Abstract
Purpose :
With the widespread availability of ultrawide field (UWF) imaging, peripheral retinal abnormalities in AMD have garnered attention. However, longitudinal studies on AMD related peripheral findings are limited. This study aims to characterize and quantify the changes in AMD related peripheral retinal features over five years, providing new insights into the longitudinal progression of AMD.
Methods :
The OPERA study is an ancillary study of the Age-Related Eye Disease Study 2 (AREDS2). A subset of OPERA participants with Optos color (UWF-C) imaging at year 5 (Y5) and year 10 (Y10) were included in this analysis. Macular and peripheral AMD features were quantified using the Opera grid with 3 concentric circles: zone 1 representing posterior pole, zone 2 mid periphery and zone 3 far periphery. AMD severity scale (AMDSS) was graded using the ETDRS grid.
Results :
Among participants enrolled in the OPERA study, 118 (227 eyes) have UWF-C available at both timepoints (Y5 and Y10). Of these, 0% ,0.9%, and 46.7% were ungradable in zones 1, 2, and 3 respectively.
In zone 1 at Y5, AMDSS was ≤5 in 7.4%, 6-8 in 44.0%, non-central geographic atrophy (GA) in 8.8%, central GA in 4.0%, and neovascular (NV) AMD in 35.7%.
In zone 2, peripheral AMD abnormalities in Y5 versus Y10 included: drusen 98.4% vs. 98.9%, hyperpigmentation 12.1% vs. 13.0%, and hypopigmentation 4.5% vs. 7.0% respectively.
Peripheral degenerations were present in Y5 versus Y10: cobblestone 19.4% vs. 28.5%, and reticular pigmentary changes 23.0% vs. 30.2% respectively.
Among 117 eyes at risk of progression to late AMD at Y10, 33.3% progressed to late AMD.
Among eyes with intermediate AMD (AMDSS 6-8), progression to late AMD occurred in 41.4% without significant peripheral findings at Y5, and 35.2% with such findings, which include drusen of 3 disc area or larger and any hypo or hyperpigmentation in zones 2 or 3.
Conclusions :
The OPERA study reveals that AMD features often extend beyond the macula, which suggests that AMD is a pan-retinal disease. The study suggests that peripheral findings might not significantly influence the progression to late AMD, but more research is required to validate these initial results.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.