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J.R. Armstrong, L.D. Hubbard, M.D. Davis, R.P. Danis, L.–Y. Lee, B. Zhang, R. Klein, B.E. Klein, AREDS Research Group; Association of Calcified Drusen With Progression of AMD in AREDS Participants . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2128.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the association of calcified drusen with progression of AMD, and to illustrate the course of such eyes, in the Age–Related Eye Disease Study (AREDS).
Calcified drusen are small refractile deposits associated with AMD, particularly geographic atrophy (GA). We compared 5–year rates of progression to advanced AMD (neovascular AMD and/or central GA), and to the development of noncentral GA, in eyes with and without calcified drusen. We limited the analysis to eyes that at baseline (a) were in AREDS category 3 (having at least one large ordinary druse [>= 125µm] or extensive intermediate drusen), (b) did not already have non–central GA, and (c) had 5 years of follow–up. We used the extended AREDS severity scale to concentrate this analysis on eyes in levels 6–8, defined as having extensive drusen area and/or pigment abnormalities but without GA. Because both eyes of one subject could have calcified drusen, we present our results based upon only right eyes.
Among 1086 right eyes in AREDS category 3, 75 eyes (4%) had calcified drusen and 2069 eyes (96%) did not. Progression rates to advanced AMD were 39% vs.13% respectively (p<0.0001 by chi–square). Dividing these progressions, neovascular AMD rates were 13% vs. 8%, central GA rates were 26% vs. 5%, and neoAMD with GA rates were none vs. 1%, respectively. Non–central GA incidence rates were 37% vs. 8%, respectively. Restricted to the 555 right eyes in AREDS levels 6–8, 38 eyes (7%) had calcified drusen and 517 eyes (93%) did not, with progression rates to advanced AMD of 39% and 25%, respectively, (p < 0.0001). Neovascular AMD rates were 13% vs. 14%, central GA rates were 26% vs. 9%, and neoAMD with GA rates were none vs. 2%, respectively. Non–central GA incidence rates were 37% vs. 13%, respectively. Considering the left eye of these 38 subjects with calcified drusen in their right eye, 36 (95%) also had this finding in their contralateral eye. Conducting the outcome analysis for left eyes yielded results very similar to those for right eyes.
AREDS results show that presence of calcified drusen at baseline signifies 3– to 4–fold increased risk for 5–year progression to geographic atrophy, both central and non–central.
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