Natural History of Drusenoid Pigment Epithelial Detachment in Age-Related Macular Degeneration: Age-Related Eye Disease Study Report No. 28

Abstract

Objective-To describe the natural history of eyes with drusenoid pigment epithelial detachments (DPED) associated with age-related macular degeneration (AMD). Design-Multi-center clinic-based prospective cohort study.Participants-Among 4757 participants enrolled in the Age-Related Eye Disease Study (AREDS), 255 were identified as having DPED in at least one eye and having 5 or more years of follow-up after the initial detection of the DPED.Methods-Baseline and annual fundus photographs were evaluated for the evolution of the fundus features and the development of advanced AMD in the forms of central geographic atrophy (CGA) or neovascular (NV) AMD. Kaplan-Meier analyses of progression to advanced AMD and of moderate vision loss (≥15 letters compared with baseline) were performed.Main Outcome Measures-Rate of progression to advanced AMD and change in visual acuity from baseline (in terms of mean letters lost and proportion losing ≥15 letters).Results-A total of 311 eyes (from 255 participants) with DPED were followed for a median follow-up time of 8 years subsequent to the initial detection of a DPED. Of the 282 eyes that did not have advanced AMD at baseline, advanced AMD developed within 5 years in 119 eyes (42%) (19% progressing to CGA and 23% to NV-AMD). In the remaining eyes that did not develop advanced AMD (n = 163), progressive fundus changes, typified by the development of calcified drusen and pigmentary changes, were detected. Visual decline was prominent among study eyes, with Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2011 March 1. Published in final edited form as:Ophthalmology. Conclusion-The natural history of eyes containing DPED is characterized by a high rate of progression to both CGA and NV-AMD. Among eyes not progressing advanced AMD, progressive development of pigmentary changes and calcified drusen were observed. Decline of visual acuity is a common outcome, with or without progression to advanced forms of AMD.

Multimodal Imaging of Nonneovascular Age-Related Macular Degeneration

“…Specifically, 19% of eyes with drusenoid PED will progress to GA and 23% will progress to NV over 5 years. 87 On clinical examination drusenoid PEDs present as wellcircumscribed yellow or yellow-white elevations of the RPE that are often contiguous with large soft drusen (Fig. 2).…”

Disappearance of central confluent soft drusen following vitrectomy and ILM peeling

“…Eye Comment Central confluent soft drusen, also called 'drusenoid pigment epithelial detachment' (DPED) has a poor prognosis and 42% of eyes progressed to advanced ARMD within 5 years. 1 No effective and overall accepted treatment of DPED is available so far. Regression of drusen has been shown after laser photocoagulation, 2 coincidental rhegmatogenous retinal detachment, 3 and intravitreal anti-VEGF therapy.…”

“…Acetazolamide, a sulphonamide-derived medication, frequently used in glaucoma and after cataract surgery, can very rarely cause idiosyncratic reaction, and few reports are present in literature. [1][2][3] We report ocular coherence tomography (OCT) scans of the posterior pole in a case of ciliary body oedema after the drug administration causing bilateral angleclosure glaucoma (ACG). In our case we found a massive choroidal effusion with posterior retinal folds and papillary oedema, never described before in literature.…”

“…[1][2][3] With regard to the posterior involvement there are only few reports of retinal folds attributed to topiramate and hydrochlorothiazide. 4,5 Papillary oedema has never been associated with sulpha drugs.…”

One year results of anti-VEGF treatment in pigment epithelial detachment secondary to macular degeneration

“…ARMD is caused by the accumulation of drusen in the macula, which is the most important part of the retina, and this process ends in serious irreversible visual impairment. Pigment epithelial detachment (PED) may be seen in all stages of ARMD and may lead to poor prognosis because of retina pigment epithelial (RPE) tears, submacular haemorrhage and, finally, disciform scars (2,3) . ANCHOR and MARINA studies showed that the vascular endothelial growth factor inhibitor (anti-VEGF), ranibizumab, was effective in the treatment of neovascular ARMD and repeated injections improved or preserved visual acuity (VA) (4,5) .…”