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April 06, 2016
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Pseudodrusen associated with development of neovascular AMD in fellow eye

The presence of pseudodrusen correlated with an increased incidence of neovascular age-related macular degeneration and geographic atrophy in fellow eyes of patients with unilateral neovascular AMD, according to a study.

Perspective from Andrew P. Schachat, MD

“Pseudodrusen should be considered along with the AREDS severity score for predicting late AMD,” the study authors said.

The authors assessed the relationship between pseudodrusen and late AMD in the fellow eyes of patients with unilateral neovascular AMD. Data were culled from the Comparison of Age-Related Macular Degeneration Treatments Trials.

The cohort analysis included 620 fellow eyes of CATT participants with unilateral neovascular AMD and no neovascular AMD or geographic atrophy in the fellow eye at baseline.

At baseline, 176 of 620 fellow eyes (28.4%) had pseudodrusen; 96 (54.5%) had dot pseudodrusen, 145 (82.4%) had reticular pseudodrusen, and 61 (34.7%) had confluent pseudodrusen.

Neovascular AMD developed within 2 years in 54 eyes with pseudodrusen (30.7%) and in 72 eyes without pseudodrusen (16.2%). The difference was statistically significant (P < .0001).

Geographic atrophy developed in 27 eyes with pseudodrusen (15.3%) and in 37 eyes without pseudodrusen (8.3%); the difference was statistically significant (P = .01).

There was an independent association between dot pseudodrusen and neovascular AMD and between confluent pseudodrusen and geographic atrophy. – by Matt Hasson

Disclosure: The authors report no relevant financial disclosures.

Perspective

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Andrew P. Schachat, MD
Andrew P. Schachat, MD
Andrew P. Schachat, MD

CATT investigators studied pseudodrusen and concluded that in fellow eyes, pseudodrusen were associated independently with a higher incidence of both neovascular AMD and geographic atrophy. Knowledge of risk factors that predict poor outcomes is important to counsel patients and to design studies; knowing who will have events allows building inclusion criteria that permit smaller sample sizes and more efficient studies.

I have two questions about incorporating information about pseudodrusen into clinical decision making. I am not sure there is an agreed-to, crisp definition of what they are. As pointed out by the authors, they are called all kinds of things “… reticular drusen, reticular pseudodrusen, reticular macular disease or reticular macular lesions, and subretinal drusenoid deposits …” Second, do we need special imaging to identify them? “Pseudodrusen were assessed using digital color fundus photography viewed under full color, green channel, and blue channel; red-free images; and fluorescein angiography.” Can we reliably identify them during a routine patient care exam at the slit lamp? While adding information about pseudodrusen to e.g., the AREDS Simple System may add predictive value, most clinicians do not currently score the presence or absence of pseudodrusen during their clinical exams. Maybe we should.

Andrew P. Schachat, MD
Vice Chairman, Cole Eye Institute, Professor of Ophthalmology, Lerner College of Medicine, Cleveland, OH
Disclosures: Schachat reports he is a full-time employee of the Cleveland Clinic, a part-time employee of the State of Ohio, a consultant for AnGes, receives royalties from Elsevier, and has a possible future interest in Easton Capital.
Sources/Disclosures

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Source:

Zhou Q, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.02.043.