Extramacular Drusen and Progression of Age-Related Macular Degeneration: Age Related Eye Disease Study 2 Report 30.

PubMed ID: 35940477

Author(s): Domalpally A, Xing B, Pak JW, Agron E, Ferris FL 3rd, Clemons TE, Chew EY. Extramacular Drusen and Progression of Age-Related Macular Degeneration: Age Related Eye Disease Study 2 Report 30. Ophthalmol Retina. 2023 Feb;7(2):111-117. doi: 10.1016/j.oret.2022.08.001. Epub 2022 Aug 6. PMID 35940477

Journal: Ophthalmology. Retina, Volume 7, Issue 2, Feb 2023

PURPOSE To identify the prevalence of extramacular drusen and their role in the progression of age-related macular degeneration (AMD).

DESIGN Retrospective analysis of a prospective cohort study.

PARTICIPANTS The study was conducted in 4168 eyes (2998 participants) with intermediate AMD in one or both eyes enrolled in the Age-Related Eye Disease Study 2 (AREDS2), a 5-year multicenter study of nutritional supplements.

METHODS Baseline 3-field 30-degree color photographs were evaluated for drusen characteristics outside the macular grid, including size, area, and location. The characteristics of extramacular drusen were compared with those of drusen within the macula.

MAIN OUTCOME MEASURES Progression rates to late AMD.

RESULTS Although extramacular drusen were observed in 3624 (86.9%) eyes, they represented a small area ( 1 disc area. Eyes with extramacular drusen exhibited larger macular drusen size and area than eyes without extramacular drusen (P < 0.001). Extramacular drusen were not associated with progression to late AMD. The hazard ratio adjusted for baseline age, sex, smoking, AMD severity level, and reticular pseudodrusen for 4043 eyes at risk of developing late AMD over 5 years was 1.17 (95% confidence interval [CI], 0.88-1.54; P = 0.27) for geographic atrophy and 0.96 (95% CI, 0.76-1.2; P = 0.7) for neovascular AMD.

CONCLUSIONS Extramacular drusen are commonly observed in eyes with AMD and are more frequent with an increasing drusen burden within the macula. In eyes with intermediate AMD, extramacular drusen do not confer additional risk to previously identified risk factors in progression to late AMD.