Drusen Volume as a Predictor of Disease Progression in Patients With Late Age-Related Macular Degeneration in the Fellow Eye

Abstract

PURPOSE. Increasing drusen volume was proposed to be a predictor of disease progression in age-related macular degeneration (AMD). In patients with late AMD in one eye, the fellow eyes without neovascularization are known to be at higher risk of developing exudative AMD. We evaluated the relationship between drusen volume in these fellow eyes and their progression to late AMD. METHODS.A retrospective analysis included fellow eyes with drusen associated with nonexudative AMD. All eyes with neovascular AMD were treated with intravitreal ranibizumab, aflibercept, and/or bevacizumab and followed for 2 years. All eyes were scanned with the Cirrus HD-OCT using a 512 3 128 scan pattern. Optical coherence tomography (OCT) data at baseline, month 12, and month 24 were collected using the advanced RPE analysis tool to quantify drusen volume within 3-and 5-mm-diameter circles centered on the fovea. Optical coherence tomography scans were also evaluated for the development of geographic atrophy (GA) or macular neovascularization (MNV). RESULTS.Eighty-nine patients who had neovascular AMD in only one eye were studied. Optical coherence tomography drusen volume in the absence of MNV could be measured in 61 participants (68.5%). After 12 months, 4 eyes (4.5%) developed MNV and 15 eyes (16.9%) developed GA. By 24 months of follow-up, an additional 5 eyes (7.1%) developed MNV and an additional 10 eyes (14.3%) developed GA. At month 24, the eyes that developed GA or MNV had baseline drusen volumes that were significantly larger than in eyes that did not develop late AMD. Patients with a drusen volume over 0.03 mm 3 had a greater than 4-fold increased risk for developing late AMD compared with those with lower drusen volumes. CONCLUSIONS.Baseline drusen volume appears to be an important predictor for the development of late AMD within 2 years in eyes that have fellow eyes being actively treated for MNV. This suggests that OCT-derived drusen volume measurements may be a useful biomarker to identify eyes at the highest risk for progression to late AMD.Keywords: macular degeneration, geographic atrophy, wet macular degeneration, retinal drusen, choroidal neovascularization, optical coherence tomography, drusen volume D espite the availability of highly effective antiangiogenic therapies, age-related macular degeneration (AMD) remains a leading cause of blindness in developed nations. 1,2Multiple epidemiologic studies and clinical trials have evaluated phenotypic risk factors for the development of late AMD, defined as the development of macular neovascularization (MNV) or central geographic atrophy (GA; Refs. 3-7 and Abdelfattah NS, et al. IOVS 2015;56:ARVO E-Abstract 892). These major risk factors include the presence of large drusen, larger drusen areas, and pigmentary alterations, and these features have been incorporated into various scales used to predict the risk of developing late AMD over time. [7][8][9][10] However, these features that predicted the risk of disease progression were restricted by the types of analyses that we...

Longitudinal Analysis of Drusen Volume in Intermediate Age-Related Macular Degeneration Using Two Spectral-Domain Optical Coherence Tomography Scan Patterns

“…Please note that while all quantitative analyses were performed using the vendor software as described in the method section, the two-dimensional pseudocolor thickness maps were exported using custom reading center software. conversion to advanced AMD stages [27][28][29][30][31][32][33]. For example, Yehoshua et al [31], using another OCT platform (Zeiss Cirrus HD-OCT) and a distance of 30 µm between neighboring B-scans, reported a mean drusen volume (inner 3-mm circle) at baseline of 0.031 ± 0.002 mm 3 , corresponding to a mean change in drusen volume of 0.010 mm 3 over 2 years in 48 eyes with intermediate AMD (number reported in cube root and here converted into mm 3 ).…”

Quantity of Intraretinal Hyperreflective Foci in Patients With Intermediate Age-Related Macular Degeneration Correlates With 1-Year Progression

“…The DV within 3-and 5-mm circles centered on the fovea were automatically generated by the instrument software (Cirrus Advanced RPE analysis software, v. 8.0; Carl Zeiss Meditec). 9,10 En face EZ normalized reflectivity was measured using a previously reported procedure. 11 Briefly, the en face image of the EZ (slab 21 lm thick with inner boundary located 45 lm above the RPE reference) was exported, and the mean brightness was calculated as the mean gray level in the circle region of interest (cROI) centered on the fovea (2-mm radius); this value was then normalized using the reflectivity of the vitreous (in the cROI) and retinal nerve fiber layer (RNFL) (in a region of interest on the nasal sector [nROI; area of 1.11 mm 2 ]) as dark and bright reference standards, respectively, using the following formula:…”

“…In this study, we retrospectively reviewed en face OCT images of intermediate AMD eyes and utilized a semiautomated method to quantify HRF in the macular area. We correlated HRF quantity with drusen volume (DV) and ellipsoid zone (EZ) normalized reflectivity, which are wellestablished markers of AMD progression 9,10 and photoreceptor damage, [11][12][13] respectively. We then evaluated the correlation between HRF quantity and progression to advanced AMD after 1 year.…”

Development of Age-Related Macular Degeneration (AMD) in the Fellow Eye of Patients with AMD Treated by Treat-and-Extend Intravitreal Therapy with Aflibercept

“…Drusen volume [23] and the presence of pseudodrusen [24] reportedly affect the development of nAMD in the fellow eye. In addition, RAP is known to be more highly associated with bilateral reticular pseudodrusen as compared to other AMD subtypes [25], and this condition might be involved in the development of neovascularization in the fellow eye [20].…”