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Presence of pseudodrusen may predict late AMD development in fellow eyes

Dot pseudodrusen were associated with wet AMD and confluent pseudodrusen with geographic atrophy.

Issue: September 2016

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The presence and type of pseudodrusen were associated with an increased incidence of late age-related macular degeneration in fellow eyes of patients with neovascular AMD, according to a study.

Pseudodrusen and AREDS scores should be considered when predicting late AMD, the study authors said.

“I think these findings have clinical relevance. Ophthalmologists can take a fundus photo, OCT or fluorescein angiogram for determining pseudodrusen,” corresponding author Gui-shuang Ying, PhD, told Ocular Surgery News. “Now we have effective anti-VEGF treatment for wet AMD, and the earlier the treatment, the more benefit from treatment. Pseudodrusen along with other AMD features (ie, features for AREDS severity score) can be used to determine whether the fellow eye is at low risk or high risk of developing late AMD. This is important because when wet AMD is present in one eye, the fellow eye is at increased risk of developing late AMD. Ophthalmologists need to watch high-risk patients closely for the development of late AMD in the fellow eye.”

This study is based on the secondary analysis of data from the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT), and the study was published in Ophthalmology.

Patients

The authors set out to gauge the relationship between pseudodrusen and the incidence of late AMD in the fellow eyes of patients with unilateral neovascular AMD.

“Most of the studies show that if you have a pseudodrusen at baseline, you are more likely to develop late AMD. This is nothing new, but all studies ... only evaluate the presence of pseudodrusen,” Ying said. “We also looked at different types of pseudodrusen. We evaluated how each type of pseudodrusen is associated with late AMD risk. No one has ever looked at how each type of pseudodrusen was associated with late AMD.”

The analysis included 620 eligible CATT participants with unilateral neovascular AMD and neither neovascular AMD nor geographic atrophy in the fellow eye at baseline.

At baseline, 176 of 620 fellow eyes (28.4%) had pseudodrusen; 96 had dot pseudodrusen, 145 had reticular pseudodrusen and 61 had confluent pseudodrusen, and 104 eyes had two or more types of pseudodrusen.

The presence of pseudodrusen was most strongly associated with older age (P < .0001), female gender (P < .0001), lower likelihood of being a current or former smoker (P = .002) and lower likelihood of being diabetic (P = .04).

Mean patient age was 81.3 years in the pseudodrusen group and 76.9 years in the non-pseudodrusen group (P < .0001).

Results

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

Late AMD developed in 73 fellow eyes with pseudodrusen (41.5%) and in 101 eyes without pseudodrusen (22.8%).

Dot pseudodrusen were associated independently with neovascular AMD (adjusted risk ratio = 2.5, P < .0001). Confluent pseudodrusen were associated independently with geographic atrophy (adjusted risk ratio = 4.4, P = .002).

“We found that different types have a different association with wet or dry AMD. Dot pseudodrusen were mostly associated with wet AMD, while confluent pseudodrusen were associated with dry AMD,” Ying said.

At each level of AREDS severity, the risk of late AMD was higher in fellow eyes with pseudodrusen than eyes without pseudodrusen. In fellow eyes with baseline pseudodrusen, the 2-year incidence rate of late AMD was 28.7% in cases with AREDS severity score of 2, 34.9% in cases with AREDS score of 3 and 50.5% in cases with AREDS score of 4.

In contrast, in eyes without baseline pseudodrusen, the 2-year incidence rate of late AMD was 10.3% in cases with AREDS score of 2, 13.7% in cases with AREDS score of 3 and 32% in cases with AREDS score of 4. – by Matt Hasson

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

• For more information:
• Gui-shuang Ying, PhD, can be reached at Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, 3535 Market St., Suite 700, Philadelphia, PA 19104; email: gsying@mail.med.upenn.edu.

Disclosure: Ying reports no relevant financial disclosures.