Purpose To present a unified description of reticular macular disease (RMD), a common clinical entity that includes reticular pseudodrusen and confers high risk of progression to advanced age-related macular degeneration (AMD). Design Population-based, retrospective, cross-sectional study. Participants Forty-two patients with reticular findings in at least one imaging modality, of whom 21 had follow-up. Methods RMD was defined as reticular pseudodrusen (RPD) in color or red-free (RF) photography and/or a reticular pattern on scanning laser ophthalmoscope (SLO) imaging (autofluorescence (AF) scans, infrared (IR) photographs or indocyanine green (ICG) angiography). Color and RF images were contrast-enhanced, and color photos were examined in green and blue channels. Image registration in different modalities allowed comparison of areas involved and assessment of lesion co-localization. Results RMD was generally present in both photography and SLO imaging. When present in two image modalities, areas of RMD either largely overlapped, or one fell within the other. Individual lesions had high spatial correspondence. Serial imaging showed faded to absent findings in eyes that developed choroidal neovascularization (CNV). Conclusions RMD is a single disease entity with stereotypical presentations in multiple imaging modalities, of which reticular pseudodrusen is one. AF, IR, and ICG suggest that it involves the retinal pigment epithelium and choriocapillaris, while photographic patterns implicate the inner choroid. IR imaging, unlike other modalities, can demonstrate RMD in the central macula. RMD is associated with progression to advanced AMD, perhaps on an inflammatory basis. RMD deserves wider recognition among clinicians caring for our elderly patients.

Purpose-To determine the risk of progression to advanced age-related macular degeneration (AMD) conferred by reticular pseudodrusen (RPD), an imaging presentation of reticular macular disease (RMD), in high-risk fellow eyes of subjects with AMD and unilateral choroidal neovascularization (CNV) in a large prospective study. Design-Cohort study.Participants-271 subjects with AMD; 94 with RPD and 177 without RPD.Methods-We studied images from a cohort of 271 subjects with AMD in the NAT 2 Study, a 3-year prospective study of subjects with unilateral CNV and large soft drusen in the fellow eye. The fellow eye, at high risk for developing advanced AMD, was the study eye. There were 5 visits per subject. Imaging at each visit consisted of color, red free, and blue light photography and fluorescein angiography. We analyzed the images for the presence of RPD, following disease progression throughout the 3-year study. Main Outcome Measures-The development of advanced AMD (CNV or geographic atrophy).Results-For the 271 subjects who completed the full 3-year study, there was a significantly higher rate of advanced AMD (56% or 53/94) in fellow eyes with RPD at any visit compared to eyes without RPD (32% or 56/177; p = 7.7E-05, χ 2 test; relative risk (RR) 1.8; 95% confidence interval (CI) 1.4-2.4). The chance of developing advanced AMD in the fellow eye in females with RPD (66%) was more than double compared to females without RPD (30%, p = 5.1E-06, RR 2.2, 95% CI 1.6-3.1).Conclusion-To our knowledge, this is the first comprehensive prospective study of reticular macular disease (RMD), a distinct clinical phenotype of AMD which includes RPD. It provides strong confirmation that RMD, a disease entity with stereotypical presentations across imaging

Purpose To investigate the incidence of reticular macular disease (RMD), a subphenotype of age-related macular degeneration (AMD), in multilobular geographic atrophy (GA) and its relation to GA progression. Methods 157 eyes of 99 subjects with AMD, primary GA, and good-quality autofluorescence (AF) and/or infrared (IR) images were classified into unilobular GA (1 lesion) or multilobular GA (>= 2 distinct and/or coalescent lesions). 34 subjects (50 eyes) had serial imaging. We determined the spatiotemporal relationships of RMD to GA and GA progression rates in 5 macular fields. Results 144/157 (91.7%) eyes had multilobular GA, 95.8% of which exhibited RMD. In subjects with serial imaging, the mean GA growth rate significantly differed between the unilobular and multilobular groups (0.40 mm2 /yrvs. 1.30 mm2 /yr, p< 0.001). Of the macular fields in these eyes, 77.1% of fields with RMD at baseline showed subsequent GA progression, while 53.4% of fields without RMD showed progression (p <0.001). Percentage of fields with RMD significantly correlated with GA progression rate(p=0.01). Conclusion AF and IR imaging demonstrates that RMD is nearly always present with multilobular GA in AMD. Further, GA lobules frequently develop in areas of RMD, suggesting progression of a single underlying disease process.

PurposeTo study the ability of volumetric spectral domain optical coherence tomography (SD-OCT) to perform quantitative measurement of the choroidal vasculature in vivo.MethodsChoroidal vascular density and vessel size were quantified using en face choroidal scans from various depths below the retinal pigment epithelium (RPE) in 58 eyes of 58 patients with either epiretinal membranes (ERM), early age-related macular degeneration (AMD), or reticular pseudo-drusen (RPD). For each patient, we used the macular volume scan (6×6 mm cube) for vessel quantification, while high-definition (HD) cross-section raster scans were used to qualitatively assess vascularity of the choroidal sub-layers, and measure choroidal thickness.ResultsOf the 58 patients, more were female (66% versus 34% male), of whom 14 (24%) had ERM, 11 (19%) early AMD, and 33 (57%) RPD. Compared to intact choriocapillaris in all ERM (100%), none of the RPD and only 5/11 (45%) early AMD eyes had visible choriocapillaris on either cross section or C-scans (p-value<0.001). When comparing select regions from the most superficial C-scans, early AMD group had lowest vascular density and RPD had highest (p-value 0.04). Qualitative evaluation of C-scans from all three groups revealed a more granular appearance of the choriocapillaris in ERM versus increased stroma and larger vessels in the RPD eyes.ConclusionsSD-OCT can be used to qualitatively and quantitatively assess choroidal vascularity in vivo. Our findings correlate to previously reported histopathologic studies. Lack of choriocapillaris on HD cross-sections or C-scans in all RPD and about half of early AMD eyes suggests earlier choroidal involvement in AMD and specifically, RPD.

Point-to-point correlation of registered IR, AF, and RF images consistently localizes the reticular pattern to the intervascular choroidal stroma on en face OCT sections. In contrast, subretinal deposits and disturbances of the inner outer segment on OCT did not colocalize with the RPD, and may represent secondary mechanical or biologic disturbances in the overlying RPE and outer retina.