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Reticular pseudodrusen and the 5 year risk of progression for late AMD- a multimodal imaging approach

Session Details

Session Title: Quick Fire Free Paper 3

Session Date/Time: Thursday 11/09/2014 | 14:30-16:00

Paper Time: 14:50

Venue: Boulevard D

First Author: : J.Quadrado Gil PORTUGAL

Co Author(s): :    J. Marques   I. Lains   M. Costa   S. Nunes   M. Cachulo   R. Silva

Abstract Details

Purpose:

To determine whether reticular pseudodrusen (RPD) confer a long-term increased risk of progression to late age-related macular degeneration (AMD) in the second eye of patients with unilateral wet AMD

Setting:

Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Portugal. Associação para a Investigação Biomédica e Inovação em Luz e Imagem, Coimbra, Portugal.

Methods:

Retrospective, observational, institutional study. Patients with wet AMD in one eye were included for evaluation of the risk of progression to late AMD in the second eye (study eye). A minimum follow-up of 5 years was required, unless progression to exudative AMD occurred first. Baseline images were analyzed, including fundus color photography (FCP), fundus auto-fluorescence (FAF), infra-red (IR) and red-free (RF) images. The images were graded using an innovative software (RetmarkerAMD®) Presence of RPD was considered when visible in at least one image mode. Baseline RPD profile and its impact in long-term AMD progression was evaluated.

Results:

63 patients (37 female) were included; with a mean age of 76.19 ± 6.63 years and mean follow-up of 66.03 ± 20.95 months. All patients had performed FCP, RF and FAF but only 33.33% (n=21) had IR available. When all cases were considered, the prevalence of RPD was 55.6% (n=35). The sub-group analysis of subjects with IR available revealed similar prevalence results (57.1%, n=12). The presence of RPD was more easily noted in IR and FAF (52.4% for both) than in FCP (15.8%). 65.1% (n=41) of the study eyes progressed to late-stage AMD, after a mean time of 30 ± 20.88 months. Time to progression was not significantly different between patients with and without RPD (30.64 and 31.77 months respectively, p=0.79). Of the study eyes which progressed, 82.9% (n=34) developed CNV and 17.1% (n=7) geographic atrophy (GA). After correcting for age and gender, the presence of RPD was significantly associated (OR=3.96, 95% CI [1.37–11.50], p=0.01) with development of late-stage AMD. This significance was maintained for CNV subtype (OR=3.31, 95% CI [1.16 – 9.49], p=0.026) but not for GA (OR=0.512, 95% CI[ 0.091 – 2.888], p=0.449).

Conclusions:

Reticular pseudodrusen are associated with an increased risk of progression to late AMD in the second eye of patients with wet AMD. A multimodal approach using FAF and IR is mandatory for detecting RPD, underdiagnosed with FCP.

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