September 2015
Volume 56, Issue 10
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Letters to the Editor  |   September 2015
Author Response: Reticular Pseudodrusen: A Common Pathogenic Mechanism Affecting the Choroid–Bruch's Membrane Complex and Retinal Pigment Epithelium for Different Retinal and Macular Diseases
Author Affiliations & Notes
  • Martin Gliem
    Department of Ophthalmology University Hospital of Bonn, Bonn, Germany.
  • Frank G. Holz
    Department of Ophthalmology University Hospital of Bonn, Bonn, Germany.
  • Peter Charbel Issa
    Department of Ophthalmology University Hospital of Bonn, Bonn, Germany.
Investigative Ophthalmology & Visual Science September 2015, Vol.56, 5916. doi:10.1167/iovs.15-17898
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      Martin Gliem, Frank G. Holz, Peter Charbel Issa; Author Response: Reticular Pseudodrusen: A Common Pathogenic Mechanism Affecting the Choroid–Bruch's Membrane Complex and Retinal Pigment Epithelium for Different Retinal and Macular Diseases. Invest. Ophthalmol. Vis. Sci. 2015;56(10):5916. doi: 10.1167/iovs.15-17898.

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      © ARVO (1962-2015); The Authors (2016-present)

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We thank Giuseppe Querques1 for his comments on our recent article on Sorsby fundus dystrophy (SFD).2 We fully agree with his observation that the drusen-like deposits at the fundus of some patients shown in our study resemble reticular pseudodrusen (RPD). We also endorse his interesting pathophysiologic considerations. 
When reviewing the literature on SFD, we noticed a lack of detailed analysis of the frequently reported drusen-like deposits. Hence, we used a multimodal imaging approach and confirmed that RPD are a characteristic finding in SFD patients, at least in earlier disease stages. However, peripheral pseudodrusen and soft drusen also occur in SFD patients. An in depth description of these findings would have gone far beyond the scope of our recent article in IOVS. However, we recently have published a focused and detailed paper on RPD in SFD,3 which essentially is in line with the insightful observations and interpretations brought forward by Dr Querques. 
Besides their association with SFD, RPD were found frequently in two other monogenetic diseases: Pseudoxanthoma elasticum4 and late onset retinal degeneration (LORD) (Cukras CA, IOVS 2015;56:ARVO E-Abstract 2379-C0029). All three diseases share a common pathophysiologic background with pathology at the level of Bruch's membrane and the retinal pigment epithelium. This indeed indicates that RPD could (at least partially) be the result of dysfunction of the choroid–BM–RPE complex. 
References
Querques G. Reticular pseudodrusen: a common pathogenic mechanism affecting the choroid–Bruch's membrane complex and retinal pigment epithelium for different retinal and macular diseases. Invest Ophthalmol Vis Sci. 2015 ; 56: 5914–5915.
Gliem M, Müller PL, Mangold E, et al. Sorsby fundus dystrophy: novel mutations, novel phenotypic characteristics, and treatment outcomes. Invest Ophthalmol Vis Sci. 2015; 56: 2664–2676.
Gliem M, Müller PL, Mangold E, et al. Reticular pseudodrusen in Sorsby fundus dystrophy. Ophthalmology. 2015; 122: 1555–1562.
Gliem M, Hendig D, Finger RP, Holz FG, Charbel Issa P. Reticular pseudodrusen associated with a diseased bruch membrane in pseudoxanthoma elasticum. JAMA Ophthalmol. 2015 ; 133: 581–588.
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