An evaluation of fundus photography and fundus autofluorescence in the diagnosis of cuticular drusen

Høeg, Tracy Beth; Moldow, Birgitte; Klein, Ronald; Cour, Morten la; Klemp, Kristian; Erngaard, Ditte; Ellervik, Christina; Buch, Helena

doi:10.1136/bjophthalmol-2015-307197

“…After removing duplicates, the updated search in October 2016 yielded 380 new references. Eighteen references were retrieved for screening on full text, [77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94] of which four met the criteria for inclusion in the systematic review. 79,80,82,91 The four new references reported four unique studies.…”

Section: Results Of the Review Updatementioning

confidence: 99%

Fundus autofluorescence imaging: systematic review of test accuracy for the diagnosis and monitoring of retinal conditions

Frampton

¹

,

Kalita

²

,

Payne

³

et al. 2017

Eye

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We conducted a systematic review of the accuracy of fundus autofluorescence (FAF) imaging for diagnosing and monitoring retinal conditions. Searches in November 2014 identified English language references. Sources included MEDLINE, EMBASE, the Cochrane Library, Web of Science, and MEDION databases; reference lists of retrieved studies; and internet pages of relevant organisations, meetings, and trial registries. For inclusion, studies had to report FAF imaging accuracy quantitatively. Studies were critically appraised using QUADAS risk of bias criteria. Two reviewers conducted all review steps. From 2240 unique references identified, eight primary research studies met the inclusion criteria. These investigated diagnostic accuracy of FAF imaging for choroidal neovascularisation (one study), reticular pseudodrusen (three studies), cystoid macular oedema (two studies), and diabetic macular oedema (two studies). Diagnostic sensitivity of FAF imaging ranged from 32 to 100% and specificity from 34 to 100%. However, owing to methodological limitations, including high and/or unclear risks of bias, none of these studies provides conclusive evidence of the diagnostic accuracy of FAF imaging. Study heterogeneity precluded meta-analysis. In most studies, the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported whether FAF images were interpreted consistently. No studies of monitoring accuracy were identified. An update in October 2016, based on MEDLINE and internet searches, identified four new studies but did not alter our conclusions. Robust quantitative evidence on the accuracy of FAF imaging and how FAF images are interpreted is lacking. We provide recommendations to address this.

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“…6 , 7 , 13 Patients with a confirmed diagnosis of cuticular drusen were five times more likely to be female. 14 The female preponderance in the cuticular subgroup seems to be peculiar considering the absence of gender difference both in early and late AMD found in large cohort studies. 15 , 16 …”

Section: Clinical Aspects Of Cuticular Drusenmentioning

confidence: 99%

“…6,7,13 Patients with a confirmed diagnosis of cuticular drusen were five times more likely to be female. 14 The female preponderance in the cuticular subgroup seems to be peculiar considering the absence of gender difference both in early and late AMD found in large cohort studies. 15,16 Genetic risk factors have been poorly investigated, but a strong association with single nucleotide polymorphism on the CFH gene (p.Tyr402His) has been reported in patients with the cuticular phenotype of drusen.…”

Section: Clinical Aspects Of Cuticular Drusen Demographic Characteristics and Genetic Factorsmentioning

confidence: 99%

“…Consequently, cuticular drusen have been correctly identified as present in 62% of cases and not present in 100% of cases. 14 In this regard, the use of a long-wavelength excitation (530–580 nm) can potentially minimize autofluorescence from the lens and increase the ability to detect heterogeneity in foveal autofluorescence due to RP/E alterations. 29 …”

Section: Multimodal Characterization Of Cuticular Drusenmentioning

confidence: 99%

“…Consequently, cuticular drusen have been correctly identified as present in 62% of cases and not present in 100% of cases. 14 In this regard, the use of a long-wavelength excitation (530-580 nm) can potentially minimize autofluorescence from the lens and increase the ability to detect heterogeneity in foveal autofluorescence due to RP/E alterations. 29 Confocal scanning laser ophthalmoscopy (cSLO) with real-time tracking improves the visualization of drusencontaining regions allowing an integrated approach with OCT b-scan.…”

Section: Fundus Autofluorescencementioning

confidence: 99%

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Clinical Manifestations of Cuticular Drusen: Current Perspectives

Fragiotta¹,

Fernández-Avellaneda²,

Breazzano³

et al. 2021

OPTH

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Cuticular drusen are part of the spectrum of age-related macular degeneration (AMD) with particular clinical and multimodal imaging characteristics. This drusen subpopulation shares several high-risk single nucleotide polymorphisms with AMD. Despite this feature, they can manifest at a relatively young age, presenting with a female preponderance. Multimodal imaging is essential for characterizing such lesions, using a combination of color fundus photographs, optical coherence tomography (OCT), fluorescein angiography (FA), and fundus autofluorescence (FAF). The classic starry-sky pattern visible on FA and the typical central hypoautofluorescent lesion with hyperautofluorescent rim on FAF is considered the result of a central retinal pigment epithelium (RPE) erosion from these triangular elevations of the RPE-basal lamina. This finding may also be responsible for the typical choroidal hypertransmission appreciated through OCT. The clinical course of cuticular drusen may be relatively benign at early stages, with small drusen presenting at a young age. However, the presence of clinical phenotypes characterized by diffuse involvement and/or accompanying large drusen in patients older than 60 years may confer a significant risk for either macular neovascularization or geographic atrophy.

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