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Jeannette J Yu, Elvira Agron, Catherine A Cukras, Traci E Clemons, Emily Y. Chew; Clinical Course and Outcomes of Drusenoid Pigment Epithelial Detachment in Age-Related Macular Degeneration in AREDS2. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5548.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the natural history of drusenoid pigment epithelial detachment (DPED) associated with age-related macular degeneration (AMD) in a retrospective longitudinal cohort study within a controlled randomized clinical trial of oral supplements for participants with at least intermediate AMD.
Participants with intermediate AMD in at least one eye (fellow eye had intermediate or late AMD) were enrolled in the Age-Related Eye Disease Study 2 (AREDS2). Baseline and annual comprehensive eye exams included best-corrected visual acuity (BCVA) and stereoscopic color fundus photographs. Fundus photographs were graded centrally with a standardized protocol by masked readers. DPED was defined as displacement of the retinal pigment epithelium away from Bruch’s membrane that is at least 350 um. The main outcome measures were progression to late AMD (central geographic atrophy [CGA] or neovascularization [NV]) and ≥ 15 letter loss in BCVA from DPED detection. Kaplan-Meier analyses (KM) and age- and sex-adjusted Cox proportional hazard regressions were performed.
Of the 4203 participants aged 50 to 85 years in AREDS2, 399 eyes of 333 participants had DPED without late AMD at time of DPED identification. 122 eyes (31%) had pre-existing DPED (prevalent) while 277 eyes (69%) developed DPED during the study (incident). For all participants with DPED, the mean (SD) age was 71.1 (7.1) years and 84% of eyes had BCVA of 20/40 or better at DPED detection. DPED significantly increased the likelihood of progression to late AMD (hazard ratio [HR]=2.65, 95% confidence interval [CI]=2.21-3.18, p<0.0001). This effect was greater for progression to CGA (HR=3.71, CI=2.89-4.76, p<0.0001) than NV (HR=1.99, CI=1.54-2.57, p<0.0001). Among incident eyes, CGA developed an average of 2.6 (1.1) years after DPED detection, compared to 2.1 (1.2) years for NV. The presence of DPED significantly increased the likelihood of losing ≥ 15 letters of BCVA from DPED detection (HR=2.73, CI=2.14-3.48, p<0.0001).
In eyes already with intermediate AMD, DPED conferred an additional hazard of vision loss and progression to late disease, particularly to CGA. These results reinforce the role of DPED as an independent risk factor for late AMD.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
KM of the cumulative percentage of eyes with DPED progressing to late AMD
KM of the cumulative percentage of eyes with DPED losing ≥ 15 letters of BCVA
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