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Vidal-Oliver L, Montolío-Marzo E, Gallego-Pinazo R, Dolz-Marco R. Optical coherence tomography biomarkers in early and intermediate age-related macular degeneration: A clinical guide. Clin Exp Ophthalmol 2024; 52:207-219. [PMID: 38214056 DOI: 10.1111/ceo.14337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
Advanced forms of age-related macular degeneration (AMD), characterised by atrophic and neovascular changes, are a leading cause of vision loss in the elderly population worldwide. Prior to the development of advanced AMD, a myriad of risk factors from the early and intermediate stages of AMD have been published in the scientific literature over the last years. The ability to precisely recognise structural and anatomical changes in the ageing macula, altogether with the understanding of the individual risk implications of each one of them is key for an accurate and personalised diagnostic assessment. The present review aims to summarise updated evidence of the relative risk conferred by diverse macular signs, commonly seen on optical coherence tomography, in terms of progression to geographic atrophy or macular neovascularization. This information may also serve as a basis for tailored follow-up monitoring visits.
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Affiliation(s)
- Lourdes Vidal-Oliver
- Department of Ophthalmology, Fundación Oftalmología Médica de la Comunidad Valenciana, Valencia, Spain
- Department of Ophthalmology, Clínico San Carlos Hospital, Madrid, Spain
- Macula Unit, Oftalvist Clinic, Valencia, Spain
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2
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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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3
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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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Agrón E, Domalpally A, Cukras CA, Clemons TE, Chen Q, Lu Z, Chew EY, Keenan TDL. Reticular Pseudodrusen: The Third Macular Risk Feature for Progression to Late Age-Related Macular Degeneration: Age-Related Eye Disease Study 2 Report 30. Ophthalmology 2022; 129:1107-1119. [PMID: 35660417 PMCID: PMC9509418 DOI: 10.1016/j.ophtha.2022.05.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To analyze reticular pseudodrusen (RPD) as an independent risk factor for progression to late age-related macular degeneration (AMD), alongside traditional macular risk factors (soft drusen and pigmentary abnormalities) considered simultaneously. DESIGN Post hoc analysis of 2 clinical trial cohorts: Age-Related Eye Disease Study (AREDS) and AREDS2. PARTICIPANTS Eyes with no late AMD at baseline in AREDS (6959 eyes, 3780 participants) and AREDS2 (3355 eyes, 2056 participants). METHODS Color fundus photographs (CFPs) from annual visits were graded for soft drusen, pigmentary abnormalities, and late AMD. Presence of RPD was from grading of fundus autofluorescence images (AREDS2) and deep learning grading of CFPs (AREDS). Proportional hazards regression analyses were performed, considering AREDS AMD severity scales (modified simplified severity scale [person] and 9-step scale [eye]) and RPD presence simultaneously. MAIN OUTCOME MEASURES Progression to late AMD, geographic atrophy (GA), and neovascular AMD. RESULTS In AREDS, for late AMD analyses by person, in a model considering the simplified severity scale simultaneously, RPD presence was associated with a higher risk of progression: hazard ratio (HR), 2.15 (95% confidence interval [CI], 1.75-2.64). However, the risk associated with RPD presence differed at different severity scale levels: HR, 3.23 (95% CI, 1.60-6.51), HR, 3.81 (95% CI, 2.38-6.10), HR, 2.28 (95% CI, 1.59-3.27), and HR, 1.64 (95% CI, 1.20-2.24), at levels 0-1, 2, 3, and 4, respectively. Considering the 9-step scale (by eye), RPD presence was associated with higher risk: HR, 2.54 (95% CI, 2.07-3.13). The HRs were 5.11 (95% CI, 3.93-6.66) at levels 1-6 and 1.78 (95% CI, 1.43-2.22) at levels 7 and 8. In AREDS2, by person, RPD presence was not associated with higher risk: HR, 1.18 (95% CI, 0.90-1.56); by eye, it was HR, 1.57 (95% CI, 1.31-1.89). In both cohorts, RPD presence carried a higher risk for GA than neovascular AMD. CONCLUSIONS Reticular pseudodrusen represent an important risk factor for progression to late AMD, particularly GA. However, the added risk varies markedly by severity level, with highly increased risk at lower/moderate levels and less increased risk at higher levels. Reticular pseudodrusen status should be included in updated AMD classification systems, risk calculators, and clinical trials.
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Affiliation(s)
- Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health (NIH), Bethesda, Maryland
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health (NIH), Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | - Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Farinha C, Barreto P, Coimbra R, Iutis A, Cachulo ML, Cunha-Vaz J, Lechanteur YTE, Hoyng CB, Silva R. Phenotypic Expression of CFH Rare Variants in Age-Related Macular Degeneration Patients in the Coimbra Eye Study. Invest Ophthalmol Vis Sci 2022; 63:5. [PMID: 35925583 PMCID: PMC9363674 DOI: 10.1167/iovs.63.9.5] [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 To determine the association between rare genetic variants in complement factor H (CFH) and phenotypic features in age-related macular degeneration (AMD) patients from the Coimbra Eye Study (CES). Methods AMD patients from the Incidence CES (NCT02748824) underwent ophthalmologic examination and color fundus photography, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence, and near-infrared imaging. Multimodal phenotypic characterization was carried out in a centralized reading center. The coding and splice-site regions of the CFH gene were sequenced through single-molecule molecular inversion probe-based next-generation sequencing in association with the EYE-RISK consortium. Variants with minor allele frequency <0.05 resulting in splice-site or protein change were selected. Differences in phenotypic features between carriers and noncarriers were analyzed using generalized estimated equations logistic regression models, considering intereye correlations. Results We included 39 eyes of 23 patients carrying rare CFH variants and 284 eyes of 188 noncarriers. Carrier status was associated with having higher drusen burden in the macula in the inner Early Treatment Diabetic Retinopathy Study circle (odds ratio [OR], 5.44 [95% confidence interval {CI}, 1.61-18.37]; P = 0.006), outer circle (OR, 4.37 [95% CI, 1.07-17.77]; P = 0.04), and full grid (OR, 4.82 [95% CI, 1.13-20.52]; P = 0.033). In SD-OCT, a lower total macular volume and lower inner retinal layers' volume (OR, 0.449 [95% CI, 0.226-0.894]; P = 0.023; OR, 0.496 [95% CI, 0.252-0.979]; P = 0.043) and pigment epithelial detachments (PEDs) (OR, 5.24 [95% CI, 1.08-25.44]; P = 0.04) were associated with carrying a rare CFH variant. Carriers with subretinal drusenoid deposits (SDD) had the rare variant P258L in all cases except one. Conclusions We identified in our cohort phenotypic differences between carriers and noncarriers of rare variants in the CFH gene. Carriers had more severe disease, namely superior drusen burden, PEDs, and thinner retinas. The rare variant P258L may be associated with SDD. Carriers are probably at increased risk of progression.
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Affiliation(s)
- Cláudia Farinha
- AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,University of Coimbra, Coimbra Institute for Clinical and Biomedical Research. Faculty of Medicine (iCBR- FMUC), Coimbra, Portugal
| | - Patrícia Barreto
- AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Rita Coimbra
- AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Adela Iutis
- Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Maria Luz Cachulo
- AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,University of Coimbra, Coimbra Institute for Clinical and Biomedical Research. Faculty of Medicine (iCBR- FMUC), Coimbra, Portugal
| | - José Cunha-Vaz
- AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,University of Coimbra, Coimbra Institute for Clinical and Biomedical Research. Faculty of Medicine (iCBR- FMUC), Coimbra, Portugal
| | - Yara T E Lechanteur
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rufino Silva
- AIBILI-Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.,University of Coimbra, Coimbra Institute for Clinical and Biomedical Research. Faculty of Medicine (iCBR- FMUC), Coimbra, Portugal
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6
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Thee EF, Colijn JM, Cougnard-Grégoire A, Meester-Smoor MA, Verzijden T, Hoyng CB, Fauser S, Hense HW, Silva R, Creuzot-Garcher C, Ueffing M, Delcourt C, den Hollander AI, Klaver CCW. The Phenotypic Course of Age-Related Macular Degeneration for ARMS2/HTRA1: The EYE-RISK Consortium. Ophthalmology 2022; 129:752-764. [PMID: 35240203 DOI: 10.1016/j.ophtha.2022.02.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Age-related maculopathy susceptibility 2 (ARMS2) is considered the most enigmatic of the genes for age-related macular degeneration (AMD). We investigated the phenotypic course and spectrum of AMD for the risk haplotype at the ARMS2 and high-temperature requirement A serine peptidase 1 (HTRA1) locus in a large European consortium. DESIGN Pooled analysis of 4 case-control and 6 cohort studies. PARTICIPANTS Individuals (N = 17 204) aged 55 years or older participating in the European Eye Epidemiology consortium. METHODS Age-related macular degeneration features and macular thickness were determined on multimodal images; data on genetics and phenotype were harmonized. Risks of AMD features for rs3750486 genotypes at the ARMS2/HTRA1 locus were determined by logistic regression and were compared with a genetic risk score (GRS) of 19 variants at the complement pathway. Lifetime risks were estimated with Kaplan-Meier analyses in population-based cohorts. MAIN OUTCOME MEASURES Age-related macular degeneration features and stage. RESULTS Of 2068 individuals with late AMD, 64.7% carried the ARMS2/HTRA1 risk allele. For homozygous carriers, the odds ratio (OR) of geographic atrophy was 8.6 (95% confidence interval [CI], 6.5-11.4), of choroidal neovascularization (CNV) was 11.2 (95% CI, 9.4-13.3), and of mixed late AMD was 12.2 (95% CI, 7.3-20.6). Cumulative lifetime risk of late AMD ranged from 4.4% for carriers of the nonrisk genotype to 9.4% and 26.8% for heterozygous and homozygous carriers. The latter received the diagnosis of late AMD 9.6 years (95% CI, 8.0-11.2) earlier than carriers of the nonrisk genotype. The risk haplotype was not associated with hard or soft drusen < 125 μm (OR, 1.2; 95% CI, 0.9-1.7), but risks increased significantly for soft drusen ≥ 125 μm (OR, 2.1; 95% CI, 1.5-3.0), up to an OR of 7.2 (95% CI, 3.8-13.8) for reticular pseudodrusen. Compared with persons with a high GRS for complement, homozygous carriers of ARMS2/HTRA1 showed a higher risk of CNV (OR, 4.1; 95% CI, 3.2-5.4); risks of other characteristics were not different. CONCLUSIONS Carriers of the risk haplotype at ARMS2/HTRA1 have a particularly high risk of late AMD at a relatively early age. Data suggest that risk variants at ARMS2/HTRA1 act as a strong catalyst of progression once early signs are present. The phenotypic spectrum resembles that of complement genes, only with higher risks of CNV.
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Affiliation(s)
- Eric F Thee
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna M Colijn
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Audrey Cougnard-Grégoire
- UMR 1219, Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Magda A Meester-Smoor
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Timo Verzijden
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany; Hoffmann-La Roche AG, Basel, Switzerland
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Rufino Silva
- Coimbra Institute for Clinical and Biomedical Research on Light and Image (AIBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Department of Ophthalmology, Coimbra Hospital and University Center, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, University Hospital Dijon, Eye and Nutrition Research Group, INRAe, Dijon, France
| | - Marius Ueffing
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Cécile Delcourt
- UMR 1219, Team LEHA, Bordeaux Population Health Research Center, Inserm, Université de Bordeaux, Bordeaux, France
| | - Anneke I den Hollander
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland.
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Yoon JM, Shin DH, Kong M, Ham DI. Age-related macular degeneration eyes presenting with cuticular drusen and reticular pseudodrusen. Sci Rep 2022; 12:5681. [PMID: 35383241 PMCID: PMC8983695 DOI: 10.1038/s41598-022-09608-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to describe the clinical characteristics of age-related macular degeneration (AMD) eyes with both cuticular drusen (CD) and reticular pseudodrusen (RPD). Clinical records of patients diagnosed with CD or RPD with multimodal imaging was reviewed for patients diagnosed with both CD and RPD. The distribution patterns of CD (macular and diffuse type) and RPD (localized, intermediate, and diffuse type), presence of soft drusen, large drusen (> 200 µm), variant subretinal drusenoid deposits, and macular complications were investigated. Of the 220 eyes of 110 patients diagnosed with CD and 926 eyes of 463 patients diagnosed with RPD, 13 eyes of seven patients met the diagnostic criteria for both CD and RPD. The mean age at initial presentation was 71.4 ± 8.8 years and six patients were female. The mean subfoveal choroidal thickness was 143.8 ± 25.1 µm. The distribution of CD was of the macular type in all eyes. Distribution of RPD was localized in 11 eyes (84.6%) and intermediate in two eyes (15.4%). Soft drusen, large drusen, and variant subretinal drusenoid deposits were present in 13 (100%), 12 (92.3%) and, seven (53.8%) eyes, respectively. Macular neovascularization was observed in two eyes (15.4%). CD and RPD can coexist in eyes with AMD. Multimodal imaging should be used for AMD eyes with features suggestive of CD and RPD, considering the high likelihood of developing late AMD.
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Affiliation(s)
- Je Moon Yoon
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | | | - Mingui Kong
- Hangil Eye Hospital Retina Center, Incheon, Korea
| | - Don-Il Ham
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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8
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Bikbov MM, Kazakbaeva GM, Rakhimova EM, Rusakova IA, Gilmanshin TR, Zainullin RM, Panda‐Jonas S, Fakhretdinova AA, Tuliakova AM, Safiullina KR, Bolshakova NI, Gizzatov AV, Ponomarev IP, Jonas JB. Prevalence and determinants of reticular pseudodrusen in the Russian Ural Eye and Medical Study. Acta Ophthalmol 2022; 100:e1701-e1707. [PMID: 35343644 DOI: 10.1111/aos.15145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the prevalence of reticular pseudodrusen (RPD) and their determinants. METHODS The Population-based Ural Eye and Medical Study conducted in Bashkortostan/Russia included 5899 participants aged 40+ years. Presence of RPDs was assessed on conventional colour fundus photographs, red-free fundus images and optical coherence tomographic images. RESULTS The study included 4914 (83.3%) individuals (mean age: 58.5 ± 10.5 years; range: 40-94 years). Using two age limits (>55 years and 40+ years) for the definitions of RPD and AMD (age-related macular degeneration), RPD prevalence was 186/4914 (3.8%; 95% confidence interval (CI): 3.3, 4.3) and 246/4914 (5.0%, 95% CI: 4.4, 5.6), respectively, and the prevalence of any AMD without RPD was 182/4914 (3.7%: 95% CI: 3.2, 4.2) and 224/4914 (4.6%; 95% CI: 4.0, 5.1) respectively. Within the subgroup of early AMD, intermediate AMD and late AMD, RPD prevalence (age limit: 40+ years) was 55.1% (95% CI: 49.5, 60.8), 42.9% (95% CI: 33.8, 51.9) and 33.3% (95% CI: 16.4, 50.3) respectively. In multivariable analysis, higher RPD prevalence (age limit 40+ years) was associated with higher age (odds ratio (OR): 1.08; 95% CI: 1.07, 1.10; p < 0.001), rural region of habitation (OR: 3.81; 95% CI: 2.76, 5.24; p < 0.001) and lower percentage of lymphocytes on leukocyte counts (OR: 0.95; 95% CI: 0.93, 0.97; p < 0.001). Higher prevalence of any AMD without RPD was associated with urban region (OR: 1.58; 95% CI: 1.18, 2.11; p = 0.002), lower diabetes prevalence (OR: 0.55; 95% CI: 0.33, 0.90; p = 0.02) and shorter axial length (OR: 0.85; 95% CI: 0.74, 0.98; p = 0.03), after adjusting for age. CONCLUSIONS Reticular pseudodrusen (mean prevalence: 3.8% (age limit >55 years); 5.0% (age limit 40+ years)) differs from AMD without RPD in its association with urban region (AMD without RPD: rural region), lower lymphocyte percentage (AMD without RPD: no association) and a lack of associations with axial length (AMD without RPD: shorter axial length) and with diabetes prevalence (AMD without RPD: lower diabetes prevalence).
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Affiliation(s)
| | | | | | | | | | | | - Songhomitra Panda‐Jonas
- Privatpraxis Prof Jonas und Dr Panda‐Jonas Heidelberg Germany
- Department of Ophthalmology University Hospital Heidelberg Heidelberg Germany
| | | | | | | | | | | | | | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim Heidelberg University Mannheim Germany
- Institute of Molecular and Clinical Ophthalmology Basel Basel Switzerland
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Rosenfeld PJ, Trivizki O, Gregori G, Wang RK. An Update on the Hemodynamic Model of Age-Related Macular Degeneration. Am J Ophthalmol 2022; 235:291-299. [PMID: 34509436 DOI: 10.1016/j.ajo.2021.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To provide an update on the hemodynamic model of age-related macular degeneration (AMD). DESIGN Evidence-based perspective. METHODS Review of the literature and experience of the authors. RESULTS Choroidal hemodynamics are not the primary cause of AMD as proposed by Ephraim Friedman in 1997. However, evidence is accumulating to suggest that choroidal perfusion is an important environmental influence that contributes to our understanding of disease progression in this complex genetic disorder. Although early and intermediate AMD seem to be influenced to a large extent by the underlying genetics, the asymmetry of disease progression to the later stages of AMD cannot be explained by genetics alone. The progression of disease and the asymmetry of this progression seem to correlate with abnormalities in choroidal perfusion that can be documented by optical coherence tomography. These perfusion abnormalities in the setting of a thickened Bruch's membrane are thought to exacerbate the impaired nutritional exchange between the retinal pigment epithelium and the choriocapillaris. We propose that the genetic susceptibility to develop AMD combined with age-related changes in macular choroidal hemodynamics, such as increasing choriocapillaris perfusion deficits and decreasing choroidal vascular densities, play an important role in disease progression and may help to explain the asymmetry between eyes, particularly in the later stages of AMD. CONCLUSIONS This updated hemodynamic model of AMD focuses on disease progression and highlights the importance of age-related changes in the choroidal circulation as a major environmental influence on disease severity in eyes that are genetically susceptible to develop AMD.
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Affiliation(s)
- Philip J Rosenfeld
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA.
| | - Omer Trivizki
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA; Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University (O.T.), Tel Aviv, Israel and the Department of Bioengineering (R.K.W.) and Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Giovanni Gregori
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA
| | - Ruikang K Wang
- Department of Ophthalmology (R.K.W.), University of Washington, Seattle, Washington, USA
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10
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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: 4] [Impact Index Per Article: 2.0] [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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11
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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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12
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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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13
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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: 48] [Impact Index Per Article: 16.0] [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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14
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Longitudinal choriocapillaris changes in the presence of reticular pseudodrusen. Sci Rep 2021; 11:18227. [PMID: 34521974 PMCID: PMC8440680 DOI: 10.1038/s41598-021-97771-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 01/15/2023] Open
Abstract
To determine longitudinal changes in choriocapillaris (CC) measures in eyes with reticular pseudodrusen (RPD) using optical coherence tomography angiography (OCTA). In this observational prospective study, 20 patients with exclusively RPD and no other alteration due to age-related macular degeneration were included. Eight RPD patients were re-examined at 5-year follow-up. Multimodal imaging was performed at baseline and at 5-year follow-up. OCTA CC images were analyzed for number, size and total area of flow deficits (FD), mean signal intensity, signal intensity standard deviation and kurtosis of signal intensity distribution in the ring area between a circle of 4 mm diameter and a circle of 6 mm diameter and in the superior ring quadrant. Area affected by RPD increased from 19.36 ± 8.39 mm2 at baseline to 37.77 ± 9.03 mm2 at 5-year follow-up. At baseline, percent of CC FD area was greater in RPD eyes (quadrant: p < 0.001; ring: p < 0.001) compared to controls. Besides, RPD eyes revealed a lower mean intensity signal (quadrant: p < 0.001; ring: p < 0.001). Evaluation of CC parameters suggested significant group × time interaction effects for CC FD (p = 0.04) and mean intensity signal (p = 0.004), in that RPD eyes presented increased CC FD and decreased mean intensity signal at follow-up. OCTA CC decorrelation signal further decreases in RPD patients over 5 years in both RPD-affected and RPD-unaffected macular areas.
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15
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Holz FG, Saßmannshausen M. Reticular Pseudodrusen: Detecting a Common High-Risk Feature in Age-Related Macular Degeneration. Ophthalmol Retina 2021; 5:719-720. [PMID: 34364530 DOI: 10.1016/j.oret.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 10/20/2022]
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16
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Morillon C, Le Goff M, Gattoussi S, Korobelnik JF, Rougier MB, Schweitzer C, Delcourt C, Delyfer MN. INCIDENCE, PROGRESSION, AND RISK FACTORS OF EPIRETINAL MEMBRANES IN THE ELDERLY. Retina 2021; 41:495-504. [PMID: 32568986 DOI: 10.1097/iae.0000000000002871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the incidence, progression rate, and risk factors for epiretinal membranes (ERMs) in a population of French elderly subjects. METHODS Seven hundred and thirty-five eyes of 413 participants of the population-based ALIENOR study were included between 2009 and 2010. Participants were re-evaluated every 2 years between 2011 and 2017 (i.e., three follow-up visits). The mean duration of follow-up was 5.09 years (SD, 1.8; range, 0.99-7.85). Epiretinal membranes were graded from spectral-domain optical coherence tomography images according to a standardized classification. RESULTS The incidence rate of ERMs was 9.42 per 100 eye-years (95% confidence interval, 7.36-12.05), corresponding to a 5-year cumulative incidence of 37.6%. In the final multivariable model, ERM incidence was significantly associated with vitreomacular or vitreopapillary adhesion at baseline (hazard ratio, 2.15; P = 0.02), choroidal thinning (hazard ratio, 1.04 per 10 μm decrease; P = 0.02), ERM in the contralateral eye (P = 0.02), and smoking after 85 years (hazard ratio, 6.01; P = 0.003). The 5-year cumulative progression rate was 6.9%. CONCLUSION Incidence of ERMs was higher in our population than that previously reported, most probably because of the use of spectral-domain optical coherence tomography images. Incident ERMs were found to be associated with vitreous adhesion at baseline, choroidal thinning, ERM in the contralateral eye, and smoking after 85 years.
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Affiliation(s)
- Caroline Morillon
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | - Mélanie Le Goff
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
| | - Sarra Gattoussi
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | - Jean-François Korobelnik
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | - Marie-Bénédicte Rougier
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | - Cédric Schweitzer
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
| | - Cécile Delcourt
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
| | - Marie-Noëlle Delyfer
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA Team, Bordeaux, France ; and
- Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France
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17
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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: 18] [Impact Index Per Article: 4.5] [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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18
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Otero-Marquez O, Chung H, Lee CS, Choi EY, Ledesma-Gil G, Alauddin S, Lee M, Bhuiyan A, Smith RT. Subretinal Deposits in Pre-eclampsia and Malignant Hypertension: Implications for Age-Related Macular Degeneration. Ophthalmol Retina 2020; 5:750-760. [PMID: 33130003 DOI: 10.1016/j.oret.2020.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the incidence of subretinal deposits that are similar in structure and stage on OCT imaging to subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) in patients with hypertensive choroidopathy secondary to severe pre-eclampsia and malignant hypertension (MHT) and the implications of this ischemic choroidopathy for the pathophysiologic characteristics of SDDs in AMD. DESIGN Retrospective cross-sectional study. PARTICIPANTS Thirty-three pre-eclampsia patients and 25 MHT patients with serous retinal detachment (SRD) in at least 1 eye were included. METHODS Serial multimodal images, including enhanced depth imaging spectral-domain OCT of eyes with hypertensive choroidopathy secondary to pre-eclampsia and MHT, were reviewed at 2 time points, the acute phase (within 4 weeks of initial hypertensive insult) and the recovery phase (beyond 4 weeks). MAIN OUTCOME MEASURES Incidence of SDD-like lesions in patients with hypertensive choroidopathy secondary to pre-eclampsia and MHT. RESULTS Subretinal drusenoid deposit-like lesions were observed exclusively in eyes with SRD. Serous retinal detachment occurred in 87.87% of eyes of pre-eclampsia patients and in 94% of eyes of MHT patients. Subretinal drusenoid deposit-like lesions occurred in 28.57% of all eyes with SRD, in 32.76% of eyes with SRD from the pre-eclampsia group, and in 23.40% of eyes with SRD from the MHT group. Vascular imaging suggested underlying choroidal ischemia in all patients (12 eyes) in which it was performed. CONCLUSIONS Choroidal ischemia may be the underlying mechanism of SDD-like lesions in patients with pre-eclampsia and MHT choroidopathy. These findings potentially are of utmost importance in understanding the mechanism of the reticular macular disease subtype of AMD. Reticular macular disease is characterized by the known association of choroidal insufficiency and SDD, with choroidal insufficiency postulated, but not proven, to be causative. Pre-eclampsia and MHT choroidopathy seems to be a model for lesions similar to SDD in AMD developing based on choroidal insufficiency and, as such, may offer further insights into the pathoetiologic features of SDD in AMD.
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Affiliation(s)
- Oscar Otero-Marquez
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hyewon Chung
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Choi
- Department of Ophthalmology, The Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gerardo Ledesma-Gil
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sharmina Alauddin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Minsub Lee
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Alauddin Bhuiyan
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - R Theodore Smith
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.
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19
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Cozzi M, Monteduro D, Parrulli S, Corvi F, Zicarelli F, Corradetti G, Sadda SR, Staurenghi G. Sensitivity and Specificity of Multimodal Imaging in Characterizing Drusen. Ophthalmol Retina 2020; 4:987-995. [PMID: 32771389 DOI: 10.1016/j.oret.2020.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To calculate the measures of accuracy of different imaging modalities in patients with early/intermediate age-related macular degeneration (AMD). DESIGN Prospective, observational, cross-sectional study. PARTICIPANTS Patients with early or intermediate AMD. METHODS All participants underwent a complete multimodal imaging assessment with a confocal scanning laser ophthalmoscope, including near-infrared reflectance (NIR), green fundus autofluorescence (G-FAF), confocal pseudocolor, and retromode deviated to right (DR) and left (DL). Drusen were topographically divided as small and medium (≤125 μ diameter) and large (>125 μ diameter), whereas subretinal drusenoid deposits (SDDs) were divided into dot and ribbon phenotypes. Multimodal imaging was considered the reference standard for detecting different subtypes of drusen and SDDs. Cohen's kappa (k) was used to test interobserver agreement for each imaging modality. MAIN OUTCOME MEASURES Capability to differentiate subtypes of drusen and SDDs with different imaging modalities. RESULTS A total of 100 eyes (62% were female participants) were evaluated. The inter-rate reliability between 2 readers for each imaging modality ranged between 0.76 and 0.95. Overall, large drusen were better identified with confocal pseudocolor imaging (96.6% sensitivity; 77.8% specificity). Smaller drusen were better detected with retromode modalities DR or DL (92% sensitivity; 58.3% specificity and 85.2% sensitivity; 83.3% specificity, respectively). Ribbon SDDs were better detected by color imaging (80.5% sensitivity; 98.3% specificity). Dot SDDs were well identified with NIR (83.1% sensitivity; 91.4% specificity) and G-FAF (84.6% sensitivity; 77.1% specificity). CONCLUSIONS Near-infrared reflectance and G-FAF should be considered for classification of dot SDDs, and confocal pseudocolor is optimal for characterizing ribbon SDDs. Among all imaging modalities, retromode technology DR and DL may be a potential supplementary modality to detect even smaller drusen.
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Affiliation(s)
- Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.
| | - Davide Monteduro
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, University of California - Los Angeles, Los Angeles, California
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, University of California - Los Angeles, Los Angeles, California
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
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