The Association Between Subretinal Drusenoid Deposits in Older Adults in Normal Macular Health and Incident Age-Related Macular Degeneration

Abstract

PurposeSubretinal drusenoid deposits (SDD) have been associated with the progression to late age-related macular degeneration (AMD). To determine whether SDD in eyes in normal macular health increases risk for early AMD, this study examined the association between presence of SDD at baseline in a cohort of older adults in normal macular health and incident AMD 3 years later.MethodsSubjects enrolled in the Alabama Study on Early Age-Related Macular Degeneration (ALSTAR) were assessed for the presence of SDD using color fundus photos, infrared reflectance and fundus autofluorescence images, and spectral-domain optical coherence tomography volumes. The study sample included 799 eyes from 455 participants in normal macular health per grading of color fundus photographs using the 9-step Age-Related Eye Disease Study (AREDS) classification system. Age-related macular degeneration was defined as eyes having an AREDS grade ≥2 at the 3-year follow-up.ResultsTwenty-five percent of participants had SDD in one or both eyes at baseline. At follow-up visit, 11.9% of eyes in the sample developed AMD. Compared to eyes without SDD, those with SDD were 2.24 (95% confidence interval [CI] 1.36–3.70) times more likely to have AMD at follow-up. After adjusting for age, C-reactive protein quartile, and family history of AMD, the association persisted.ConclusionsResults suggest that SDD in older eyes with normal macular health as defined by the AREDS scale is a risk factor for the development of early AMD. Older adults in seemingly normal macular health yet having SDD may warrant closer clinical monitoring for the possible onset of early AMD.

Prevalence of peripapillary choroidal neovascular membranes (PPCNV) in an elderly UK population—the Bridlington eye assessment project (BEAP): a cross-sectional study (2002–2006)

“…Alternatively, it could reflect the older age of the cohort included in the present study. RPD or subretinal drusenoid deposits (SDD) cover a large area of the retina including the peripapillary zone [15,17], and are known to be associated with nAMD [18][19][20]. We have previously reported their prevalence in 22% of eyes with newly presenting nAMD in a hospital eye service [19], a finding similar to that in participants with PPCNV in this population.…”

Association Between Visual Function and Subretinal Drusenoid Deposits in Normal and Early Age-Related Macular Degeneration Eyes

“…In fact, recently we showed that SDD in normal eyes doubles the risk for incident early AMD three years later. 6 Slowed dark adaptation may require further pathological steps beyond the mere appearance of SDD, such as their expansion and resulting confluence, 27, 28 plus perturbation of RPE cell bodies in addition to the apical processes. 29 Within this framework, the presence of SDD remains an important signature not only as phenotypic entities in AMD patients currently in normal macular health, but potentially as a biomarker for increased risk for future visual decline in patients currently in normal macular health, an issue deserving of further investigation.…”

“…26 Second was the two-fold risk for incident AMD in AREDS1 (normal) eyes with SDD by our criteria in this cohort. 6 …”

“…Nevertheless, patients in normal macular health and early AMD who have SDD warrant observation due to their increased risk for incident early AMD and its progression. 6, 37–40 …”

“…5 Furthermore, our prospective study has shown that SDD presence in normal eyes doubles their risk for incident early AMD three years later. 6 Histology and adaptive optics assisted imaging show that these lesions exert a stage-specific effect on photoreceptor structure. 4, 7 …”