Purchase this article with an account.
Julia S. Steinberg, Jasmin A. Auge, Steffen Schmitz-Valckenberg, Monika Fleckenstein, Glenn J. Jaffe, Frank G. Holz, GAP-Study Group; Longitudinal Analysis Of Reticular Drusen Associated With Geographic Atrophy In Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):848.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To characterize longitudinal structural changes and extension rate of reticular drusen (RDR) area of in subjects with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) in the multicenter, prospective natural history Geographic Atrophy Progression (GAP)-study.
Three-field confocal scanning laser ophthalmoscopy fundus autofluorescence (FAF, exc = 488, em 500 - 800 nm, Heidelberg Retina Angiograph/Spectralis, Heidelberg Engineering, Germany) of 42 subjects with GA (mean age 75.9 years, range 60 - 90) were included. Two independent readers determined the presence, topographic distribution and pattern of RDR at baseline and at 18 months. Furthermore, the convex hull of the extent of RDR as the minimum polygon encompassing the entire area of RDR involvement in three-field FAF composite images was quantified. Bland-Altman statistics were used to assess intra- and inter-observer variability.
RDR were detectable in 25 (60%) subjects in at least one eye and on at least one visit. In 16 eyes of 10 subjects, RDR boundaries were clearly delineable both at baseline and at month 18. In this subset, RDR involvement was limited to the central 30° field in 5 eyes. The density (= number of individual RDR per involved retinal area) gradually declined with increasing eccentricity. Over time, RDR retinal area involvement and density increased. In some eyes, single RDR became coalescent in the center macula associated with a laminar, mottled decreased FAF signal. Quantitative analysis showed a mean average RDR extent of 51.29 mm² (95%-confidence interval [CI] 38.94 to 63.65) at baseline. The mean differences for intra-observer agreements were 1.83 mm2 (95%CI 0.36 to 3.31) for reader 1 and -1.16 mm2 (95%CI,-2.44 to 0.13) for reader 2 .The mean difference of inter-observer agreement was 0.34 mm2 (95% CI, -0.50 to 1.18). At month 18, a mean growth rate of 5.69 mm2/year (95%CI 2.20 to 9.19) was measured.
In-vivo cSLO imaging allows for both qualitative and quantitative mapping of dynamic changes of RDR areas within a relatively short time period. Continuous enlargement of the affected retinal area indicates progression of this phenotypic characteristic associated with GA in AMD. Systematic recordings of RDR progression appears warranted in future natural history and interventional studies in dry AMD. The functional impact and relevance as potential novel prognostic marker needs to be addressed in expanded observational studies using adequate imaging modalities.
This PDF is available to Subscribers Only