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João Pedro Marques, João Quadrado Gil, Inês Laíns, Miguel Ângelo Costa, Sandrina Nunes, Maria Luz Cachulo, Rufino Silva; RETICULAR PSEUDODRUSEN AND THE FIVE-YEAR RISK OF PROGRESSION FOR LATE AMD. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3779.
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© ARVO (1962-2015); The Authors (2016-present)
Despite recent advances in retinal imaging, reticular pseudodrusen (RPD) remain an under-reported and under-researched retinal phenotype. The presence of RPD has been recognized as a significant risk factor for exudative age-related macular degeneration (eAMD) but a long-term follow-up is lacking. We conducted a retrospective observational clinical study to assess the influence of RPD on the 5-year risk of progression to late-stage disease, in a population of unaffected fellow eyes of eAMD.
Only fellow eyes of patients with unilateral eAMD were included. Minimum follow-up was 5 years, unless progression to late-AMD occurred first. Using an innovative grading software (RetmarkerAMD®, Critical Health SA), the areas of drusen and RPD were measured in baseline color fundus photographs (CFP), fundus auto-fluorescence (FAF), infra-red (IR) and red-free (RF) images. Presence of RPD was assumed whenever noticeable in at least one imaging modality. Main outcome measures were the incidence of choroidal neovascularization (CNV) and geographic atrophy (GA).
Sixty-three patients, mean-aged 76.19±6.63 years and with a mean follow-up of 66.03±20.95 months, were included. Prevalence of RPD was 55.56% (n=35). RPD were more frequently recognized in IR and FAF (52.4% for both) than in CFP (15.8%). Forty-one (65.1%) of the study eyes progressed to late-stage AMD: 82.9% (n=34) developed CNV and 17.1% (n=7) developed GA. Time to progression was not significantly different between patients with and without RPD (30.64 and 31.77 months respectively, p=0.79). After correcting for age and sex, presence of RPD was significantly associated (OR=3.96, p=0.01) with the development of late-stage AMD. Significance was maintained for CNV (OR=3.96, p=0.011) but not for GA (OR=0.943, p=0.94). Mean total area of RPD did not correlate with the risk of progression, regardless of the imaging modality used for measurement. Mean drusen area also did not significantly impact the 5-year risk of progression for late AMD (p=0.99). Multivariate analysis using a model that included intermediate and large drusen, revealed that the independent association between RPD and progression was maintained (OR=5.14, p=0.009).
RPD are associated with increased long-term risk of progression to late AMD in the second eye of patients with wet AMD, even in the presence of other known risk factors.
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