No abstract

Purpose To determine whether reticular pseudodrusen (RPD) confer an increased risk of progression to late-stage age-related macular degeneration (AMD) in fellow eyes of those recently diagnosed with unilateral choroidal neovascularization (CNV). Design Retrospective study Participants 200 consecutive participants with CNV secondary to AMD in one eye and no signs of late stage AMD in the fellow eye. Methods Clinical examination and comprehensive retinal imaging including spectral-domain optical coherence tomography (SD-OCT), near-infrared reflectance (NIR), and colour fundus photography at baseline and every follow-up visit. Main Outcome Measures Incidence of geographic atrophy (GA) and CNV in the fellow eye. Results Mean age was 77 (±7) years, and 61% of the cohort were female. 116 (58%) had RPD, 68% had drusen ≥125 μm, 36% pigmentary changes, 10% had both drusen ≥125 μm and pigmentary changes, and 17% had only RPD in their fellow eyes. After a mean follow-up of 2.3 years, 36% developed CNV and 14% GA. Those with RPD developed late-stage AMD more often (61% versus 33.4%, p<0.001), and more often GA (22.4% with RPD versus 2.4% without RPD, p<0.001). RPD was an independent risk factor for the development of GA (hazard ratio (HR) 4.93; p=0.042), but not for CNV (HR 1.19; p=0.500), at least within the follow-up of this study. Both drusen ≥125μm and pigmentary changes at baseline were a significant risk factor for the development of CNV and GA (HR 1.96 – 11.73; p ≤ 0.020). Conclusions RPD appear to confer an increased risk of progression to GA, additive to drusen and pigmentary changes. The presence of RPD needs to be taken into account when discussing a patient's prognosis and planning management.

Fundus autofluorescence imaging revealed that areas of nGA were most commonly characterized by both hyper- and hypoautofluorescent changes, which differs from areas of drusen-associated atrophy that most often appeared hypoautofluorescent. These findings provide important insights into the FAF characteristics of areas undergoing atrophic changes in eyes still considered to be in the early stages of AMD by current methods, and thus assist in the characterization of disease severity in these early stages.