Associations Between Retinal Pigment Epithelium and Drusen Volume Changes During the Lifecycle of Large Drusenoid Pigment Epithelial Detachments

Abstract

PurposeDrusenoid pigment epithelial detachments (PEDs) are a defined path to atrophy in age-related macular degeneration (AMD). We analyzed the relationships between retinal pigment epithelium (RPE) and drusen volume changes during the PED lifecycle, using spectral-domain optical coherence tomography (SD-OCT).MethodsTwenty-one cases of drusenoid PED tracked using SD-OCT through periods of growth and collapse were evaluated. Volumetric calculations and piece-wise linear regression analysis were used to determine the breakpoint between growth and collapse. Spectral-domain OCT scans were independently evaluated for the appearance of intraretinal hyperreflective foci, acquired vitelliform lesions (AVLs), and disruptions to the RPE+basal lamina band. Timing of these events with respect to the breakpoint was statistically evaluated. Morphometric characteristics of drusenoid PEDs were correlated with rate of PED collapse and final visual acuity.ResultsMean age of subjects was 75.3 years and mean period of follow up was 4.1 years (median 4.5 years; range, 0.6–6.6 years). The lifecycle of drusenoid PEDs was asymmetric, in that the rate of collapse (0.199 mm3/month) is significantly faster (P < 0.001) than the rate of growth (0.022 mm3/month). Appearance of intraretinal hyperreflective foci and AVLs preceded the breakpoint (both P < 0.001). The timing of disruptions to the RPE+basal lamina band did not differ from the breakpoint (P = 0.510). Maximal height, volume, and diameter of drusenoid PEDs were inversely correlated with final visual acuity (all P < 0.001) and positively correlated with the rate of PED collapse (all P < 0.001).ConclusionsSpectral-domain OCT signatures, plausibly attributable to anteriorly migrated RPE and disintegration of the RPE layer, precede or occur simultaneously with changes in volume of drusenoid PED during the lifecycle of this lesion.

The Evolution of the Plateau, an Optical Coherence Tomography Signature Seen in Geographic Atrophy

“…10 Growth and collapse of large PED appear to be on a continuum with similar changes described for smaller drusen. 10 Why a PED in any one eye proceeds to a plateau or to collapse is not known at present.…”

Multimodal Imaging Patterns for Development of Central Atrophy Secondary to Age-Related Macular Degeneration

“…In this example, confluent drusen with ill-defined hypopigmentary changes and central hyperpigmentary clumping were seen by CFP at baseline. 43 FAF imaging showed a cartwheel-like configuration with levels of increased and decreased signal intensities. Hyperreflective irregularities were visible by NIR imaging.…”

Histologic and Optical Coherence Tomographic Correlates in Drusenoid Pigment Epithelium Detachment in Age-Related Macular Degeneration

“…D-PED volume was determined by applying the Cavalieri principle of stereologic analysis to SD-OCT scans, 23 as we have done previously: 24,25 (i) The area between the outer boundary of the RPE+BL band and inner boundary of the BrM band for each slice in the volume was calculated using manual planimetry; (ii) The volume between two consecutive OCT slices (herein called a segment) was then determined using this equation: $$d\left(\frac{A_x+A_{x+1}}{2}\right)$$ where:…”