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Amitha Domalpally, Jeong W Pak, Elvira Agron, Traci E Clemons, Emily Y Chew; Reticular Pseudodrusen as a Risk Factor for Progression of Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2216.
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Reticular pseudodrusen (RPD) is a retinal feature visible in eyes with age-related macular degeneration (AMD). The purpose of this project is to determine the prevalence of RPD in eyes with various stages of AMD and assess the role of RPD as an independent risk factor for the development of late AMD.
The Age-Related Eye Disease Study 2 (AREDS2) was a 5-year multicenter study evaluating the efficiency of nutritional supplements on preventing progression to late AMD. Patients with intermediate AMD in one or both eyes were included in the study. Color photographs were evaluated at annual visits for drusen and pigment changes and AREDS AMD severity scale. Fundus autofluorescence images (FAF) from the AREDS2 ancillary study were evaluated in a subset of participants at a central reading center for the presence of RPD using well-defined criteria. Late AMD was defined as any geographic atrophy (GA) or neovascular AMD (NVAMD). Multivariate repeated measures logistic regression was used to assess the association of RPD with late AMD.
Autofluorescence images were evaluated for 5021 eyes of 2516 participants. RPD was seen in 1377(27.4%) of 839 participants (33.5%) with bilateral RPD in 64.4% of participants. Prevalence of RPD varied with AMD level: 13.1% in early AMD (n=388), 30.8% in intermediate AMD(n=3587), 33.4% in GA(n=284) and 16.4% in NVAMD (n=761). Mean age of participants with RPD was 75.2 years (SD 6.9) compared to 71.7 (7.9) in those without. RPD was also more frequent in females (65.1% vs 53.4%). Progression to late AMD over 5 years, assessed in 3921 eyes with early/intermediate AMD showed higher rates in eyes with RPD (39.1% vs 24.1%, p<0.0001). Odds ratio adjusted for baseline age, gender, race, educational status, smoking and AMD severity level was 1.63(95% CI 1.34,1.97, p < 0.0001) for GA and 0.88(95% CI 0.73,1.07, p = 0.213) for NVAMD.
Reticular pseudodrusen are seen in a third of patients with AMD and varies with AMD severity. Patients with RPD have an increased risk of progression to GA but not NVAMD. This study suggests that pseudodrusen are an important component of AMD and need to be included in classification systems used for patient prognosis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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