Abstract
Purpose :
Drusenoid pigment epithelial detachment (DPED) is a known AMD feature conferring high risk of progression to advanced disease. Spectral domain optical coherence tomography (SD-OCT) allows for 3D analysis of changes in retinal lesions. In this study, we examined longitudinal transformations of DPEDs in patients with AMD.
Methods :
Patients enrolled in a longitudinal study of dark adaptation (NCT01352975) with a range of AMD severities from no AMD to advanced atrophic disease were imaged annually with SD-OCT. DPEDs were identified by segmenting the retinal pigment epithelium (RPE) and Bruch’s membrane (BM) layers and imposing an RPE-BM thickness requirement of at least 75 µm, with diameter at least 433 µm. Utilizing plots of RPE-BM thickness in the identified DPED region, we quantified spatially localized drusen thickness and size changes for eyes with follow-ups (>=2 years). For each visit, we analyzed changes in total DPED volume and in local RPE-BM thickness. Grading of SD-OCTs was performed by the Wisconsin Reading Center, including identification of incomplete and complete RPE and outer retinal atrophy (iRORA and cRORA) and hyperreflective loci (HRF).
Results :
The study population comprised 21 eyes (aged 76.7±6.1 years) from 15 participants with DPED lesions (mean follow-up time 3.43±1.05 (µ±σ), range 2-6 years). Of these, 17 eyes had HRF. During follow-up, 7 eyes developed iRORA and 3 out of these 7 developed cRORA. Total DPED volume varied widely between eyes and, in individual eyes, over time, with mean volume of 0.16±0.18 (µ±σ) mm3. Of the 7 eyes only 4 had a reduction in total DPED volume during iRORA development. However, analysis of local RPE-BM height changes demonstrated that regions of RPE-BM regression were present in all the eyes that developed iRORA.
Conclusions :
In AMD, DPED lesions are highly dynamic, with localized areas of both increasing and regressing RPE-BM thicknesses which occur simultaneously and/or longitudinally. Monitoring local spatial changes in RPE elevation highlights eyes at high risk of developing atrophy (identified by iRORA). Identifying patients with DPED and longitudinally tracking lesion regressions spatially in the macula could help to identify features that confer high risk of progression to advanced disease, and potentially make them candidates for future clinical trials.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.