTCA and was categorised as normal, non-obstructive or obstructive. Specific AMD features in UWF images were graded. Standardised grids were used to record the spatial location of AMD features, including RPD. Multivariate confounder adjusted regression models assessed the association between RPD and CAD. RESULTS The 534 participants were aged 27-75 years (mean 58±9 years; 425 (80%) ≥50 years) with a male preponderance (56%). Within the study sample, 178 (33%) had no CAD, 351 (66%) had CAD. RPD was detected in 30 participants (5.6%) and bilaterally in 23. Most participants with bilateral RPD had intermediate AMD 17 (74%). After adjustment for potential confounders (age, sex, drusen >125 µm, smoking status), multivariate analysis found no significant association between CAD and RPD (OR 1.31; 95% CI (0.57 to 3.01); p=0.52). A significant association was identified between RPD and intermediate AMD (OR 3.18; 95% CI (1.61 to 6.27); p=0.001). CONCLUSION We found no evidence to support an association between CAD and RPD. RPD was strongly associated with intermediate AMD features. TRIAL REGISTRATION NUMBER NCT01149590, Post results.
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Affiliation(s)
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Nicola B Quinn
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Tom J MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Gavin Robertson
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Enrico Pellegrini
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | | | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Baljean Dhillon
- VAMPIRE Project, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Edwin Jr van Beek
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ian S Young
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Comparison between Widefield En Face Swept-Source OCT and Conventional Multimodal Imaging for the Detection of Reticular Pseudodrusen. Ophthalmology 2017; 124:205-214. [DOI: 10.1016/j.ophtha.2016.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 12/12/2022] Open
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Leisy HB, Ahmad M, Marmor M, Smith RT. Association between Decreased Renal Function and Reticular Macular Disease in Age-Related Macular Degeneration. Ophthalmol Retina 2017; 1:42-48. [PMID: 31047393 DOI: 10.1016/j.oret.2016.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare renal function in patients with age-related macular degeneration (AMD) with and without concurrent reticular macular disease (RMD). DESIGN Retrospective cohort study. PARTICIPANTS Patients with documented AMD with and without RMD. METHODS Via our electronic health record system, we retrospectively identified patients assigned an International Classification of Diseases, Ninth Edition, code associated with AMD between January 2012 and January 2016. Patients met inclusion criteria if they had at least 1 macular spectral-domain optical coherence tomography volume scan, 1 provider note, and 1 glomerular filtration rate (GFR) value in the electronic medical record. We evaluated images for the presence or absence of RMD; we defined RMD as the presence of at least 1 subretinal drusenoid deposit in at least 1 macular slice. Patients with RMD in at least 1 eye were deemed RMD positive. Patients with bilateral choroidal neovascularization were excluded from analysis. MAIN OUTCOME MEASURE Observation of renal function in RMD patients. RESULTS Inclusion criteria were met by 119 patients (mean age, 75 years; range, 46-101 years). To account for the significant difference in RMD prevalence at extreme ages, we limited our study population to 107 patients 50 to 90 years of age. A GFR less than 60 ml/min/1.73 m2 was found in 45.0% (27/60) of those with RMD compared with 12.8% (6/47) of those without RMD (odds ratio, 5.6; 95% confidence interval, 2.1-15). Multivariate logistic regression indicated that low GFR was a significant predictor for RMD, even after accounting for differences in age, diabetes, hypertension, hyperlipidemia, and other potential confounders. When comparing within classification subsets for RMD and GFR in patients with choroidal thickness data, significant choroidal thinning was associated with RMD (170 vs. 228 μm; P = 0.01) and GFR less than 60 ml/min/1.73 m2 (144 vs. 219 μm; P = 0.0008). CONCLUSIONS Our analysis showed an association between RMD and renal dysfunction. Larger cross-sectional and longitudinal studies of the association of RMD with kidney function are warranted to better understand the nature and biological basis of this observed connection.
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Affiliation(s)
- Heather B Leisy
- Department of Ophthalmology, New York University School of Medicine, New York, New York.
| | - Meleha Ahmad
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Michael Marmor
- Departments of Population Health, Environmental Medicine, and Medicine, New York University School of Medicine, New York, New York
| | - R Theodore Smith
- Department of Ophthalmology, New York University School of Medicine, New York, New York
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29
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Elfandi S, Ooto S, Ueda-Arakawa N, Takahashi A, Yoshikawa M, Nakanishi H, Tamura H, Oishi A, Yamashiro K, Yoshimura N. Clinical and Genetic Characteristics of Japanese Patients with Age-Related Macular Degeneration and Pseudodrusen. Ophthalmology 2016; 123:2205-12. [DOI: 10.1016/j.ophtha.2016.06.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 02/06/2023] Open
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30
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Perspectives on reticular pseudodrusen in age-related macular degeneration. Surv Ophthalmol 2016; 61:521-37. [DOI: 10.1016/j.survophthal.2016.02.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 11/20/2022]
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31
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Cheng H, Kaszubski PA, Hao H, Saade C, Cunningham C, Freund KB, Smith RT. The Relationship Between Reticular Macular Disease and Choroidal Thickness. Curr Eye Res 2016; 41:1492-1497. [PMID: 27115048 DOI: 10.3109/02713683.2015.1127391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Subretinal drusenoid deposits (SDD) are the main structural lesion of reticular macular disease (RMD), a phenotype of age-related macular degeneration (AMD). We aim to demonstrate spatiotemporal relationships between SDD and choroidal thickness (CTh) alterations in RMD+ and RMD- eyes. METHODS Thirty-three eyes (26 subjects) with early AMD/no SDD (RMD-) and 18 eyes (16 subjects) with early AMD/SDD (RMD+) underwent enhanced depth imaging spectral domain optical coherence tomography (SD-OCT) for CTh measurements at 11 points per scan, in 5 horizontal B scans, creating a grid of 55 points/eye. The 55 points were treated as a cluster, controlling within-subject correlation. Marginal generalized estimating equation modeling was used to estimate the association between CTh and RMD status. All eyes were divided by their median age (≤82 and >82 years) for stratified analyses. RESULTS CTh was not significantly reduced in RMD+ eyes compared with RMD- eyes (mean difference [MD] -16.84 μm, P = 0.24). Among younger subjects, mean CTh was significantly reduced in RMD+ versus RMD- eyes (MD -53.72 μm, P = 0.01). Conversely, among older subjects, there was no significant difference in CTh between RMD+ and RMD-. CONCLUSIONS In RMD, the association of SDD and CTh alterations varies with age but not by macular region. Among younger subjects (<82 years old), CTh was significantly thinner in RMD+ versus RMD- eyes.
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Affiliation(s)
- Hao Cheng
- a Department of Ophthalmology , The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China.,b Department of Ophthalmology , New York University School of Medicine , New York , NY , USA
| | - Patrick A Kaszubski
- b Department of Ophthalmology , New York University School of Medicine , New York , NY , USA
| | - Hua Hao
- c Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Celine Saade
- b Department of Ophthalmology , New York University School of Medicine , New York , NY , USA
| | - Colleen Cunningham
- b Department of Ophthalmology , New York University School of Medicine , New York , NY , USA
| | - K Bailey Freund
- b Department of Ophthalmology , New York University School of Medicine , New York , NY , USA.,d Vitreous-Retina-Macula Consultants of New York , New York , NY , USA
| | - R Theodore Smith
- b Department of Ophthalmology , New York University School of Medicine , New York , NY , USA
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32
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Zarubina AV, Neely DC, Clark ME, Huisingh CE, Samuels BC, Zhang Y, McGwin G, Owsley C, Curcio CA. Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging. Ophthalmology 2016; 123:1090-100. [PMID: 26875000 DOI: 10.1016/j.ophtha.2015.12.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the prevalence of subretinal drusenoid deposits (SDD) in older adults with healthy maculas and early and intermediate age-related macular degeneration (AMD) using multimodal imaging. DESIGN Cross-sectional study. PARTICIPANTS A total of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration from primary care ophthalmology clinics. METHODS Subjects were imaged using spectral domain optical coherence tomography (SD OCT) of the macula and optic nerve head (ONH), infrared reflectance, fundus autofluorescence, and color fundus photographs (CFP). Eyes were assessed for AMD presence and severity using the Age-Related Eye Disease Study (AREDS) 9-step scale. Criteria for SDD presence were identification on ≥1 en face modality plus SD OCT or on ≥2 en face modalities if absent on SD OCT. Subretinal drusenoid deposits were considered present at the person level if present in 1 or both eyes. MAIN OUTCOME MEASURES Prevalence of SDD in participants with and without AMD. RESULTS Overall prevalence of SDD was 32% (197/611), with 62% (122/197) affected in both eyes. Persons with SDD were older than those without SDD (70.6 vs. 68.7 years, P = 0.0002). Prevalence of SDD was 23% in subjects without AMD and 52% in subjects with AMD (P < 0.0001). Among those with early and intermediate AMD, SDD prevalence was 49% and 79%, respectively. After age adjustment, those with SDD were 3.4 times more likely to have AMD than those without SDD (95% confidence interval, 2.3-4.9). By using CFP only for SDD detection per the AREDS protocol, prevalence of SDD was 2% (12/610). Of persons with SDD detected by SD OCT and confirmed by at least 1 en face modality, 47% (89/190) were detected exclusively on the ONH SD OCT volume. CONCLUSIONS Subretinal drusenoid deposits are present in approximately one quarter of older adults with healthy maculae and in more than half of persons with early to intermediate AMD, even by stringent criteria. The prevalence of SDD is strongly associated with AMD presence and severity and increases with age, and its retinal topography including peripapillary involvement resembles that of rod photoreceptors. Consensus on SDD detection methods is recommended to advance our knowledge of this lesion and its clinical and biologic significance.
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Affiliation(s)
- Anna V Zarubina
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David C Neely
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark E Clark
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carrie E Huisingh
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian C Samuels
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yuhua Zhang
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine A Curcio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
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van der Maten E, Westra D, van Selm S, Langereis JD, Bootsma HJ, van Opzeeland FJH, de Groot R, Ruseva MM, Pickering MC, van den Heuvel LPWJ, van de Kar NCAJ, de Jonge MI, van der Flier M. Complement Factor H Serum Levels Determine Resistance to Pneumococcal Invasive Disease. J Infect Dis 2016; 213:1820-7. [PMID: 26802141 DOI: 10.1093/infdis/jiw029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022] Open
Abstract
Streptococcus pneumoniae is a major cause of life-threatening infections. Complement activation plays a vital role in opsonophagocytic killing of pneumococci in blood. Initial complement activation via the classical and lectin pathways is amplified through the alternative pathway amplification loop. Alternative pathway activity is inhibited by complement factor H (FH). Our study demonstrates the functional consequences of the variability in human serum FH levels on host defense. Using an in vivo mouse model combined with human in vitro assays, we show that the level of serum FH correlates with the efficacy of opsonophagocytic killing of pneumococci. In summary, we found that FH levels determine a delicate balance of alternative pathway activity, thus affecting the resistance to invasive pneumococcal disease. Our results suggest that variation in FH expression levels, naturally occurring in the human population, plays a thus far unrecognized role in the resistance to invasive pneumococcal disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Marieta M Ruseva
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | - Matthew C Pickering
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | | | | | | | - Michiel van der Flier
- Laboratory of Pediatric Infectious Diseases Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Rastogi N, Smith RT. Association of age-related macular degeneration and reticular macular disease with cardiovascular disease. Surv Ophthalmol 2015; 61:422-33. [PMID: 26518628 DOI: 10.1016/j.survophthal.2015.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 09/26/2015] [Accepted: 10/02/2015] [Indexed: 02/04/2023]
Abstract
Age-related macular degeneration is the leading cause of adult blindness in the developed world. Thus, major endeavors to understand the risk factors and pathogenesis of this disease have been undertaken. Reticular macular disease is a proposed subtype of age-related macular degeneration correlating histologically with subretinal drusenoid deposits located between the retinal pigment epithelium and the inner segment ellipsoid zone. Reticular lesions are more prevalent in females and in older age groups and are associated with a higher mortality rate. Risk factors for developing age-related macular degeneration include hypertension, smoking, and angina. Several genes related to increased risk for age-related macular degeneration and reticular macular disease are also associated with cardiovascular disease. Better understanding of the clinical and genetic risk factors for age-related macular degeneration and reticular macular disease has led to the hypothesis that these eye diseases are systemic. A systemic origin may help to explain why reticular disease is diagnosed more frequently in females as males suffer cardiovascular mortality at an earlier age, before the age of diagnosis of reticular macular disease and age-related macular degeneration.
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Affiliation(s)
- Neelesh Rastogi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - R Theodore Smith
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA.
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Alten F, Eter N. Current knowledge on reticular pseudodrusen in age-related macular degeneration. Br J Ophthalmol 2014; 99:717-22. [DOI: 10.1136/bjophthalmol-2014-305339] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/28/2014] [Indexed: 11/03/2022]
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36
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Malek G, Lad EM. Emerging roles for nuclear receptors in the pathogenesis of age-related macular degeneration. Cell Mol Life Sci 2014; 71:4617-36. [PMID: 25156067 DOI: 10.1007/s00018-014-1709-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 12/20/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of vision loss in the elderly in the Western world. Over the last 30 years, our understanding of the pathogenesis of the disease has grown exponentially thanks to the results of countless epidemiology, genetic, histological, and biochemical studies. This information, in turn, has led to the identification of multiple biologic pathways potentially involved in development and progression of AMD, including but not limited to inflammation, lipid and extracellular matrix dysregulation, and angiogenesis. Nuclear receptors are a superfamily of transcription factors that have been shown to regulate many of the pathogenic pathways linked with AMD and as such they are emerging as promising targets for therapeutic intervention. In this review, we will present the fundamental phenotypic features of AMD and discuss our current understanding of the pathobiological disease mechanisms. We will introduce the nuclear receptor superfamily and discuss the current literature on their effects on AMD-related pathophysiology.
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Affiliation(s)
- Goldis Malek
- Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Road, AERI Room 4006, Durham, NC, 27710, USA,
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Saade C, Smith RT. Reticular macular lesions: a review of the phenotypic hallmarks and their clinical significance. Clin Exp Ophthalmol 2014; 42:865-74. [PMID: 24803342 DOI: 10.1111/ceo.12353] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/08/2014] [Indexed: 12/18/2022]
Abstract
Reticular macular lesions, also known as 'reticular macular disease', 'reticular drusen', 'reticular pseudodrusen', or 'subretinal drusenoid deposits', are a pattern of lesions commonly found in age-related macular degeneration and best visualized using at least two imaging techniques in combination. Reticular lesions have four stages of progression observable on spectral domain optical coherence tomography, but they do not show the usual signs of regression of soft drusen (calcification and pigment changes). Furthermore, reticular lesions correlate histologically with subretinal drusenoid deposits localized between the retinal pigment epithelium and the inner segment ellipsoid band. Reticular lesions are most commonly seen in older age groups of female patients with age-related macular degeneration and are usually bilateral. They are not clearly associated with known age-related macular degeneration genes and are highly associated with late-stage age-related macular degeneration and an increased mortality rate. They are also associated with alterations in the neural retina and choroid.
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Affiliation(s)
- Celine Saade
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
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39
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Hogg RE, Silva R, Staurenghi G, Murphy G, Santos AR, Rosina C, Chakravarthy U. Clinical characteristics of reticular pseudodrusen in the fellow eye of patients with unilateral neovascular age-related macular degeneration. Ophthalmology 2014; 121:1748-55. [PMID: 24856310 DOI: 10.1016/j.ophtha.2014.03.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To describe associations between reticular pseudodrusen, individual characteristics, and retinal function. DESIGN Cohort study. PARTICIPANTS We recruited 105 patients (age range, 52-93 years) who had advanced neovascular age-related macular degeneration (AMD) in only 1 eye from 3 clinical centers in Europe. METHODS Minimum follow-up was 12 months. The eye selected for study was the fellow eye without advanced disease. Clinical measures of vision were distance visual acuity, near visual acuity, and results of the Smith-Kettlewell low-luminance acuity test (SKILL). Fundus imaging included color photography, red-free imaging, blue autofluorescence imaging, fluorescein angiography, indocyanine green angiography, and optical coherence tomography using standardized protocols. These were used to detect progression to neovascular AMD in the study eye during follow-up. All imaging outputs were graded for the presence or absence of reticular pseudodrusen (RPD) using a multimodal approach. Choroidal thickness was measured at the foveal center and at 2 other equidistant locations from the fovea (1500 μm) nasally and temporally. Metrics on retinal thickness and volume were obtained from the manufacturer-supplied automated segmentation readouts. MAIN OUTCOME MEASURES Presence of RPD, distance visual acuity, near visual acuity, SKILL score, choroidal thickness, retinal thickness, and retinal volume. RESULTS Reticular pseudodrusen was found in 43 participants (41%) on 1 or more imaging method. The SKILL score was significantly worse in those with reticular drusen (mean score ± standard deviation [SD, 38±12) versus those without (mean score ± SD, 33±9) (P = 0.034). Parafoveal retinal thickness, parafoveal retinal volume, and all of the choroidal thickness parameters measured were significantly lower in those with reticular drusen than in those without. The presence of RPD was associated with development of neovascular AMD when corrected for age and sex (odds ratio, 5.5; 95% confidence interval, 1.1-28.8; P = 0.042). All participants in whom geographic atrophy developed during follow-up had visible RPD at baseline. CONCLUSIONS Significant differences in retinal and choroidal anatomic features, visual function, and risk factor profile exist in unilateral neovascular AMD patients with RPD compared with those without; therefore, such patients should be monitored carefully because of the risk of developing bilateral disease.
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Affiliation(s)
- Ruth E Hogg
- Center for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Rufino Silva
- Ophthalmology Unit, Centro Hospitalar e Universitário Coimbra, and Faculty Medicine, University of Coimbra, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Giovanni Staurenghi
- Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - George Murphy
- Center for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Ana R Santos
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Chiara Rosina
- Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Usha Chakravarthy
- Center for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom.
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Boddu S, Lee MD, Marsiglia M, Marmor M, Freund KB, Smith RT. Risk factors associated with reticular pseudodrusen versus large soft drusen. Am J Ophthalmol 2014; 157:985-993.e2. [PMID: 24491417 DOI: 10.1016/j.ajo.2014.01.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate genetic, environmental, and systemic risk factors in prospectively identified subjects with the age-related macular degeneration (AMD) phenotypes of (1) reticular pseudodrusen without large soft drusen and (2) large soft drusen without reticular pseudodrusen. DESIGN Prospective case-case comparison. METHODS In a clinical practice setting, patients with AMD were sequentially screened using clinical examination and scanning laser ophthalmoscopy imaging to prospectively identify subjects (n = 73) with the phenotypes of (1) reticular pseudodrusen without large soft drusen (n = 30) or (2) large soft drusen without reticular pseudodrusen (n = 43). Subjects were genotyped for 2 alleles associated with AMD, age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH). A questionnaire was administered to collect history of smoking, hypertension, diabetes, and hyperlipidemia, as well as personal and family history of AMD. RESULTS The reticular pseudodrusen group was older (median age 87 vs 81 years, P = .04) and had more female subjects (83.3% vs 48.8%, P = .003), later ages of AMD onset (83 vs 70 years, P = .0005), and a greater frequency of hypertension (76.7% vs 55.8%, P = .08). No significant differences were found in the distribution of the ARMS2 risk allele (P = .4) between the reticular pseudodrusen (homozygous = 20.0%; heterozygous = 56.7%) and large soft drusen (homozygous = 19.0%; heterozygous = 42.9%) phenotypes, or in the distribution of the CHF risk allele (P = .7) between the reticular pseudodrusen (homozygous = 26.7%; heterozygous = 56.7%) and large soft drusen (homozygous = 21.4%; heterozygous = 66.7%) phenotypes. CONCLUSIONS The reticular pseudodrusen phenotype was associated with increased age, later age of AMD onset, and female sex.
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Grewal DS, Chou J, Rollins SD, Fawzi AA. A pilot quantitative study of topographic correlation between reticular pseudodrusen and the choroidal vasculature using en face optical coherence tomography. PLoS One 2014; 9:e92841. [PMID: 24658298 PMCID: PMC3962468 DOI: 10.1371/journal.pone.0092841] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/27/2014] [Indexed: 02/01/2023] Open
Abstract
Purpose To analyze the topographic correlation between reticular pseudodrusen (RPD) visualized on infrared reflectance (IR) and choroidal vasculature using en-face volumetric spectral-domain optical coherence tomography (SD-OCT). Methods A masked observer marked individual RPD on IR images using ImageJ (NIH, Bethesda, MD). Using the macular volume scan (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA), the RPE slab function was used to generate a C-scan of the most superficial choroidal vasculature. An independent masked grader created a topographic binary map of the choroidal vasculature by thresholding the en-face image, which was overlaid onto the IR map of RPD. For each IR image, ImageJ was used to generate a random set of dots as “control lesions”. Results 17 eyes of 11 patients (78±13.7 years) with RPD were analyzed. The average number of RPD lesions identified on IR images was 414±71.5, of which 49.6±4.3% were located overlying the choroidal vasculature, compared to 45.4±4.0% in controls (p = 0.014). 50.4±4.3% of lesions overlay the choroidal stroma, of which 76.5±3.1% were ≤3 pixels from the choroidal vessels. The percentage of RPD lesions located within ≤3 pixels from the choroidal vasculature was significantly greater than the percentage located ≥7 pixels away. (p<0.0001). Compared to controls (71.6±3.8%), RPD were more likely to be located ≤3 pixels away from choroidal vessels (p = 0.014). In contrast, control lesions were more likely to be ≥7 pixels away from choroidal vessels than RPD (9.1±1.9% vs. 4.8±1.2%, respectively, p = 0.002). Conclusions Our analysis shows that RPD lesions follow the underlying choroidal vasculature. Approximately half the RPD directly overlay the choroidal vessels and the majority of the remaining lesions were ≤3 pixels (≤30microns) from the vessel edge, supporting the hypothesis that RPD maybe related to pathologic changes at the choroidal level.
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Affiliation(s)
- Dilraj S. Grewal
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jonathan Chou
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Stuart D. Rollins
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Amani A. Fawzi
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
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Yoneyama S, Sakurada Y, Mabuchi F, Imasawa M, Sugiyama A, Kubota T, Iijima H. Genetic and clinical factors associated with reticular pseudodrusen in exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2014; 252:1435-41. [PMID: 24595987 DOI: 10.1007/s00417-014-2601-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/17/2014] [Accepted: 02/07/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUNDS Reticular pseudodrusen (RPD) is considered to be a distinct entity from soft drusen and a risk factor for age-related macular degeneration (AMD). In the present study, we investigate the genetic and clinical factors associated with reticular pseudodrusen (RPD) in patients with exudative AMD, including polypoidal choroidal vasculopathy (PCV), typical neovascular AMD, and retinal angiomatous proliferation (RAP). METHODS The presence or absence of RPD was studied among 408 patients with exudative AMD in at least one eye, and the clinical characteristics of those with RPD were investigated as well as genetic polymorphisms of ARMS2 A69S (rs10490924) and CFH I62V (rs800292). Subfoveal choroidal thickness was also evaluated in a limited number of subjects using the EDI mode of spectral-domain optical coherence tomography. RESULTS The prevalence of RPD was significantly higher in RAP eyes than in typical neovascular AMD or in PCV eyes (38.2% of 26 eyes, 13.6% of 132 eyes and 0% of 250 eyes respectively, P < 0.0001). RPD was significantly more prevalent in the elderly (P < 0.0001) and female (P < 0.0001) subjects. The subfoveal choroidal thickness was thinner in eyes with RPD than in those without (129.7 ± 61.7 μm vs 42.6 ± 84.9 μm, P < 0.0001). The frequency of risk variants of ARMS2 A69S was significantly higher in eyes with RPD than in those without RPD (85.7% vs 63.8%, P = 0.0009), although the frequency of CFH I62V was not significantly different between those with and without RPD. Logistic regression analysis revealed that age (odds ratio [OR]:1.10; 95% confidence interval [CI]: 1.04-1.18; p = 0.002), female gender (OR:4.26; 95%CI: 1.72-10.4; p = 0.002), T-allele at ARMS2 A69S (OR: 3.23; 95%CI: 1.36-7.68; p = 0.008) and RAP (OR: 4.25; 95%CI:1.49-12.1; p = 0.007) were risk factors for RPD. CONCLUSIONS Among eyes with exudative AMD, RPD is more common in eyes with RAP having a thin choroid at the fovea, especially in old, female patients with the risk variant of ARMS2 A69S.
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Affiliation(s)
- Seigo Yoneyama
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Shimokato 1110, Chuo, Yamanashi, 409-3898, Japan
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Joachim N, Mitchell P, Rochtchina E, Tan AG, Wang JJ. Incidence and progression of reticular drusen in age-related macular degeneration: findings from an older Australian cohort. Ophthalmology 2013; 121:917-25. [PMID: 24332537 DOI: 10.1016/j.ophtha.2013.10.043] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 10/28/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To assess the 15-year incidence and progression of reticular drusen and associations of this lesion with age-related macular degeneration (AMD) risk factors. DESIGN Population-based cohort. PARTICIPANTS Blue Mountains Eye Study participants (n = 3654) 49 years of age and older attended baseline examinations; of these, 75.8%, 76.7%, and 56.1% of survivors attended 5-year, 10-year, and 15-year follow-up examinations, respectively. METHODS Color retinal photographs were obtained and comprehensive questionnaires were administered at each visit, and DNA samples were genotyped. Fundus autofluorescence images were not available. Reticular drusen identified from photographs were confirmed with side-by-side grading using the Wisconsin AMD grading protocol. Incidence was assessed using Kaplan-Meier product limit survival methods, controlling for competing risk of death. Associations between smoking, fish consumption, serum lipids, systemic and dietary factors, the CFH single nucleotide polymorphism (SNP) rs1061170 and ARMS2 SNP rs10490924, and the 15-year incidence of reticular drusen were analyzed in discrete logistic regression models. Generalized estimating equation models were used to analyze eye-specific relationships between these risk factors and 5-year progression from reticular drusen to late AMD. MAIN OUTCOME MEASURES Incidence and progression of reticular drusen. RESULTS The 15-year cumulative incidence of reticular drusen was 4.0% (n = 95). Increasing age (per decade increase; odds ratio [OR], 3.4; 95% confidence interval [CI], 2.6-4.4), female sex (OR, 2.0; 95% CI, 1.3-3.2), and presence of risk alleles of CFH-rs1061170 (OR, 1.8; 95% CI, 1.3-2.4) or ARMS2-rs10490924 (OR, 3.0; 95% CI, 2.1-4.4) were associated with higher reticular drusen incidence. Current smoking at baseline predicted higher reticular drusen incidence (OR 2.1, 95% CI 1.0-4.5) after adjusting for age, sex, CFH-rs1061170 and ARMS2-rs10490924 polymorphisms. Of 118 eyes with reticular drusen, 40 (33.9%) developed late AMD over 5 years. A higher proportion of eyes with reticular drusen located outside versus within the macular area progressed to late AMD (50.0% vs. 37.8%). Dietary lutein-zeaxanthin intake was associated with decreased likelihood of progression from reticular drusen to late AMD (adjusted OR, 0.5; 95% CI, 0.3-1.0). CONCLUSIONS Known AMD risk factors were associated with greater long-term risk of reticular drusen. Neither total area nor central location of reticular drusen predicted 5-year progression to late AMD. Increased consumption of lutein-zeaxanthin predicted a lower risk of progression.
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Affiliation(s)
- Nichole Joachim
- Centre for Vision Research, Department of Ophthalmology, and Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, and Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Elena Rochtchina
- Centre for Vision Research, Department of Ophthalmology, and Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Ava Grace Tan
- Centre for Vision Research, Department of Ophthalmology, and Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - Jie Jin Wang
- Centre for Vision Research, Department of Ophthalmology, and Westmead Millennium Institute, University of Sydney, Sydney, Australia; Centre for Eye Research Australia, Melbourne University, Melbourne, Australia.
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Genetic and environmental factors associated with reticular pseudodrusen in age-related macular degeneration. Retina 2013; 33:998-1004. [PMID: 23549092 DOI: 10.1097/iae.0b013e31827b6483] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To analyze the genetic and environmental factors associated with reticular pseudodrusen (RPD) in age-related macular degeneration (AMD). METHODS In a large population, AMD patients (n = 519) with and without RPD were assessed with a standardized examination including infrared images and spectral domain optical coherence tomography scans. Three groups were defined: Group 1: AMD patients with RPD (n = 105); Group 2: AMD patients without RPD (n = 414); and Group 3: controls with no AMD and no RPD (n = 430). Four genes associated with AMD (CFH, ARMS2/HTRA1, C3, apolipoprotein E) and environmental factors were assessed between the 3 groups. RESULTS None of the environmental factors studied were more significantly associated to either Group 1 or Group 2. The odds ratios and 95% confidence intervals for individuals homozygous for the CFH risk allele were 4.0 (2.1-7.7) ([95% confidence interval: 2.1-7.7]; P < 0.0004) in Group 1 and 4.3 ([2.6-7.1]; P < 0.0004) in Group 2, compared with Group 3. The odds ratios for individuals homozygous for the ARMS2 risk allele for Groups 1 and 2 compared with Group 3 were 16.3 ([7.6-35.4]; P < 0.0004) and 11.9 ([6.3-22.3]; P < 0.0004), respectively. None of the genotypes studied were more significantly associated to Group 1 than Group 2. CONCLUSION Genotypes known to be associated with AMD were similarly observed in patients with and without RPD.
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Curcio CA, Messinger JD, Sloan KR, McGwin G, Medeiros NE, Spaide RF. Subretinal drusenoid deposits in non-neovascular age-related macular degeneration: morphology, prevalence, topography, and biogenesis model. Retina 2013; 33:265-76. [PMID: 23266879 PMCID: PMC3870202 DOI: 10.1097/iae.0b013e31827e25e0] [Citation(s) in RCA: 297] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To characterize the morphology, prevalence, and topography of subretinal drusenoid deposits, a candidate histological correlate of reticular pseudodrusen, with reference to basal linear deposit (BlinD), a specific lesion of age-related macular degeneration, and to propose a biogenesis model for both lesion. METHODS Donor eyes with median death-to-preservation of 2:40 hours were postfixed in osmium tannic acid paraphenylenediamine and prepared for macula-wide high-resolution digital sections. Annotated thicknesses of 21 chorioretinal layers were determined at standard locations in sections through the fovea and the superior perifovea. RESULTS In 22 eyes of 20 white donors (83.1 ± 7.7 years), SDD appeared as isolated or confluent drusenoid dollops punctuated by tufts of retinal pigment epithelium apical processes and associated with photoreceptor perturbation. Subretinal drusenoid deposits and BlinD were detected in 85 and 90% of non-neovascular age-related macular degeneration donors, respectively. Subretinal drusenoid deposit was thick (median, 9.4 μm) and more abundant in the perifovea than in the fovea (P < 0.0001). BlinD was thin (median, 2.1 μm) and more abundant in the fovea than in the perifovea (P < 0.0001). CONCLUSION Subretinal drusenoid deposits and BlinD prevalence in age-related macular degeneration eyes are high. Subretinal drusenoid deposits organized morphology, topography, and impact on surrounding photoreceptors imply specific processes of biogenesis. Contrasting topographies of subretinal drusenoid deposits and BlinD suggest relationships with differentiable aspects of rod and cone physiology, respectively. A 2-lesion 2-compartment biogenesis model incorporating outer retinal lipid homeostasis is presented.
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Affiliation(s)
- Christine A Curcio
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Prevalence and genomic association of reticular pseudodrusen in age-related macular degeneration. Am J Ophthalmol 2013; 155:260-269.e2. [PMID: 23111182 DOI: 10.1016/j.ajo.2012.08.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 08/22/2012] [Accepted: 08/22/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE To survey the prevalence of reticular pseudodrusen in late age-related macular degeneration (AMD) using multiple imaging methods, and to investigate the association between reticular pseudodrusen and polymorphisms in complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS2) genes. DESIGN Retrospective case series. METHODS This study included 216 consecutive patients with late AMD (typical AMD, polypoidal choroidal vasculopathy [PCV], retinal angiomatous proliferation [RAP], or geographic atrophy). Eyes were assessed for reticular pseudodrusen using the blue channel of color fundus photography, infrared reflectance, fundus autofluorescence, and spectral-domain optical coherence tomography. The major AMD-associated single nucleotide polymorphisms (CFH Y402 rs1061170, CFH I62V rs800292, and ARMS2 A69S rs10490924) were genotyped. RESULTS Forty-nine eyes of 30 patients had a reticular pattern in ≥2 imaging modalities and were diagnosed with reticular pseudodrusen. Of these, 16 had bilateral late AMD, whereas 32 of 186 patients without reticular pseudodrusen had bilateral late AMD (P < .001). The prevalence of reticular pseudodrusen was 83% in RAP, 50% in geographic atrophy, 9% in typical AMD, and 2% in PCV. The frequency of the T allele in ARMS2 A69S in patients with and without reticular pseudodrusen was 78.6% and 59.9%, respectively (P=.007). CONCLUSIONS The prevalence of reticular pseudodrusen was low in PCV cases. About 50% of patients with reticular pseudodrusen had bilateral late AMD. The connection of ARMS2 risk allele and reticular pseudodrusen was confirmed in a Japanese population.
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Witmer MT, Kozbial A, Daniel S, Kiss S. Peripheral autofluorescence findings in age-related macular degeneration. Acta Ophthalmol 2012; 90:e428-33. [PMID: 22578271 DOI: 10.1111/j.1755-3768.2012.02434.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To describe the peripheral autofluorescent findings in patients with age-related macular degeneration (AMD) using ultrawide-field imaging. METHODS We retrospectively reviewed the ultra-wide-field autofluorescent images of all patients diagnosed with AMD or macular drusen at the Department of Ophthalmology of Weill Cornell Medical College from July 2010 to September 2011. Peripheral autofluorescent phenotypes included normal autofluorescence, focal pinpoint hyperfluorescence, granular fluorescent changes, patchy hypofluorescence, and reticular hypofluorescence. RESULTS One hundred and ten consecutive patients (220 eyes) with a diagnosis of AMD or macular drusen were imaged using ultra-wide-field autofluorescent technology during the study period. Eighty-three patients (157 eyes) were included in the final analysis. Peripheral autofluorescent abnormalities were present in 63.6% of eyes with AMD versus 35.7% of control eyes (p=0.049). Granular fluorescent changes (p=0.0001) and patchy hypofluorescence (p=0.0015) were more common in eyes with advanced AMD than in eyes with early AMD or control eyes. Granular fluorescent changes were also more common in eyes with choroidal neovascularization (p=0.026) or geographic atrophy (p=0.0001). Patchy hypofluorescence (0.0001) was more common in eyes with geographic atrophy. CONCLUSIONS Peripheral autofluorescent abnormalities are common in eyes with AMD. The peripheral findings in eyes with AMD may represent different phenotypes, which may indicate different environmental or genetic factors in the development of AMD. Characterizing the different peripheral phenotypes may have implications for diagnosis and treatment of AMD subtypes.
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Gorin MB. Genetic insights into age-related macular degeneration: controversies addressing risk, causality, and therapeutics. Mol Aspects Med 2012; 33:467-86. [PMID: 22561651 DOI: 10.1016/j.mam.2012.04.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/10/2012] [Indexed: 01/19/2023]
Abstract
Age-related macular degeneration (AMD) is a common condition among the elderly population that leads to the progressive central vision loss and serious compromise of quality of life for its sufferers. It is also one of the few disorders for whom the investigation of its genetics has yielded rich insights into its diversity and causality and holds the promise of enabling clinicians to provide better risk assessments for individuals as well as to develop and selectively deploy new therapeutics to either prevent or slow the development of disease and lessen the threat of vision loss. The genetics of AMD began initially with the appreciation of familial aggregation and increase risk and expanded with the initial association of APOE variants with the disease. The first major breakthroughs came with family-based linkage studies of affected (and discordant) sibs, which identified a number of genetic loci and led to the targeted search of the 1q31 and 10q26 loci for associated variants. Three of the initial four reports for the CFH variant, Y402H, were based on regional candidate searches, as were the two initial reports of the ARMS2/HTRA1 locus variants. Case-control association studies initially also played a role in discovering the major genetic variants for AMD, and the success of those early studies have been used to fuel enthusiasm for the methodology for a number of diseases. Until 2010, all of the subsequent genetic variants associated with AMD came from candidate gene testing based on the complement factor pathway. In 2010, several large-scale genome-wide association studies (GWAS) identified genes that had not been previously identified. Much of this historical information is available in a number of recent reviews (Chen et al., 2010b; Deangelis et al., 2011; Fafowora and Gorin, 2012b; Francis and Klein, 2011; Kokotas et al., 2011). Large meta analysis of AMD GWAS has added new loci and variants to this collection (Chen et al., 2010a; Kopplin et al., 2010; Yu et al., 2011). This paper will focus on the ongoing controversies that are confronting AMD genetics at this time, rather than attempting to summarize this field, which has exploded in the past 5 years.
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Affiliation(s)
- Michael B Gorin
- Department of Ophthalmology, David Geffen School of Medicine, UC, Los Angeles, CA, USA.
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A. Martillo M, Marsiglia M, D. Lee M, Pumariega N, Bearelly S, Smith RT. Is reticular macular disease a choriocapillaris perfusion problem? MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2012; 1:37-41. [PMID: 24600618 PMCID: PMC3939745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The etiology of reticular macular disease (RMD), a sub-phenotype of age-related macular degeneration (AMD), is controversial and has not been clarified. RMD is suspected to be a multifactorial, complex disease with genetic, environmental, and systemic factors playing an important role in its origin. Findings from combinations of different imaging modalities suggest that the pattern that characterizes this condition is associated with an alteration of the choriocapillaris blood flow. If the choroid is indeed affected in RMD, the possible linkage with inflammatory or other systemic diseases could be better supported.
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Affiliation(s)
| | - Marcela Marsiglia
- Department of Ophthalmology, New York University, New York, USA,Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, USA,LuEsther T. Mertz Retinal Research Center and Manhattan Eye, Ear and Throat Hospital, New York USA
| | - Michele D. Lee
- Department of Ophthalmology, New York University, New York, USA
| | | | - Srilaxmi Bearelly
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, USA
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