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N. M. Pumariega, M. A. Sohrab, V. LeTien, M. Busuioc, R. T. Smith, E. H. Souied; Prospective Study of Reticular Pseudodrusen and Progression to Advanced Age-Related Macular Degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2010;51(13):4947.
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To determine the risk for progression conferred by reticular pseudodrusen in high risk fellow eyes of patients with AMD and unilateral choroidal neovascularization (CNV) in a large prospective study.
We studied images from 300 patients in the Nat2 Study, sponsored by B&L (Bausch and Lomb Inc, Montpellier, France), a 3-year prospective study of patients with unilateral CNV and large soft drusen in the fellow eye. The study eye was the fellow eye, at high risk for developing CNV. The patients were treated with a proprietary drug or placebo, and the primary endpoint was the development of CNV in the study eye. There were 5 visits per patient. Imaging at each visit consisted of color, red free, and blue light photography and fluorescein angiography. Complete data were available for 271 patients. We analyzed the images for the presence of reticular pseudodrusen, following progression throughout the 3-year study.
For the 271 patients who completed the full 3-year study, there was a significantly higher rate of subsequent CNV (38/89 or 43%) in eyes with reticular pseudodrusen at any visit compared to eyes without RMD (50/182 or 27%, p = 0.01, chi sq test). Serial imaging showed faded to absent findings in eyes that developed CNV. We did not examine for a possible effect of the proprietary drug on reticular disease.
To our knowledge, this is the first prospective study of reticular macular disease. It provides strong confirmation that reticular pseudodrusen, a disease entity with stereotypical presentations across imaging modalities, is associated with high risk of progression to advanced AMD, perhaps on an inflammatory basis. Regression of reticular pseudodrusen as CNV develops also could explain why reticular patterns may be absent when CNV is already present and why the significance of reticular pseudodrusen may be currently underestimated. Reticular pseudodrusen deserve wider recognition and consideration by clinicians caring for patients with macular disease.
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