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OphthalmologyFebruary 201673 citations

Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging.

Zarubina Anna V, Neely David C, Clark Mark E, Huisingh Carrie E, Samuels Brian C, Zhang Yuhua, McGwin Gerald, Owsley Cynthia, Curcio Christine A


AI Summary

Multimodal imaging revealed subretinal drusenoid deposits (SDD) in 23% of healthy maculas and over half of AMD patients, strongly linking SDD to AMD presence/severity and suggesting its clinical importance.

Abstract

Purpose

To assess the prevalence of subretinal drusenoid deposits (SDD) in older adults with healthy maculas and early and intermediate age-related macular degeneration (AMD) using multimodal imaging.

Design

Cross-sectional study.

Participants

A total of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration from primary care ophthalmology clinics.

Methods

Subjects were imaged using spectral domain optical coherence tomography (SD OCT) of the macula and optic nerve head (ONH), infrared reflectance, fundus autofluorescence, and color fundus photographs (CFP). Eyes were assessed for AMD presence and severity using the Age-Related Eye Disease Study (AREDS) 9-step scale. Criteria for SDD presence were identification on ≥1 en face modality plus SD OCT or on ≥2 en face modalities if absent on SD OCT. Subretinal drusenoid deposits were considered present at the person level if present in 1 or both eyes.

Main outcome measures

Prevalence of SDD in participants with and without AMD.

Results

Overall prevalence of SDD was 32% (197/611), with 62% (122/197) affected in both eyes. Persons with SDD were older than those without SDD (70.6 vs. 68.7 years, P = 0.0002). Prevalence of SDD was 23% in subjects without AMD and 52% in subjects with AMD (P < 0.0001). Among those with early and intermediate AMD, SDD prevalence was 49% and 79%, respectively. After age adjustment, those with SDD were 3.4 times more likely to have AMD than those without SDD (95% confidence interval, 2.3-4.9). By using CFP only for SDD detection per the AREDS protocol, prevalence of SDD was 2% (12/610). Of persons with SDD detected by SD OCT and confirmed by at least 1 en face modality, 47% (89/190) were detected exclusively on the ONH SD OCT volume.

Conclusions

Subretinal drusenoid deposits are present in approximately one quarter of older adults with healthy maculae and in more than half of persons with early to intermediate AMD, even by stringent criteria. The prevalence of SDD is strongly associated with AMD presence and severity and increases with age, and its retinal topography including peripapillary involvement resembles that of rod photoreceptors. Consensus on SDD detection methods is recommended to advance our knowledge of this lesion and its clinical and biologic significance.


MeSH Terms

AgedAged, 80 and overApolipoprotein A-IApolipoproteins BC-Reactive ProteinComplement System ProteinsCross-Sectional StudiesFemaleHumansMacula LuteaMaleMiddle AgedMultimodal ImagingOptic DiskPrevalenceProspective StudiesRetinal DrusenTomography, Optical CoherenceWet Macular Degeneration

Key Concepts6

The overall prevalence of subretinal drusenoid deposits (SDD) was 32% (197/611) in older adults (aged ≥60 years) enrolled in the Alabama Study of Early Age-Related Macular Degeneration, with 62% (122/197) of affected individuals having SDD in both eyes.

EpidemiologyCross-sectionalCross-sectional studyn=611 subjects aged ≥60 yearsCh10

Persons with subretinal drusenoid deposits (SDD) were older than those without SDD (70.6 vs. 68.7 years, P = 0.0002) in a cross-sectional study of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration.

EpidemiologyCross-sectionalCross-sectional studyn=651 subjects aged ≥60 yearsCh10

The prevalence of subretinal drusenoid deposits (SDD) was 23% in subjects without age-related macular degeneration (AMD) and 52% in subjects with AMD (P < 0.0001) in a cross-sectional study of 651 subjects aged ≥60 years.

EpidemiologyCross-sectionalCross-sectional studyn=651 subjects aged ≥60 yearsCh10

Among those with early and intermediate age-related macular degeneration (AMD), subretinal drusenoid deposits (SDD) prevalence was 49% and 79%, respectively, in a cross-sectional study of 651 subjects aged ≥60 years.

EpidemiologyCross-sectionalCross-sectional studyn=651 subjects aged ≥60 yearsCh10

After age adjustment, individuals with subretinal drusenoid deposits (SDD) were 3.4 times more likely to have age-related macular degeneration (AMD) than those without SDD (95% confidence interval, 2.3-4.9) in a cross-sectional study of 651 subjects aged ≥60 years.

PrognosisCross-sectionalCross-sectional studyn=651 subjects aged ≥60 yearsCh10

Using color fundus photographs (CFP) only for subretinal drusenoid deposits (SDD) detection per the Age-Related Eye Disease Study (AREDS) protocol, the prevalence of SDD was 2% (12/610) in a cross-sectional study of 651 subjects aged ≥60 years.

DiagnosisCross-sectionalCross-sectional studyn=610 subjects aged ≥60 yearsCh4

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