Drusenoid PED, metamorphopsia affect AMD prognosis

Large drusenoid pigment epithelium detachment and metamorphopsia are risk factors for progression of choroidal neovascularization in age-related macular degeneration, according to a long-term study.

W. Roquet and colleagues at the University of Creteil, France, followed 61 eyes of 32 patients with untreated drusenoid pigment epithelium detachment (PED) for a mean of 4.6 years. Drusenoid PED was defined in the study as 0.5 disc diameter of confluent soft drusen under the center of the macula. All patients underwent a variety of tests, including visual acuity measurement, fundus exam, stereo color photography and fluorescein and indocyanine green angiography. Select cases underwent optical coherence tomography during the last exam.

Three natural outcomes were identified. Persistence of drusenoid PED was seen in 38%, development of geographic atrophy in 49% and development of choroidal neovascularization in 13%. Eyes with drusenoid PED had a 50% chance of developing geographic atrophy after 7 years, the researchers said. If the drusenoid PED was greater than 2 disc diameters upon presentation, progression to atrophy or ingrowth of CNV occurred after 2 years (P < .01), they found.

At follow-up of more than 10 years, three-quarters of eyes with drusenoid detachments progressed to geographic atrophy and one-quarter progressed to CNV, the researchers said.

Optical coherence tomography was helpful in distinguishing between coalescent soft drusen and drusenoid PED, the researchers said. It also helped identify the accumulation of sub- or intraretinal fluid in eyes with choroidal neovascularization.

“The evaluation of eyes at risk requires use of all imaging means in order to ascertain the diagnosis of CNV,” the authors said in the abstract of their paper, which is published in the May issue of British Journal of Ophthalmology.