Reticular Drusen as a Baseline Risk Factor for Progression to Advanced AMD in AREDS

Abstract

Abstract: : Purpose: To assess the clinical course of eyes with reticular drusen at baseline in the Age–Related Eye Diseases Study (AREDS). Methods: Reticular drusen have historically been considered a risk factor for progression to advanced AMD. We compared progression rates between eyes with and without this finding in eyes at high–risk for progression to advanced AMD (within steps 6–9 of the AREDS AMD scale – generally eyes with large drusen, with and without pigment changes). In addition, we identified 24 such eyes from two of the 11 AREDS clinics and specifically reviewed all available photographs from these eyes for the presence and extent of ordinary drusen, calcified drusen, pigment abnormalities, and for location and persistence of reticular drusen, looking for trends in phenotypic progression. Results: Among the 1223 eyes in AREDS with grades of levels 6–9 at baseline and having 5 years follow–up, 86 (7%) had definite reticular drusen. Among these 86 eyes, 43 (50%) progressed to advanced AMD, 29% to neoAMD and 36% to GA (15% had both). In the comparison group of 1137 eyes in levels 6–9 without reticular drusen, 551 (45%) progressed, 27% to neoAMD and 27% to GA (9% had both). Conclusions: In eyes with large drusen and pigment changes, those with reticular drusen had a minimally higher rate of progression to advanced AMD, chiefly due to possibly higher incidence of GA. No unique findings related to progression were found in this review of cases.

Keywords: age-related macular degeneration • drusen • retina