Peripheral Retinal Changes in Elderly Subjects: the Alienor Study

Abstract

 

Purpose:

 

Peripheral disease resembling age related macular degeneration (AMD), such as drusen, pigmentary changes and atrophy might be important in patients’ quality of life, as they mainly rely on non-central vision for navigation. Using new developments in wide-field imaging permits the study of peripheral retina. Understanding the role of peripheral changes in relation to normal and pathological aging can influence our ability to treat AMD patients more appropriately.

 

Methods:

 

The ALIENOR (Antioxydants, LIpides Essentiels, Nutrition and maladies OculaiRes) Study is a population-based epidemiological study on nutrition and age-related eye diseases. In 2009-2010, 538 residents of Bordeaux (France), aged 75 years or more had an eye examination, including ultra wide field (200°) colour and autofluorescence (AF) images using Optos P200C AF ultra-wide angle laser scanning ophthalmoscope (UW-SLO). Images were subsequently graded at Moorfields Eye Hospital Reading Centre. Peripheral and central changes were graded using a standardised grid developed for this imaging modality. Presence or absence of hard and soft drusen, retinal pigment epithelial (RPE) changes, atrophy or choroidal neovascularisation (CNV) was graded on colour and AF images for the macula and the periphery.

 

Results:

 

All but 11 patients had gradable images. Features normally associated with AMD were found in 278 patients (52.8%). Peripheral only drusen was found in 33.4% of the participants, while 14.4% had drusen in the centre and the periphery. Macula only drusen was found in 21 eyes. The 35 eyes with geographic atrophy in the macula all had abnormal periphery. CNV was found in 12 eyes of 9 patients. No patient with end-stage disease in the macula had normal periphery. There was no AMD like CNV or PED in the periphery.

 

Conclusions:

 

Phenotyping peripheral changes on Optos P200C AF UW-SLO confirmed that there are wide ranging pathological changes in the periphery even in those with no central disease. The predictive values for these peripheral pathological changes are yet to be determined.

 

Keywords: retina • imaging/image analysis: clinical • clinical (human) or epidemiologic studies: systems/equipment/techniques