Examining peripheral drusen in AMD patients through ultra-wide field pseudocolor imaging

Abstract

Purpose : Age-related macular degeneration (AMD) is a leading cause of blindness that has been associated with peripheral drusen on ultra-wide field (UWF) imaging. We investigated the prevalence and types of peripheral drusen present in retinal patients diagnosed with AMD, to better understand their link to AMD stage.

Methods : We performed a retrospective, observational clinical study. UWF pseudocolor fundus (Optos P200DTx) and Spectral-Domain Optical Coherence Tomography (SD-OCT) images were collated from the eyes of consecutive retinal patients at Shiley Eye Institute, UCSD between 1^st January and 29^th December 2021. The demographic data for each patient was recorded and UWF images with unobstructed views of >60% of each quadrant and visibility of fourth-order arterioles were retained for analysis. A masked retinal specialist determined the stage of AMD for patients by examining SD-OCT scans. The retinal specialist recorded the type of peripheral drusen observed in UWF images (Figure 1). Differences between cohorts were evaluated using T-tests and generalized linear mixed-effects models to account for both eyes of patients. Fisher’s Exact Test was used to evaluate relationships for categorical variables. Statistical analysis was performed using R software. P-values ≤ 0.05 were considered significant.

Results : A total of 481 eyes (284 subjects) were included in the study after quality control (mean age 73.2±1.3years, 64.1% female). A total of 285 eyes (59.3%) were diagnosed with AMD, of which 45 (9.4%), 144 (29.9%), and 95 (19.8%) eyes were staged to be early, intermediate, and late-stage AMD. Peripheral drusen were noted in 315 eyes (65.5%). Hard drusen was most commonly seen (243 eyes, 50.5%), followed by mixed drusen (39 eyes, 8.1%) and cuticular drusen (31 eyes, 6.4%). Intermediate stage AMD was associated with peripheral drusen (P=0.018), most significantly hard drusen (P=0.022). Patients without an AMD diagnosis were also associated with peripheral drusen (P=0.041), with a significant presence of hard drusen (P=0.023).

Conclusions : Peripheral drusen, most commonly hard drusen, was seen in retinal patients including those without AMD. Our study did not find an increased association with stage of AMD, indicating that other factors than those causing macular disease may affect the development of peripheral drusen. This data is useful to add to the literature of peripheral drusen in AMD.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.