September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Prevalence and natural course of refractile drusen in eyes with intermediate age-related macular degeneration
Author Affiliations & Notes
  • Akio Oishi
    Department of Ophthalmology, University of Bonn, Bonn, Germany
  • Maho Oishi
    Department of Ophthalmology, University of Bonn, Bonn, Germany
  • Sarah Thiele
    Department of Ophthalmology, University of Bonn, Bonn, Germany
  • Jennifer Nadal
    Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
  • Monika Fleckenstein
    Department of Ophthalmology, University of Bonn, Bonn, Germany
  • Frank G Holz
    Department of Ophthalmology, University of Bonn, Bonn, Germany
  • Steffen Schmitz-Valckenberg
    Department of Ophthalmology, University of Bonn, Bonn, Germany
  • Footnotes
    Commercial Relationships   Akio Oishi, Alcon Japan (F), Bayer (R), Novartis (R); Maho Oishi, None; Sarah Thiele, Carl Zeiss Meditec (F), Heidelberg Engineering (F), Optos (F); Jennifer Nadal, None; Monika Fleckenstein, Bayer (R), Carl Zeiss Meditec (F), Genentech (F), Genentech (R), Heidelberg Engineering (F), Heidelberg Engineering (R), Merz (C), Novartis (R), Optos (F), US20140303013 A1 pending (P); Frank Holz, Alcon (C), Allergan (C), Bayer Healthcare (C), Genentech (C), Heidelberg Engineering (C), Novartis (C), Roche (C); Steffen Schmitz-Valckenberg, Alcon/Novartis (C), Alcon/Novartis (F), Allergan (F), Bayer (F), Bayer (R), Carl Zeiss Meditec AG (F), Formycon (F), Genentech/Roche (F), Heidelberg Engineering (F), Heidelberg Engineering (R), Optos (F)
  • Footnotes
    Support  German Ministry of Education and Research (BMBF)
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1606. doi:
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      Akio Oishi, Maho Oishi, Sarah Thiele, Jennifer Nadal, Monika Fleckenstein, Frank G Holz, Steffen Schmitz-Valckenberg; Prevalence and natural course of refractile drusen in eyes with intermediate age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1606.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : Refractile drusen represent a phenotypic feature in various stages of age-related macular degeneration (AMD). Aim of this analysis was to evaluate prevalence, natural course, and clinical significance of refractile druse associated with intermediate AMD in a prospective, longitudinal natural history study.

Methods : Ninety-eight eyes of 98 subjects (mean age 73.1 ± 7.1 years) with intermediate AMD were included. At baseline and at each year, multimodal retinal imaging including infrared reflectance (IR), blue reflectance (BR), fundus autofluorescence, and optical coherence tomography (OCT) over a review period of up to 4 years was performed. Refractile drusen were identified in color fundus photographs and longitudinal changes of individual lesions were analyzed in different imaging modalities. Incidence of late atrophic and neovascular AMD was compared between eyes with and without refractile drusen.

Results : Twenty of 98 eyes had refractile drusen at baseline with a total lesion number of 115. Lesions were bilateral in 14 subjects. Refractile drusen showed a hyperreflective appearance on IR (80.9%) and BR (93.9%). Corresponding hyperreflective material at the level of Bruch’s membrane by OCT was noted in 33 %. Longitudinal observations revealed both spontaneous regression of refractile drusen (n = 10) as well as progression to geographic atrophy (n = 30) or exudative changes (n = 25). If refractile drusen were present at baseline, the development of central GA was more frequently observed as compared to eyes with no refractile drusen at baseline (9/15 vs 6/57, excluding patients who dropped out). The presence of refractile drusen resulted in similar rates for the incidence of choroidal neovascularization (3/15 vs 16/57).

Conclusions : The results indicate that refractile drusen in eyes with intermediate AMD may represent a predictive marker for the progression towards GA rather than CNV. Expanded future natural history as well as interventional studies should record the presence of refractile drusen for further validation of these initial observations.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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