Abstract
Purpose :
To describe the ultrastructure of subretinal drusenoid deposits (SDD) during progression and regression over 3 years in patients with age-related macular degeneration (AMD); to observe the photoreceptors surrounding SDD, using multimodal imaging including a research adaptive optics scanning laser ophthalmoscope (AOSLO).
Methods :
Six eyes of 4 patients with intermediate AMD (grade 5-8 on the AREDS 9-step scale for color fundus photography) were studied 4 times over 3.5 years. No eyes progressed to advanced AMD in this period. Participants underwent infrared reflectance (IR), spectral domain coherence tomography (SD-OCT), and AOSLO with a new-generation research instrument. SDD presence and progression were assessed by multimodal imaging and a 3-stage SD-OCT-based grading system. To evaluate change over time, shapes and ultrastructure of individual SDD lesions identified at baseline were examined by AOSLO. Photoreceptors surrounding SDD were assessed in AOSLO and SD-OCT.
Results :
SDD progression was followed by a combination of IR reflectance, AOSLO, and SDOCT. En face imaging revealed an inward spread of SDD towards the fovea over 3.5 years. Stage 3 SDD are typically circular yet we observed stage 3 lesions that were lumpy or bi-lobed, with some changing their shape (Figure 1). A return of characteristic photoreceptor reflectivity in AOSLO (punctate) and in SD-OCT (prominent ellipsoid zone) was observed after regression of some SDD in some individuals.
Conclusions :
The dynamism of SDD ultrastructure disclosed by high-resolution AOSLO imaging provides deep insight into the lesion impact on surrounding photoreceptor structure over several years. Whether a return of reflectivity after lesion regression implies a true rejuvenation of photoreceptors is an important question under intensive ongoing investigation.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.