No abstract

Purpose To use spectral domain optical coherence tomography (SD-OCT) to investigate risk factors predictive for development of atrophy of drusenoid lesions (drusen and drusenoid pigment epithelium detachment) in eyes with non-neovascular age-related macular degeneration (NNVAMD). Design Cohort study. Participants Forty-one eyes from 29 patients with NNVAMD. Methods Patients with NNVAMD who underwent registered SD-OCT imaging over a minimum period of six months, were reviewed. Drusenoid lesions that accompanied by new atrophy onset at 6 month or last follow up were further analyzed. Detailed lesion change was described throughout the study period. Odds ratios (OR) and risk for new local atrophy onset were calculated. Main Outcomes Measures Drusenoid lesion features and longitudinal changes in features including maximum lesion height, lesion diameter, lesion internal reflectivity, presence and extent of overlying intraretinal hyperreflective features (HRF). Subfoveal choroidal thickness and choroidal thickness measured below each lesion. Results 543 individual drusenoid lesions were identified at baseline, while 28 lesions developed during follow-up. The mean follow-up time was 21.3 ± 8.6 (range, 6-44) months. 3.2% (18/571) of drusenoid lesions progressed to atrophy within 18.3±9.5 (range: 5-28) months of initial visit. Drusenoid lesions with heterogenous internal reflectivity were significantly associated with new atrophy onset at 6 month (OR=5.614, 95% confidence interval (CI) =1.277-24.673) and new atrophy onset at last follow up (OR=7.005, CI=2.300-21.337). Lesions with presence of HRF also were significant predictors for new atrophy onset at 6 month (OR=30.161, CI=4.766-190.860) and at last follow up (OR=11.211, CI=2.513-50.019). Lesions with a baseline maximum height over 80 microns or choroidal thickness less than 135 microns showed positive association with the new atrophy onset at last follow up (OR=7.886, CI=2.105-29.538 and OR=3.796, CI=1.154-12.481, respectively). Conclusions In this study, the presence of HRF overlying drusenoid lesions, a heterogeneous internal reflectivity of these lesions, was found consistently to be predictive of local atrophy onset in the ensuing months. These findings provide further insight into the natural history of anatomical change occurring in patients with NNVAMD.