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Thomas R Friberg, Emily Y Chew, Amitha Domalpally, Srinivas R Sadda, Traci E Clemons, Ronald P Danis, ; Peripheral Retinal Findings in color images in Age-Related Macular Degeneration - OPERA, an AREDS 2 Ancillary Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4017.
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While Age-Related Macular degeneration is, by definition, a macular disease, features of AMD may occur outside of the posterior pole. We determined the prevalence of peripheral retinal abnormalities in eyes of Age-Related Eye Disease Study 2 (AREDS 2) subjects with at least one large druse in the macula of each eye or with late AMD in the macula of one eye.
Wide-field fundus imaging using an Optomap P200Tx was performed on 442 eyes of subjects in the AREDS II OPERA (Optos PERipheral retinA) Study using an eye steering protocol. Images of 423 eyes were successfully montaged after correcting for non-linearity, and a custom grid was used to divide each image into zones for grading: Zone 1 (area between the retinal vascular arcades), Zone 3 (peripheral to vortex veins) and Zone 2 (region between Zones 1 and 3). Trained readers documented the morphological abnormalities found within each zone including drusen type, size, and number, the presence of hypo- and hyperpigmentation, cobblestone degeneration, and reticular pigment degeneration.
Reticular pigment degeneration was found in Zone 2 in 26.5% of eyes and in superior Zone 3 in 22.7% of eyes. Reticular pigmentation seen on color images was present in autofluorescent images 67% of the time. Regarding gradability, 100% of Zone 1, 99.8% of Zone 2, 94.8% of Zone 3 superior quadrants, and 74.7% of Zone 3 inferior quadrants were deemed of sufficient quality to be graded. Drusen were present in Zone 1 in 61% of eyes, in Zone 2 in 75% of eyes, and in Zone 3 in 56% of gradable eyes. Reticular pseudodrusen were present in 10%, 15%, and 1% of eyes in the same regions. Cobblestone degeneration was seen in Zone 3 superior in 6.8% of eyes.
Peripheral retinal abnormalities are very common in eyes with at least intermediate age-related macular degeneration. Drusen were found outside of the posterior pole in up to 75% of eyes. Reticular pigmentary degeneration was the most common pigmentary abnormality in our subjects. Peripheral retinal phenotypic features may have implications regarding the risk of visual loss in AMD patients.
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