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Jeong W Pak, Kyle McDaniel, Emily Chew, Amitha Domalpally; Quantitative Multimodal Imaging of Reticular Pseudodrusen in Age-related Macular Degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2020;61(7):1836.
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© ARVO (1962-2015); The Authors (2016-present)
Reticular pseudodrusen (RPD) presents high risk of progression to late AMD, particularly geographic atrophy. Detailed features of RPD such as distribution and area have been less studied. The purpose of this study is to characterize and compare RPD features from multimodal imaging.
The Age-Related Eye Disease Study 2 (AREDS2) is a multicenter study evaluating the efficiency of nutritional supplements on preventing progression to late AMD. Participants with the 10-year visit have infrared (IR), autofluorescence (AF) and OCT images. Eyes with RPD identified on the AF were included in this analysis. OCT was used as a complementary image to confirm RPD presence. RPD evaluation included location within the grid, distribution, foveal and peripapillary involvement and pattern. The RPD area was measured using planimetry independently on IR and AF.
RPD was identified in 363 eyes (28.9 %) with AF in the AREDS2 10-year visit population. Mean RPD area was significantly different between IR (20.86 mm2 ±14.25) and AF (15.76 mm2 ±11.91, p<0.0001). The mean difference of RPD area between IR and AF was 5.1 mm2 (95% confidence limits -6.7, 16.9, p<0.0001). When compared by AMD stages, the mean RPD area with IR for early AMD (n=10) was 26.43 mm2 ±14.59, and for intermediate AMD (n=100) 21.64 mm2 ±15.11, for geographic atrophy (n=157) 22.37 mm2 ±14.57 and for neovascular AMD (n=96) 17.07 mm2 ±12.19; p=0.015. With AF, the mean RPD area in the 4 groups was 17.73 mm2 ±9.98, 16.37 mm2 ±12.57, 16.42 mm2 ±12.79, 13.88 mm2 ±9.60; p=0.333, respectively. Foveal involvement of RPD was seen in 28.2% with IR and 1.6% with AF. RPD distribution was 97.3% superiorly, 74.5% temporally, 71.5% inferiorly, 64.1% nasally with IR, while 83.6%, 41.4%, 35.1%, 26.9% with AF, respectively. Peripapillary presence of RPD was detected 70.4% with IR and 43.3% with AF. On IR, RPD was present mostly both within and outside grid (67.1%). RPD within grid was 15.1% and RPD outside only was 17.8%. Dot pattern was seen in 27.1%; ribbon pattern in 57.8% and mixed in 15.1%.
Multimodal evaluation of RPD demonstrates improved visualization of RPD from IR imaging. The RPD area can be measured from both IR and AF but is not interchangeable. RPD area does not seem to change significantly based on AMD status. Longitudinal assessment is needed to understand the significance of distribution and pattern in disease progression.
This is a 2020 ARVO Annual Meeting abstract.
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