COMMENTARY

Reticular Pseudodrusen and AMD

Saranya C. Balasubramaniam, MD; Sophie J. Bakri, MD

Disclosures

December 26, 2014

Reticular Pseudodrusen: A Risk Factor for Geographic Atrophy in Fellow Eyes of Individuals With Unilateral Choroidal Neovascularization

Finger RP, Wu Z, Luu CD, et al
Ophthalmology. 2014;121:1252-1256

Study Summary

Reticular pseudodrusen (RPD) are small, gray deposits located above the retinal pigment epithelium. In recent years, RPD have been recognized as a risk factor for the development of late-stage age-related macular degeneration (AMD). The Age-Related Eye Disease Study (AREDS)[1] shed light on other risk factors for the development of late-stage AMD. These included the presence of drusen 125 µ in size or larger, pigmentary changes, and late-stage disease in the fellow eye.

Spectral domain optical coherence tomography (SD-OCT) and near-infrared reflectance (NIR) can detect RPD with great sensitivity. This retrospective study was the first to use SD-OCT and NIR with the aim of determining the relationship between RPD and the development of late-stage AMD. Previous studies did not use this imaging and, thus, could have missed the presence of RPD.

This study looked at 200 eyes with unilateral choroidal neovascularization (CNV) to determine whether RPD was an independent risk factor for progression to late-stage AMD (geographic atrophy or CNV) in fellow eyes. For eyes with unilateral CNV, progression to late-stage AMD in fellow eyes has been reported to be 11%-12% at 1-2 years, 21% at 3 years, and 27% at 4 years. This study found that the overall progression to late-stage AMD in patients with RPD was 61% over 2.5 years. This is significantly higher than the rates of progression reported for patients without RPD. Furthermore, they found that the risk conferred by RPD may exacerbate existing risk in patients with large drusen or pigmentary changes.

Viewpoint

Through the use of SD-OCT and NIR, this study provides evidence that RPD act as an independent risk factor for the development of geographic atrophy in the fellow eye of patients with unilateral CNV. Furthermore, in patients who already have such high risk features as large drusen or pigmentary changes, RPD may exacerbate the risk of progressing to CNV and geographic atrophy. In patients already at high risk for progression to late-stage AMD in their fellow eyes owing to large drusen, pigmentary changes, or unilateral CNV, the presence of RPD should also factor into determining a patient's prognosis for developing late-stage disease in the fellow eye.

Abstract

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