1
|
Velaga SB, Alagorie AR, Emamverdi M, Ashrafkhorasani M, Habibi A, Nittala MG, Sing G, Haines J, Pericak-Vance MA, Stambolian D, Sadda SR. Alterations of the Ganglion Cell Complex in Age-Related Macular Degeneration: An Amish Eye Study Analysis. Am J Ophthalmol 2024; 265:80-87. [PMID: 38677638 DOI: 10.1016/j.ajo.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE To compare the ganglion cell complex (GCC) thickness in eyes with age-related macular degeneration (AMD) vs healthy controls in an elderly Amish population. DESIGN Prospective cross-sectional study. METHODS This is a post hoc analysis of the family-based prospective study of Amish subjects. Study subjects underwent imaging with the Cirrus HD-OCT (Carl Zeiss Meditec Inc) using a macular cube protocol of 512 × 128 scans (128 horizontal B-scans, each comprising 512 A-scans) over a 6 mm × 6 mm region centered on the fovea. The ganglion cell analysis algorithm calculated the GCC thickness by segmenting the outer boundaries of the retinal nerve fiber layer (RNFL) and inner plexiform layer (IPL) in all B-scans of the volume, with the region between these boundaries representing the combined thickness of the ganglion cell layer (GCL) and the IPL. A number of parameters were used to evaluate the GCC thickness: the average GCC thickness, minimum (lowest GCC thickness at a single meridian crossing the elliptical annulus), and sectoral (within each of 6 sectoral areas: superior, superotemporal, superonasal, inferior, inferonasal, and inferotemporal). The stage of AMD was graded on color fundus photographs in accordance with the Beckman Initiative for Macular Research classification system. RESULTS Of 1339 subjects enrolled in the Amish eye study, a total of 1294 eyes of 1294 subjects had all required imaging studies of sufficient quality and were included in the final analysis. Of these, 798 (62%) were female. Following age adjustment, the average GCC thickness was significantly (P < .001) thinner in AMD subjects (73.71 ± SD; 13.77 µm) compared to normals (77.97 ± 10.42 µm). An independent t test showed that the early AMD (75.03 ± 12.45 µm) and late AMD (61.64 ± 21.18 µm) groups (among which eyes with geographic atrophy [GA] had the lowest thickness, of 58.10 ± 20.27 µm) had a statistically significant lower GCC thickness compared to eyes without AMD. There was no significant differences in average GCC thickness between early AMD and intermediate AMD (76.36 ± 9.25 µm) eyes. CONCLUSIONS The GCC thickness in AMD eyes is reduced compared to normal eyes; however, the relationship is complex, with the greatest reduction in late AMD eyes (particularly eyes with GA) but no difference between early and intermediate AMD eyes.
Collapse
Affiliation(s)
- Swetha Bindu Velaga
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ahmed Roshdy Alagorie
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Ophthalmology (A.R.A.), Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mehdi Emamverdi
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maryam Ashrafkhorasani
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Abbas Habibi
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Muneeswar Gupta Nittala
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gagan Sing
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Haines
- Department of Population & Quantitative Health Sciences (J.H.), Case Western Reserve University, Cleveland, Ohio, USA; Institute for Computational Biology (J.H.), Case Western Reserve University, Cleveland, Ohio, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics (M.A.P.-V), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dwight Stambolian
- Department of Ophthalmology (D.S.), University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Srinivas R Sadda
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Durmaz Engin C, Karti O, Kandemir K. Subretinal Drusenoid Deposits in a Patient With HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelet) Syndrome. Cureus 2024; 16:e52239. [PMID: 38352084 PMCID: PMC10862175 DOI: 10.7759/cureus.52239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Subretinal drusenoid deposits (SDD) are findings that can be observed in age-related macular degeneration as well as in ischemic ocular diseases. These deposits are believed to be of prognostic importance, as they have been shown to be associated with choroidal neovascularization. HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome is a condition linked with severe preeclampsia, and it presents ocular findings such as hypertensive retinopathy, serous retinal detachment, and cortical visual impairment. This case report discusses the presence and course of SDD in a female patient who presented with hypertensive retinochoroidopathy secondary to HELLP syndrome.
Collapse
Affiliation(s)
- Ceren Durmaz Engin
- Department of Ophthalmology, Buca Seyfi Demirsoy Education and Research Hospital, Izmir, TUR
| | - Omer Karti
- Department of Ophthalmology, Faculty of Medicine, Democracy University, Izmir, TUR
| | - Kutlay Kandemir
- Department of Ophthalmology, Buca Seyfi Demirsoy Education and Research Hospital, Izmir, TUR
| |
Collapse
|
4
|
Grewal MK, Chandra S, Gurudas S, Rasheed R, Sen P, Menon D, Bird A, Jeffery G, Sivaprasad S. Functional clinical endpoints and their correlations in eyes with AMD with and without subretinal drusenoid deposits-a pilot study. Eye (Lond) 2022; 36:398-406. [PMID: 33750892 PMCID: PMC8807627 DOI: 10.1038/s41433-021-01488-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/09/2021] [Accepted: 02/22/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate functional clinical endpoints and their structural correlations in AMD, with a focus on subretinal drusenoid deposits (SDD). METHODS This prospective study enroled 50 participants (11 controls, 17 intermediate AMD (iAMD) with no SDD, 11 iAMD with SDD and 11 non-foveal atrophic AMD). Participants underwent best-corrected visual acuity (BCVA), low luminance visual acuity (LLVA), low luminance questionnaire (LLQ), scotopic thresholds, rod-intercept time (RIT), photopic flicker electroretinograms and multimodal imaging. Functional and structural relationships were assessed. RESULTS Compared with healthy participants, BCVA, LLVA, scotopic thresholds were depressed, and RIT prolonged in iAMD patients with SDD (p = 0.028, p = 0.045, p = 0.014 and p < 0.0001 respectively). Patients with SDD also had reduced scotopic function and delayed RIT compared to iAMD without SDD (p = 0.005 and p < 0.0001). Eyes with SDD and non-foveal atrophy did not differ functionally. Nor did healthy subjects compared with iAMD without SDD. Functional parameters were significantly associated with scotopic thresholds (r = 0.39-0.64). BCVA, LLVA and scotopic thresholds correlated well with ONL volume, ONL thickness and choroidal thickness (r = 0.34-0.61). CONCLUSION Eyes with SDD are surrogate markers of photoreceptor abnormalities comparable with non-central atrophy and should be sub-analysed in clinical trials evaluating potential prophylactic agents to decrease the progression of AMD and may even require different therapeutic interventions.
Collapse
Affiliation(s)
- Manjot Kaur Grewal
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK ,grid.439257.e0000 0000 8726 5837NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Shruti Chandra
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK ,grid.439257.e0000 0000 8726 5837NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Sarega Gurudas
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK
| | - Rajna Rasheed
- grid.439257.e0000 0000 8726 5837NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Piyali Sen
- grid.439257.e0000 0000 8726 5837NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Deepthy Menon
- grid.439257.e0000 0000 8726 5837NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Alan Bird
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK
| | - Glen Jeffery
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK
| | - Sobha Sivaprasad
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK ,grid.439257.e0000 0000 8726 5837NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| |
Collapse
|
5
|
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.
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Han DK, Kim HK. Analyses of Risk Factors of Age-related Macular Degeneration Using Routine Health Check-up Data. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Ocular Imaging for Enhancing the Understanding, Assessment, and Management of Age-Related Macular Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:33-66. [PMID: 33847997 DOI: 10.1007/978-3-030-66014-7_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Age-related macular degeneration (AMD) is a progressive neuro-retinal disease and the leading cause of central vision loss among elderly individuals in the developed countries. Modern ocular imaging technologies constitute an essential component of the evaluation of these patients and have contributed extensively to our understanding of the disease. A challenge with any review of ocular imaging technologies is the rapid pace of progress and evolution of these instruments. Nonetheless, for proper and optimal use of these technologies, it is essential for the user to understand the technical principles underlying the imaging modality and their role in assessing the disease in various settings. Indeed, AMD, like many other retinal diseases, benefits from a multimodal imaging approach to optimally characterize the disease. In this chapter, we will review the various imaging technologies currently used in the assessment and management of AMD.
Collapse
|
9
|
Subtype-differentiated impacts of subretinal drusenoid deposits on photoreceptors revealed by adaptive optics scanning laser ophthalmoscopy. Graefes Arch Clin Exp Ophthalmol 2020; 258:1931-1940. [PMID: 32488329 DOI: 10.1007/s00417-020-04774-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/17/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To examine the structure of photoreceptors surrounding two subtypes of subretinal drusenoid deposits (SDD), namely, dot and ribbon SDD, using multimodal imaging including adaptive optics scanning laser ophthalmoscopy (AOSLO) and spectral-domain optical coherence tomography (SD-OCT). METHODS Twenty-six eyes of 13 patients with age-related macular degeneration (AMD) and SDD and 16 eyes of 8 subjects in normal chorioretinal health were studied. SDD presence, stage, and subtype were determined using color fundus photographs, infrared reflectance, autofluorescence imaging, and SD-OCT. SDD and surrounding photoreceptors were imaged using AOSLO. The structure of cone photoreceptors and SDD was examined at the baseline and at 2-year follow-up studies in 6 patients. RESULTS Dot SDD were identified in 18 eyes of 9 patients and coexisting dot and ribbon SDD were observed in 8 eyes of 4 patients. While a characteristic photoreceptor mosaic was clearly revealed by AOSLO in the area unaffected by lesions in those eyes with dot-only SDD, in unaffected areas adjacent to retinal regions with predominantly ribbon SDD, photoreceptors could no longer be visualized. CONCLUSION The invisibility of the photoreceptor mosaic in unaffected areas adjacent to retinal regions with predominantly ribbon SDD suggests degeneration in the outer segment and the interdigitation zone, which impairs the waveguiding ability of the photoreceptors. Our study implies possible differentiation of disease outcome and functional impact in different types of SDD.
Collapse
|
10
|
Optical coherence tomography evidence of macular ganglion cell-inner plexiform layer thinning in eyes with subretinal drusenoid deposits. Eye (Lond) 2019; 33:1290-1296. [PMID: 30926911 DOI: 10.1038/s41433-019-0405-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/30/2019] [Accepted: 03/01/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES The purpose of this study was to evaluate macular ganglion cell layer-inner plexiform layer (GCL-IPL) and choroidal thickness in early age-related macular degeneration (AMD) in eyes with subretinal drusenoid deposits (SDD). SUBJECTS/METHODS Comprehensive ophthalmological examination was performed. Near infrared reflectance and raster images using enhanced depth imaging were acquired with spectral domain optical coherence tomography. Drusen and SDD were diagnosed based on raster scans and near infrared reflectance. GCL-IPL maps were generated with automated segmentation and choroidal thickness maps were obtained by manually delineating the choroid-scleral boundary. RESULTS Forty-eight eyes from 48 patients (mean age 77.5 ± 5.7, range 68-90 years) with a diagnosis of early AMD and 42 eyes of 42 age-matched control subjects (mean age 76.9 ± 5.7, range 67-88 years) were included. Of these, 28 eyes (58.3%) had drusen alone, 4 eyes (8.3%) had SDD alone, and 16 eyes (33.3%) had drusen associated with SDD. Compared with controls, average choroidal thickness was significantly decreased in AMD eyes (P < 0.05). There was no significant difference in choroidal thickness in eyes with SDD with respect to those with drusen alone. GCL-IPL thickness was reduced in an annular pattern at the 3 and 6 mm macular areas in AMD patients with respect to controls (P < 0.05). GCL-IPL thickness at 3 mm was significantly reduced in eyes with SDD with respect to those with drusen alone (P = 0.03). CONCLUSIONS The GCL-IPL is reduced in thickness with an annular pattern in early AMD and is significantly thinner in eyes with SDD.
Collapse
|
11
|
Lee M, Lee H, Kim HC, Chung H. Changes in Stromal and Luminal Areas of the Choroid in Pachychoroid Diseases: Insights Into the Pathophysiology of Pachychoroid Diseases. ACTA ACUST UNITED AC 2018; 59:4896-4908. [DOI: 10.1167/iovs.18-25018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Minsub Lee
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyungwoo Lee
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyung Chan Kim
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyewon Chung
- Department of Ophthalmology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
|
14
|
Choriocapillaris Vascular Density Changes in Patients with Drusen: Cross-Sectional Study Based on Optical Coherence Tomography Angiography Findings. Ophthalmol Ther 2018; 7:101-107. [PMID: 29383674 PMCID: PMC5997591 DOI: 10.1007/s40123-018-0119-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction The purpose of this study was to investigate the extent and morphology of the choriocapillaris’ density defect in patients with drusen in non-neovascular age-related macular degeneration (AMD). Methods Participants in this study were 36 patients with non-neovascular AMD and drusen. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain-optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA). Results In all studied cases, the presence of drusen was associated with choriocapillaris’ reduced blood flow signal of different extent and severity. Three types of choriocapillaris’ non-perfusion were observed, along with an association between the size of drusen and the morphology of choriocapillaris’ density defect. Moreover, the extent of choriocapillaris’ density change has been related to ellipsoid zone disruption and therefore to visual impairment. Conclusions Our study showed that in patients with drusen due to non-neovascular AMD, there is choriocapillaris’ impairment of different morphology in OCTA, which is mainly related to the size and location of the drusen.
Collapse
|
15
|
Ho CY, Lek JJ, Aung KZ, McGuinness MB, Luu CD, Guymer RH. Relationship between reticular pseudodrusen and choroidal thickness in intermediate age-related macular degeneration. Clin Exp Ophthalmol 2018; 46:485-494. [PMID: 29236343 DOI: 10.1111/ceo.13131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/02/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Reticular pseudodrusen (RPD) is strongly associated with late age-related macular degeneration (AMD) but their aetiology remains unknown. RPD have been associated with reduced choroidal thickness (ChT) but most studies are limited by small sample size and varying severity of AMD. BACKGROUND To investigate the relationship between choroidal thickness and RPD in eyes with intermediate AMD (iAMD), controlling for variables known to influence ChT. DESIGN Retrospective cohort study. PARTICIPANTS Participants were recruited from Centre for Eye Research Australia. METHODS Colour fundus photographs, fundus auto fluorescence, near-infrared and spectral-domain ocular coherence tomography (OCT) were graded for RPD. ChT was measured from enhanced-depth imaging OCT scans at the centre of fovea, 1500 and 3000 μm nasal, temporal, superior and inferior from centre of fovea. MAIN OUTCOME MEASURES ChT between RPD and non-RPD group. RESULTS A total of 297 eyes from 152 subjects were included. A total of 84 (28%) had RPD and were older than non-RPD group (75.1 ± 5.4 years and 68.7 ± 6.9 years, respectively; P < 0.001). In unadjusted analysis, the RPD group was significantly associated with thinner choroids across all measured locations (P ≤ 0.022). After adjustment for variables, the presence of RPD was no longer associated with ChT (P ≥ 0.132 for all locations) but age (P < 0.001) and refractive error (P = 0.002) remained significantly associated with ChT. CONCLUSIONS AND RELEVANCE Age and refractive error, rather than RPD, was significantly associated with reduced ChT in eyes with iAMD. Choroidal insufficiency may be a less important variable in RPD aetiology than previously considered.
Collapse
Affiliation(s)
- Chi Yd Ho
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Jia J Lek
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Khin Z Aung
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
16
|
Paavo M, Lee W, Merriam J, Bearelly S, Tsang S, Chang S, Sparrow JR. Intraretinal Correlates of Reticular Pseudodrusen Revealed by Autofluorescence and En Face OCT. Invest Ophthalmol Vis Sci 2017; 58:4769-4777. [PMID: 28973322 PMCID: PMC5624777 DOI: 10.1167/iovs.17-22338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We sought to determine whether information revealed from the reflectance, autofluorescence, and absorption properties of RPE cells situated posterior to reticular pseudodrusen (RPD) could provide insight into the origins and structure of RPD. Methods RPD were studied qualitatively by near-infrared fundus autofluorescence (NIR-AF), short-wavelength fundus autofluorescence (SW-AF), and infrared reflectance (IR-R) images, and the presentation was compared to horizontal and en face spectral domain optical coherence tomographic (SD-OCT) images. Images were acquired from 23 patients (39 eyes) diagnosed with RPD (mean age 80.7 ± 7.1 [SD]; 16 female; 4 Hispanics, 19 non-Hispanic whites). Results In SW-AF, NIR-AF, and IR-R images, fundus RPD were recognized as interlacing networks of small scale variations in IR-R and fluorescence (SW-AF, NIR-AF) intensities. Darkened foci of RPD colocalized in SW-AF and NIR-AF images, and in SD-OCT images corresponded to disturbances of the interdigitation (IZ) and ellipsoid (EZ) zones and to more pronounced hyperreflective lesions traversing photoreceptor-attributable bands in SD-OCT images. Qualitative assessment of the outer nuclear layer (ONL) revealed thinning as RPD extended radially from the outer to inner retina. In en face OCT, hyperreflective areas in the EZ band correlated topographically with hyporeflective foci at the level of the RPE. Conclusions The hyperreflective lesions corresponding to RPD in SD-OCT scans are likely indicative of degenerating photoreceptor cells. The darkened foci at positions of RPD in NIR-AF and en face OCT images indicate changes in the RPE monolayer with the reduced NIR-AF and en face OCT signal suggesting a reduction in melanin that could be accounted for by RPE thinning.
Collapse
Affiliation(s)
- Maarjaliis Paavo
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - John Merriam
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Stephen Tsang
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Stanley Chang
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| |
Collapse
|
17
|
Chatziralli I, Theodossiadis G, Panagiotidis D, Pousoulidi P, Theodossiadis P. Choriocapillaris' alterations in the presence of reticular pseudodrusen compared to drusen: study based on OCTA findings. Int Ophthalmol 2017; 38:1887-1893. [PMID: 28779271 DOI: 10.1007/s10792-017-0671-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the qualitative changes of choriocapillaris in the presence of reticular pseudodrusen (RPD) and compare them with conventional small drusen due to dry age-related macular degeneration (AMD). PROCEDURES Participants in this study were 59 patients with non-neovascular AMD, presenting either RPD (23 patients) or drusen (36 patients) of similar size. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography. RESULTS The morphology of RPD in SD-OCT was depicted either as conical or as amorphous in shape. Both types were found to affect the ellipsoid zone. The presence of RPD was associated with choriocapillaris' reduced blood flow signal (non-perfusion), while the same but less intense choriocapillaris' non-perfusion appearance was noticed in the presence of drusen of the same size. In 13% of patients with RPD, ghost-like vessels were observed in the non-perfusion area of choriocapillaris, while in none patients with drusen ghost vessels were present. In all 23 patients with RPD, the choriocapillaris non-perfusion was correspondent to the location of RPD. Additionally, in about 35% of them, choriocapillaris' impairment was also observed, covering areas outside RPD. CONCLUSIONS Morphological impairment of choriocapillaris was more intense in patients with RPD than in those with conventional drusen of the same size. The existence of ghost vessels in the area of choriocapillaris' density defect suggested that choriocapillaris' alterations may occur in patients with RPD.
Collapse
Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, 1, Rimini street, 12462, Haidari, Athens, Greece.
| | - George Theodossiadis
- 2nd Department of Ophthalmology, University of Athens, 1, Rimini street, 12462, Haidari, Athens, Greece
| | | | | | - Panagiotis Theodossiadis
- 2nd Department of Ophthalmology, University of Athens, 1, Rimini street, 12462, Haidari, Athens, Greece
| |
Collapse
|
18
|
Zheng F, Gregori G, Schaal KB, Legarreta AD, Miller AR, Roisman L, Feuer WJ, Rosenfeld PJ. Choroidal Thickness and Choroidal Vessel Density in Nonexudative Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Imaging. Invest Ophthalmol Vis Sci 2017; 57:6256-6264. [PMID: 27849311 PMCID: PMC5114036 DOI: 10.1167/iovs.16-20161] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To analyze the relationship between choroidal thickness and the distribution of choroidal blood vessels in eyes with nonexudative AMD. Methods Eyes with a diagnosis of nonexudative AMD were imaged using a prototype 100-kHz swept-source (SS) optical coherence tomography (OCT) instrument (Carl Zeiss Meditec, Dublin, CA, USA) with a central wavelength of 1050 nm. We used an OCT cube scan pattern consisting of 512 × 512 A-scans over a 12 × 12 mm retinal area. The eyes were partitioned into two groups based on the presence or absence of reticular pseudodrusen (RPD). All scans were segmented using an automated algorithm. In addition, five eyes from each of the two groups were randomly chosen for manual segmentation. Binary choroidal vessels maps were generated from suitable OCT choroidal slabs, and the relationship between the density of large choroidal vessels and choroidal thickness was analyzed using an Early Treatment Diabetic Retinopathy Study–like target centered on the fovea. Results Twenty-five eyes were enrolled in each group. The automated algorithm produced accurate choroidal thickness maps with an average difference between the manual and automated segmentations of 13.7 μm. There was a significant and stable correlation between choroidal thickness and choroidal vessel density across the two groups. Both average choroidal thickness and vessel density were significantly lower in eyes with RPD. Conclusions Our fully automated choroidal segmentation algorithm was able to capture the different patterns of choroidal thickness over a wide area. Choroidal thickness has a clear relationship with the density of large choroid vessels in our sample, irrespective of the presence or absence of RPD.
Collapse
Affiliation(s)
- Fang Zheng
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 2Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Giovanni Gregori
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Karen B Schaal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Andrew D Legarreta
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Andrew R Miller
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Luiz Roisman
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - William J Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| |
Collapse
|
19
|
Nesper PL, Soetikno BT, Fawzi AA. Choriocapillaris Nonperfusion is Associated With Poor Visual Acuity in Eyes With Reticular Pseudodrusen. Am J Ophthalmol 2017; 174:42-55. [PMID: 27794427 PMCID: PMC5253325 DOI: 10.1016/j.ajo.2016.10.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To study choriocapillaris blood flow in age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA) and study its correlation to visual acuity (VA) in eyes with reticular pseudodrusen (RPD) vs those with drusen without RPD (drusen). DESIGN Cross-sectional study. METHODS Patients with either drusen or RPD in early AMD underwent OCTA imaging of the superior, inferior, and/or nasal macula. We quantified "percent choriocapillaris area of nonperfusion" (PCAN) in eyes with RPD vs those with drusen. We assessed the repeatability of PCAN and its correlations with VA. RESULTS Twenty-nine eyes of 26 patients with RPD and 21 eyes of 16 age-matched AMD patients with drusen were included. Qualitatively, the choriocapillaris in areas with RPD showed focal dark regions without flow signal on OCTA (nonperfusion). The repeatability coefficient of PCAN was 0.49%. Eyes with RPD had significantly greater PCAN compared with eyes with drusen (7.31% and 3.88%, respectively; P < .001). We found a significant correlation between PCAN and VA for the entire dataset (r = 0.394, P = .005). When considering eyes with RPD separately, this correlation was stronger (r = 0.474, P = .009) but lost significance when considering eyes with drusen separately (r = 0.175, P = .45). CONCLUSIONS Eyes with RPD have significantly larger areas of choriocapillaris nonperfusion compared with eyes with drusen and no RPD. The correlation between PCAN and VA in this RPD population provides a potential mechanistic explanation for vision compromise in RPD compared with other forms of drusen in AMD.
Collapse
Affiliation(s)
- Peter L Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brian T Soetikno
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Medical Scientist Training Program, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Functional Optical Imaging Laboratory, Department of Biomedical Engineering, Northwestern University, Chciago, Illinois
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| |
Collapse
|
20
|
Cicinelli MV, Rabiolo A, Marchese A, de Vitis L, Carnevali A, Querques L, Bandello F, Querques G. Choroid morphometric analysis in non-neovascular age-related macular degeneration by means of optical coherence tomography angiography. Br J Ophthalmol 2017; 101:1193-1200. [DOI: 10.1136/bjophthalmol-2016-309481] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/16/2016] [Accepted: 12/13/2016] [Indexed: 01/27/2023]
|
21
|
RETICULAR PSEUDODRUSEN ARE NOT A PREDICTIVE FACTOR FOR THE 1-YEAR RESPONSE TO INTRAVITREAL RANIBIZUMAB IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2017; 37:53-59. [DOI: 10.1097/iae.0000000000001134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
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]
|
23
|
PREVALENCE OF RETICULAR PSEUDODRUSEN IN AGE-RELATED MACULAR DEGENERATION USING MULTIMODAL IMAGING. Retina 2016; 36:46-52. [PMID: 26090899 DOI: 10.1097/iae.0000000000000648] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the rate of reticular pseudodrusen (RPD) in age-related macular degeneration using multimodal imaging, including color fundus photography, the blue channel image of fundus photography, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography, as well as to compare the sensitivities and specificities of these modalities for detecting RPD. METHODS This prospective study included 243 eyes from 125 consecutive patients with age-related macular degeneration. They underwent fundus examination including color fundus photography, blue channel, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography in both eyes. To be considered as having RPD, eyes had to have reticular patterns on spectral domain optical coherence tomography in a large studied cube of 30° × 25° or on infrared reflectance with at least one other examination. RESULTS The mean age of the 125 patients was 81.1 years (± 8.1). Eighty-six patients (68.8%) were diagnosed with RPD. Spectral domain optical coherence tomography, infrared reflectance, and multicolor imaging had the highest sensitivity (99.3, 84.6, and 87.1%, respectively) and specificity (100%). The color fundus photography, blue channel, and fundus autofluorescence had lower sensitivity to detect RPD. CONCLUSION Reticular pseudodrusen is frequently associated with soft drusen in patients with age-related macular degeneration. As RPD may be rarely located only in the perifoveal area, spectral domain optical coherence tomography with a larger cube (30 × 25°) than that usually used (20 × 20°) had the highest sensitivity and specificity to detect RPD and is recommended to optimize the rate of detection.
Collapse
|
24
|
Khan KN, Mahroo OA, Khan RS, Mohamed MD, McKibbin M, Bird A, Michaelides M, Tufail A, Moore AT. Differentiating drusen: Drusen and drusen-like appearances associated with ageing, age-related macular degeneration, inherited eye disease and other pathological processes. Prog Retin Eye Res 2016; 53:70-106. [DOI: 10.1016/j.preteyeres.2016.04.008] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/24/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
|
25
|
RETICULAR PSEUDODRUSEN ON INFRARED IMAGING ARE TOPOGRAPHICALLY DISTINCT FROM SUBRETINAL DRUSENOID DEPOSITS ON EN FACE OPTICAL COHERENCE TOMOGRAPHY. Retina 2016; 35:2593-603. [PMID: 26131588 DOI: 10.1097/iae.0000000000000666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the quantitative and topographic relationship between reticular pseudodrusen (RPD) on infrared reflectance (IR) and subretinal drusenoid deposits (SDD) on en face volumetric spectral domain optical coherence tomography. METHODS Reticular pseudodrusen were marked on IR images by a masked observer. Subretinal drusenoid deposits were visualized on en face sections of spectral domain optical coherence tomography below the external limiting membrane and identified by a semiautomated technique. Control RPD lesions were generated in a random distribution for each IR image. Binary maps of control and experimental RPD and SDD were merged and analyzed in terms of topographic localization and quantitative drusen load comparison. RESULTS A total of 54 eyes of 41 patients diagnosed with RPD were included in this study. The average number of RPD lesions on IR images was 320 ± 44.62 compared with 127 ± 26.02 SDD lesions on en face (P < 0.001). The majority of RPD lesions did not overlap with SDD lesions and were located >30 μm away (92%). The percentage of total SDD lesions overlapping RPD was 2.91 ± 0.87% compared with 1.73 ± 0.68% overlapping control RPD lesions (P < 0.05). The percentage of total SDD lesions between 1 and 3 pixels of the nearest RPD lesion was 5.08 ± 1.40% compared with 3.33 ± 1.07% between 1 and 3 pixels of the nearest control RPD lesion (P < 0.05). CONCLUSION This study identified significantly more RPD lesions on IR compared with SDD lesions on en face spectral domain optical coherence tomography and found that a large majority of SDD (>90% of lesions) were >30 μm away from the nearest RPD. Together, our findings indicate that RPD and SDD are two entities that are only occasionally topographically associated, suggesting that at some stage in their development, they may be pathologically related.
Collapse
|
26
|
Zhou Q, Daniel E, Maguire MG, Grunwald JE, Martin ER, Martin DF, Ying GS. Pseudodrusen and Incidence of Late Age-Related Macular Degeneration in Fellow Eyes in the Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmology 2016; 123:1530-40. [PMID: 27040149 DOI: 10.1016/j.ophtha.2016.02.043] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/29/2016] [Accepted: 02/23/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the association between pseudodrusen and incidence of late age-related macular degeneration (AMD) in fellow eyes of patients with unilateral neovascular AMD (nAMD). DESIGN Cohort study within the Comparison of AMD Treatments Trials (CATT). PARTICIPANTS Patients with neither nAMD nor geographic atrophy (GA) in the fellow eye at baseline. METHODS Presence and type (dot, reticular, or confluent) of baseline pseudodrusen were assessed using digital color fundus photography (CFP) viewed under full color, green channel, and blue channel; red-free images; and fluorescein angiography (FA). Incidence of nAMD was based on monthly clinical examination and reading center evaluation of images at years 1 and 2. Incidence of GA was based on reading center evaluation of CFP and FA images at years 1 and 2. Associations of baseline pseudodrusen with incident nAMD and GA were summarized with adjusted risk ratios (aRRs) and their 95% confidence intervals (CIs) from multivariate Cox models, with adjustment of covariates identified through backward stepwise selection. MAIN OUTCOME MEASURES Incident nAMD and GA. RESULTS Among 620 fellow eyes, 176 (28.4%) had baseline pseudodrusen (55% dot, 82% reticular, 35% confluent). Within 2 years, nAMD occurred in 54 eyes (30.7%) with pseudodrusen and in 72 eyes (16.2%) without pseudodrusen (aRR, 2.05; 95% CI, 1.43-2.93); GA occurred in 27 eyes (15.3%) with pseudodrusen and in 37 eyes (8.3%) without pseudodrusen (aRR, 1.89; 95% CI, 1.13-3.17); late AMD occurred in 73 eyes (41.5%) with pseudodrusen and in 101 eyes (22.8%) without pseudodrusen (aRR, 2.07; 95% CI, 1.51-2.83). Dot pseudodrusen were associated independently with nAMD (aRR, 2.53; 95% CI, 1.60-4.00), whereas confluent pseudodrusen were associated independently with GA (aRR, 4.35; 95% CI, 1.69-11.2). Eyes with pseudodrusen had increased incidence of late AMD regardless of whether the Age-Related Eye Diseases Study (AREDS) severity score was 2 (28.7% vs. 10.3%), 3 (34.9% vs. 13.7%), or 4 (50.5% vs. 32.0%). CONCLUSIONS In fellow eyes of CATT participants, pseudodrusen were associated independently with a higher incidence of both nAMD and GA. Dot pseudodrusen were associated with nAMD, whereas confluent pseudodrusen were associated with GA. Pseudodrusen should be considered along with the AREDS severity score for predicting late AMD.
Collapse
Affiliation(s)
- Qiang Zhou
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ebenezer Daniel
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen G Maguire
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan E Grunwald
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - E Revell Martin
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | |
Collapse
|
27
|
Zhou Q, Shaffer J, Ying GS. Pseudodrusen in the Fellow Eye of Patients with Unilateral Neovascular Age-Related Macular Degeneration: A Meta-Analysis. PLoS One 2016; 11:e0149030. [PMID: 26895455 PMCID: PMC4760707 DOI: 10.1371/journal.pone.0149030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/26/2016] [Indexed: 11/18/2022] Open
Abstract
Importance The fellow eye of patients with unilateral neovascular age-related degeneration (nAMD) is at increased risk of developing late AMD. Several cohort studies have evaluated the prevalence of pseudodrusen and the association between pseudodrusen and late AMD in the fellow eye of patients with unilateral nAMD. However, these studies have limited sample sizes and their results are inconsistent. Objective To evaluate the prevalence rate of pseudodrusen, and the association between pseudodrusen and incidence of late AMD (nAMD and geographic atrophy (GA)) in the fellow eye of patients with unilateral nAMD. Data Sources The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched up to July 2015, as well as other systematic reviews. Study Selection All cohort studies for pseudodrusen with late AMD in the fellow eye of patients with unilateral nAMD. Data Extraction and Synthesis The numbers of patients with and without pseudodrusen at baseline and the numbers of incident nAMD and GA during follow up among patients with and without pseudodrusen were independently extracted by 2 authors. The results were pooled using random-effects meta-analysis. Heterogeneity was assessed using the I2 test. Main Outcome Measures Prevalence rate of pseudodrusen, risk ratios (RRs) and their 95% confidence intervals (95% CIs) for associations between pseudodrusen and the incidence of nAMD and GA in the fellow eye. Results Five cohort studies (N = 677 patients) from 8 countries across 4 continents were included. The pooled prevalence rate of pseudodrusen in the fellow eye was 48.1% (95% Cl: 36.7–59.5%, I2 = 87%). Pseudodrusen were associated with an increased risk of nAMD (RR = 1.54, 95% Cl: 1.10–2.16, I2 = 42%), GA (RR = 4.70, 95% Cl: 1.22–18.1, I2 = 64%), and late AMD (RR = 2.03, 95% Cl: 1.35–3.06, I2 = 60%). Conclusions For patients with unilateral nAMD, pseudodrusen were present in about half of the fellow eyes. The presence of pseudodrusen was associated with a 1.5 times higher risk of developing nAMD, a 4.7 times higher risk of developing GA, and a 2 times higher risk of developing late AMD. Pseudodrusen should be considered in evaluating the risk of late AMD development; however, due to considerable heterogeneity across these studies, a larger study is needed to validate these findings.
Collapse
Affiliation(s)
- Qiang Zhou
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. China
- * E-mail:
| | - James Shaffer
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gui-shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
28
|
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.
Collapse
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.
| |
Collapse
|
29
|
Chang YS, Kim JH, Yoo SJ, Lew YJ, Kim J. Fellow-eye neovascularization in unilateral retinal angiomatous proliferation in a Korean population. Acta Ophthalmol 2016; 94:e49-53. [PMID: 25981599 DOI: 10.1111/aos.12748] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/30/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the incidence of fellow-eye neovascularization in retinal angiomatous proliferation (RAP) in a Korean population and associated risk factors. METHOD This retrospective, observational study included 81 eyes (81 patients) diagnosed with unilateral RAP who were followed up for ≥12 months. The RAP diagnosis was based on an indocyanine green angiography reviewed by two retinal specialists. In fellow eyes experiencing neovascularization, the period between RAP diagnosis and neovascularization was compared between eyes with and without reticular pseudodrusen. RESULTS The mean age (±standard deviation) of the 81 patients was 74.7 ± 6.1 years. The mean follow-up period was 27.8 ± 12.4 months. Fellow-eye neovascularization was noted in 31 patients (38.3%), and 24 of these (77.4%) was a RAP subtype. Fellow-eye involvement was noted within 12 months in 13 eyes (16.0%). The period between diagnosis and fellow-eye neovascularization was significantly shorter in eyes with reticular pseudodrusen (mean 13.8 ± 8.5 months) than in eyes without reticular pseudodrusen (mean 21.2 ± 9.1 months; p = 0.031). CONCLUSION In our cohort of unilateral RAP patients, fellow-eye neovascularization was noted in 38.3% in 27.8 months. The presence of reticular pseudodrusen in the fellow eye was closely associated with relatively early onset.
Collapse
Affiliation(s)
- Young Suk Chang
- Department of Ophthalmology; Konyang University College of Medicine; Daejeon South Korea
| | - Jae Hui Kim
- Department of Ophthalmology; Kim's Eye Hospital; Konyang University College of Medicine; Seoul South Korea
| | - Su Jin Yoo
- Department of Ophthalmology; Kim's Eye Hospital; Konyang University College of Medicine; Seoul South Korea
| | - Young Ju Lew
- Department of Ophthalmology; Kim's Eye Hospital; Konyang University College of Medicine; Seoul South Korea
| | - Jooyeon Kim
- Department of Ophthalmology; Kim's Eye Hospital; Konyang University College of Medicine; Seoul South Korea
| |
Collapse
|
30
|
The lack of concordance between subretinal drusenoid deposits and large choroidal blood vessels. Am J Ophthalmol 2014; 158:710-5. [PMID: 25034112 DOI: 10.1016/j.ajo.2014.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the concordance between pseudodrusen as manifested by subretinal drusenoid deposits and large choroidal blood vessels using stereological analysis of spectral-domain optical coherence tomography (SD OCT) images. DESIGN Retrospective, observational case series. METHODS The SD OCT images of 31 consecutive patients with the clinical appearance of pseudodrusen from a private-referral retinal clinic were retrospectively reviewed. A grid of 19 evenly spaced vertical lines was randomly superimposed on each SD OCT image using ImageJ to perform systematic uniform random sampling. The main outcome measure was the likelihood of association between subretinal drusenoid deposits and large choroidal vessels. RESULTS Uniform random systematic sampling of 589 samples found the proportion of geometric probes intersecting subretinal drusenoid deposits to be 0.28, large choroidal vessel 0.65, and both 0.19. This value was nearly identical to the product of the joint probabilities and was within the 95% confidence interval (0.15-0.21) of the point estimate as calculated by the binomial theorem, indicating mutual independence. The subretinal drusenoid deposits were associated with neither large choroidal vessels nor the intervals in between. CONCLUSIONS Our results demonstrate that there is no concordance between subretinal drusenoid deposits and large choroidal vessels or the stroma in between. As a consequence, hypotheses postulating that subretinal drusenoid deposits are associated with large choroidal vessels or the choroidal stromal spaces should be abandoned. Stereological techniques are powerful methods used in image evaluation in other fields of study and appear to have utility in analyzing OCT findings of the retina and choroid.
Collapse
|
31
|
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]
|