Abstract
Abstract: :
Purpose:To identify possible reasons for loss of visual acuity (> 15 letters or 3 lines) NOT attributable to the development of late AMD in the untreated eyes of patients in the Complications of AMD Prevention Trial (CAPT). Methods:Untreated eyes with 3 or more lines of visual acuity loss at one or more visits and no choroidal neovascularization (CNV), serous detachment of the pigment epithelium (S–PED), or geographic atrophy (GA) (defined as an endpoint criteria––within 3000µ of the foveal center and > 1 MPS Disc Area) or cataract were identified from 1052 eyes with bilateral large drusen (>10 drusen at least 125µ size) in the CAPT preventative laser treatment trial. Color stereo photographs and fluorescein angiograms from the baseline visit and the first visit with visual acuity loss were assessed. Sequential visits were examined when eyes had gradual or transient VA loss. Changes in fundus features observed within 500µ of the foveal center which could possibly account for the vision loss were noted. Results:72 eyes were identified: 10 eyes (14%) with a > 6 line loss; 62 eyes (86%) with a 3–5 line loss. 13 eyes (18%) had a transient loss. In eyes with > 6 line loss, macular hole (3), new GA (2), CRVO (1), vitreous hemorrhage (1), and drusen remodeling (1) were noted in 8 of the 10 eyes. Two eyes had unexplained > 6 line vision loss. In eyes with 3–5 lines of vision loss, the most frequent features were drusen remodeling (45%) and pigmentary changes(26%). New areas of GA involving the central macula (16%), but not meeting endpoint criteria, and epiretinal membrane (3%) were also observed. In 10% of the eyes, no fundus changes from baseline were observed which could explain the change in vision. Conclusions:Among patients with bilateral large drusen, drusen remodeling and pigmentary changes in the central macula are the most common features observed in the untreated eyes in CAPT with vision loss of > 3 lines in the absence of CNV, S–PED or GA.
Keywords: age–related macular degeneration • drusen • clinical (human) or epidemiologic studies: natural history