Local and Global Associations of Reticular Pseudodrusen in Age-related Macular Degeneration.

PubMed ID: 38278174

Author(s): Duic C, Mukherjee S, Pfau K, Thavikulwat A, Domalpally A, Keenan TDL, Chew E, Cukras C. Local and Global Associations of Reticular Pseudodrusen in Age-related Macular Degeneration. Ophthalmol Retina. 2024 Jan 24:S2468-6530(24)00042-3. doi: 10.1016/j.oret.2024.01.016. Online ahead of print. PMID 38278174

Journal: Ophthalmology. Retina, Jan 2024

PURPOSE To investigate the spatial distribution of reticular pseudodrusen (RPD) in eyes with age-related macular degeneration (AMD) and their correlation with functional measures, retinal thickness, and changes over time.

DESIGN Longitudinal, cohort study.

PARTICIPANTS Thirty-five participants with RPD and spectrum of AMD severity (including no AMD).

METHODS Multimodal imaging was graded by a reading center, including evaluation of color fundus imaging to assess AMD severity scores. RPD presence on optical coherence tomography (OCT) volumes was confirmed on en-face imaging and the RPD extent was contoured on infrared (IR) images. One study eye per participant underwent rod-mediated dark adaptation (RMDA), measuring rod intercept time (RIT) at 5° and/or 12° superior to the fovea.

MAIN OUTCOME METHODS The primary outcome was RIT and OCT thickness measures which were correlated with RPD area.

RESULTS A total of 51 eyes had ≥1 visit with RPD detected (mean follow-up 2.19±2.04 years, range 0-5 years), totaling 169 eye-based visits with RPD. Of the 51 eyes with RPD, 5 (9.8%) developed GA and 17 (33.3%) progressed to neovascular AMD. Larger RPD areas were detected more frequently in AMD severity scores 6-7. RPD area within an eye generally increased over time. The lesion distribution showed a predilection for the superior retina, especially the outer superior subfield of the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid, with the central subfield having least involvement. RPD area was inversely correlated with central subfield thickness and positively correlated with RIT at 5° (p=0.001; r2=0.01) and 12° (p=0.004; r2=0.01). RMDA at 5° reached the test ceiling in >85% of visits, irrespective of RPD lesion presence/absence at the test location. Retinal thickness decreased monotonically, with the central subfield demonstrating the greatest percentage change over five years (Δ=-5.47%).

CONCLUSIONS In AMD, RPD involve predominantly the superior retina but can involve all ETDRS subfields and evolve over time. Eyes with RPD exhibit structural and functional impairments that can be measured beyond the boundaries of the RPD lesions, suggesting changes associated with RPD are associated with both local changes and a more widespread process.