Reticular Pseudodrusen and Relationship to AMD in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2), an ancillary study of the Women’s Health Initiative

Abstract

Purpose : Reticular pseudodrusen (RPD) are most often seen in the setting of age-related macular degeneration (AMD), and are an independent risk factor in the progression to geographic atrophy (GA). However, RPD characteristics are poorly defined in natural history studies. We aim to determine the prevalence of RPD in CAREDS2 participants and assess associations with demographics, AMD status, and visual acuity. The secondary aims include describing the morphological features of RPD in the CAREDS2 participants.

Methods : Multimodal imaging included spectral domain optical coherence tomography (SD OCT, Heidelberg Engineering, Heidelberg, Germany) and infrared reflectance (IR) to identify RPD characteristics, such as presence, location (within or outside the ETDRS grid and quadrant/s), peripapillary presence, pattern, and RPD area. AMD features were also recorded from SD OCT, IR and color photographs, such as the presence of late AMD, nascent GA, large drusen (>125 µm), and hyperreflective foci. Lastly, the presence of RPD was assessed on color fundus photography.

Results : In 927 eyes from 466 female participants (age 69 to 98), RPD were present in 130 eyes (15% of eyes, 16% of participants). There was increasing prevalence with age; 7% in participants aged < 78 years, 14% in 78-83 years, and 30% in > 83 years. The mean visual acuity (letters read) was 76.8 among RPD participants with RPD and 81.6 in participants without RPD (P = 0.001). Of 130 eyes with RPD, 81 eyes (62%) had coexisting AMD, including late AMD (13%), large drusen (54%), hyperreflective foci (20%) and nascent GA (3%). In 229 eyes with no evidence of AMD, 81 eyes (35%) contained RPD. RPD were most commonly observed with a ribbon morphology (53%) and were located both within and outside the ETDRS grid (65%) with a distribution involving more than one quadrant (44%). The mean area of RPD was 17.4 (SD, 14.7) mm². RPD were visualized with color fundus photography in 37 eyes (4% of eyes, 28% of eyes with RPD visualized on SD OCT/IR).

Conclusions : The prevalence of RPD increases with age and is associated with AMD and reduced visual acuity. RPD can be seen independently of AMD and may represent an earlier disease state. Multimodal imaging with SD OCT and IR has significantly greater sensitivity for visualizing RPD than color fundus photography.

This is a 2020 ARVO Annual Meeting abstract.