Clinical Features and Natural Course of Drusenoid Pigment Epithelial Detachments in Age–related Macular Degeneration

Abstract

Abstract: : Purpose: To describe the clinical features, natural course, and visual outcomes for drusenoid pigment epithelial detachments (PED) in eyes with age–related macular degeneration (AMD). Methods: In the Age–Related Eye Disease Study (AREDS), there were 103 eyes of 94 individuals with drusenoid PED present at baseline. Drusenoid PED was defined as an elevated mound of large drusen or many confluent drusen with well–defined borders, pale yellow to white color, with a minimum diameter of 360 microns. Among the 85 individuals with unilateral drusenoid PED, 6 eyes (7%) were excluded from the analysis due to the presence of late AMD or a confounding ocular lesion. Of the remaining 79 unilateral cases, 8 (9%) had late AMD in their fellow eye. None of the 9 individuals with bilateral drusenoid PED had late AMD in either eye at baseline. Patients were followed prospectively for a median period of 8.5 years (range: 1.5 – 10.5 years). Eye examinations, including best–corrected visual acuity, retinal evaluation, and fundus photography, were performed at yearly intervals. Outcome rates of incidence of any late AMD, neovascular AMD, central geographic atrophy, and vision loss of 15 letters or more from baseline were evaluated for 79 unilateral cases and the 9 bilateral cases. Participants with bilateral drusenoid PED were evaluated for first outcome across both eyes. Results: Fifty–five individuals (63%) with drusenoid PED developed late AMD (neovascular AMD only = 12 (14%); central geographic atrophic atrophy only = 29 (33%); neovascular AMD and central geographic atrophic atrophy = 14 (16%). Fifty seven individuals (65%) developed vision loss of 15 or more letters (3 lines). Conclusion: Eyes with drusenoid PED have a high likelihood of progressing to advanced AMD, with the majority progressing to central geogrphic atrophy.

Keywords: age–related macular degeneration • drusen • clinical (human) or epidemiologic studies: prevalence/incidence