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C. A. Cukras, E. Agrón, M. L. Klein, F. L. Ferris, III, E. Y. Chew, G. Gensler, W. T. Wong, Age-Related Eye Disease Study Research Group; Drusenoid Pigment Epithelial Detachment as an Added Risk Factor for Disease Advancement in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):96.
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To evaluate the contribution of drusenoid pigment epithelial detachments (DPED), a macular lesion associated with age-related macular degeneration (AMD), to the risk of AMD progression.
From the 4757 participants enrolled in the clinic-based prospective cohort Age-Related Eye Disease Study (AREDS), 255 participants, designated the DPED group, were identified as having DPED in at least one eye with 5 or more years of follow-up after the initial detection of the DPED. The 3679 participants without DPED served as a control population. Annual standardized and reading-center graded photographs were used to follow the development of advanced AMD. Eyes without advanced AMD but with intermediate AMD and DPEDs were compared with control eyes lacking DPED but containing large drusen with or without hyperpigmentary changes. Participants in the DPED and comparison groups were also categorized using a simplified 4-point clinical risk "person" scale based upon presence of large drusen and/or hypo/hyperpigmentary changes (AREDS Report #18), and inter-group comparisons were assessed.
Among eyes with DPED at study baseline (n=282), 42% progressed to advanced AMD by 5 years. Control eyes with intermediate AMD but lacking DPEDs (n=2163 for large drusen and n=1122 for large drusen and hyperpigmentary changes) had significantly lower progression rates (18% of eyes with large drusen, 25% of eyes with both large drusen and hyperpigmentary changes). Among participants without advanced AMD in either eye, but with the highest risk score on the simplified scale (score 4), 50% of those in the DPED group (n=115) recorded a new progression event over 5 years compared with 39% for those in the control group lacking DPEDs (n=226).
After matching for known fundus risk factors, the presence of DPED remains an independent risk factor for progression to advanced AMD. The occurrence of a DPED as a macular lesion confers an increased risk of disease progression in addition to previous identified risk factors (presence of large drusen, pigmentary changes, history of advanced AMD in fellow eye) and may be employed as a prognostic factor in AMD progression.
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