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Alisa Therese Thavikulwat, Tharindu de silva, Tiarnan D L Keenan, Catherine Cukras, Emily Chew; Optical coherence tomography of drusenoid pigment epithelial detachments in AREDS2. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1813.
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© ARVO (1962-2015); The Authors (2016-present)
Drusenoid pigment epithelial detachments (DPEDs) in age-related macular degeneration (AMD) are associated with increased risk of progression to geographic atrophy (GA). We analyzed DPEDs using spectral-domain optical coherence tomography (SD-OCT) to determine features influencing DPED progression in the Age-Related Eye Disease Study 2 (AREDS2) Ancillary SD-OCT (A2A) Study.
The A2A study prospectively performed SD-OCT (Bioptigen, Inc, Research Triangle Park, NC) on a subset of AREDS2 participants (4 sites) with intermediate AMD. Eyes with DPED on color fundus photography (CFP) were included in this analysis. Volumetric OCT scans were analyzed using OCT Explorer (Retinal Image Analysis Lab, Iowa Institute for Biomedical Imaging, Iowa City, IA). For each eye, the OCT scan on the first visit when DPED was present on CFP was reviewed to identify the B-scan with the longest retinal pigment epithelium elevation (RPEE). DPED length and height were measured in this reference area then followed longitudinally. The Duke Reading Center graded OCT hyperreflective foci.
Of 33 eligible eyes, 6 were excluded, 3 for DPED absence during A2A and 3 for having non-DPED pathology (fibrosis and epiretinal membrane) on multimodal imaging. Twenty-seven eyes of 21 participants (mean age 72.6±6.8 years) were included in this analysis. In 48 scans, RPEE was identified on OCT with a corresponding DPED absent grade on CFP. These DPED lengths were statistically significantly shorter than those on 33 scans when a DPED present grade had been given (mean length 1417±572 µm vs. 1850±796 µm, P=0.01).Of 26 eyes with follow-up, 15 (57.7%) had persistent DPEDs and 11 (42.3%) had DPED collapse over 4.1±1.1 years of follow-up. All eyes with collapse had focal hyperreflectivity over the DPED on the reference scan, compared to 73.3% (11/15) of eyes without collapse. During the last 2 visits prior to collapse, 6 (66.7%) of 9 eyes with ≥2 scans prior to collapse had decreased DPED length, compared to only 2 (13.3%) of 15 eyes with persistent DPEDs.Of 11 eyes with DPED collapse, 6 (54.5%) developed GA. All 4 eyes with reticular pseudodrusen (RPD) had collapse with GA. Half of the 4 eyes with neovascular AMD and collapse developed GA.
DPEDs defined on CFP may have additional information on OCT to predict progression. Hyperreflective loci, RPD, and decreasing DPED size may be risk factors for DPED collapse and GA development.
This is a 2020 ARVO Annual Meeting abstract.
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