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Anita Zenger, Marie B. Rougier, III, Paulo E. Stanga, Steffen Schmitz-Valckenberg, Lukas Reznicek, Ute E. Wolf-Schnurrbusch; Evaluation of Peripheral Fundusautofluorescence Changes in Patients with Wet ARMD: The OTELLO Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6534.
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To evaluate peripheral morphological changes in patients with wet Age-Related Macular Degeneration (ARMD) in a multicenter setting.
Patients older than 50 years with clear optical media and choroidal neovascularisation (CNV) due to wet ARMD from 5 centers (Bordeaux, Manchester, Munich, Bonn, Bern) were enrolled in the retrospective OTELLO Study (OpTos wEt age-reLated macular degeneration). Undilated wide-angle two wavelength colour images and fundus autofluorescence (FAF) images were taken with the Optos P200CAF ultra-wide angle laser scanning ophthalmoscope. The presence and distribution of hard and/or soft drusen, hemorrhages, and pigment epithelial changes were analyzed using the color images. The presence and/or absence of hypo- or hyperfluorescence were evaluated using the FAF images. The macular zone (MZ) and the mid periphery (MP) and the far periphery (FP) were graded using an adjusted grid. The demographic data and the fluorescein angiography (FA) based diagnosis before first Anti VEGF treatment was noted.
In total 50 patients (mean age 80±8 years, range 54-92 years) were included into the study. In the color fundus images hard drusen were found in the MZ in 44% of patients, in the MP in 50%, and in the FP in 20% of patients. Soft drusen were found in 60% in the MZ, in 42% in the MP, and in 68% in the FP. Hemorrhages in association to the wet ARMD changes were noted in 9/50 eyes in the MZ, 5/50 eyes in the MP and never in the FP. In the FAF we observed in 78% of eyes hyperfluorescent areas in the MZ, in 70% of eyes in the MP, and in 14% of eyes in the FP. Hypofluorescent changes were noted in 72% of eyes in the MZ, in 74% of eyes and in only 8% of eyes in the FP. Patients with PED showed only in few cases (3%) peripheral changes. Most changes in the MP and the FP were found in patients with classic CNV (55%) and occult CNV (43%).
Our study demonstrates that imaging with an Optos P200CAF allows to analyze peripheral morphologic features in patients with AMD. The most prominent feature in color images are soft drusen visible equally distributed in the posterior pole and the periphery. In FAF images most abnormalities were found in the macular zone and the mid periphery, whereas in the far periphery only a few abnormalities were observed. Wide field imaging could improve our knowledge on peripheral changes patients with AMD.
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