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Rachel Cymerman, Nicole Pumariega, Adam Sperber, Nathalie Massamba, Eric Souied, Roland Smith; Progression of Reticular Macular Disease (RMD) in Age-Related Macular Degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2013;54(15):4167.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the progression of RMD, also known as reticular pseudodrusen, using scanning laser ophthalmoscopy (SLO) infrared (IR) images, and compare patterns to those of geographic atrophy (GA) and soft drusen.
We retrospectively identified 54 consecutive patients (54 eyes) from a single institution (L’Hôpital Intercommunal de Créteil, France) who had RMD  on IR imaging in one eye; advanced AMD, either GA or choroidal neovascularization (CNV), in the fellow eye; ≥ 2 examinations with IR imaging; and ≥ 1 year of follow-up. Eight patients were excluded due to poor image quality. For the remaining 46 eyes, we calculated reticular IR lesion areas and progression rates in a 56.25 mm^2 image area (7.5 mm x 7.5 mm square centered on the fovea) using custom interactive software . Images were analyzed by 2 independent evaluators, with discrepancies resolved by a senior grader. Images from the fellow eye were also examined for underlying pathology.
Of the 46 patients included in our study, 33 were female and 13 were male. The mean age at baseline was 81 +/- 7 years. The mean duration of follow-up was 27 months (range: 11-59 months). In the fellow eye, 43 patients (93.4%) exhibited CNV, and 3 patients (6.6%) exhibited GA. The mean reticular lesion area within the 56.25 mm^2 image area was 27.00 mm^2 (48.1% of the image area) at baseline. The mean reticular lesion area growth rate was 3.67 mm^2 +/- 3.21 mm^2/year (range: 0.05-16.25 mm2/year). Qualitatively, no regression of the outer perimeter of the reticular pattern was observed over time.
The reticular lesion area in patients with early AMD grows quickly but with significant individual variability (3.67 +/- 3.21 mm^2/year), with no signs of regression in this cohort. This rate is faster (though analogous) to that of GA progression (published range: 1.5-2.5 mm^2/year) , but differs greatly from that of the quantitatively described remodeling and regression of soft drusen . Since reticular lesions have been shown to increase the risk of late-stage AMD (GA and CNV) , the presence and progression of RMD in AMD deserves wider recognition by clinicians caring for AMD patients. 1. Pumariega et al. (2011) Ophthalmology; 118(8):1619-25 2. Smith et al. (2005) Arch Ophthalmol;123:200-6 3. Holz et al. (2007) Am J Ophthalmol;143:463-72 4. Smith et al. (2010) Br J Ophthalmol;94:1618-23
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