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  • Impact of drusen and drusenoid retinal pigment epithelium elevation size and structure on the integrity of the retinal pigment epithelium layer

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Clinical science
Impact of drusen and drusenoid retinal pigment epithelium elevation size and structure on the integrity of the retinal pigment epithelium layer
  1. Ferdinand Schlanitz1,
  2. Bernhard Baumann2,
  3. Stefan Sacu1,
  4. Lukas Baumann3,
  5. Michael Pircher2,
  6. Christoph K Hitzenberger2,
  7. Ursula Margarethe Schmidt-Erfurth1
  1. 1 Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
  2. 2 Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
  3. 3 Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Professor Ursula Margarethe Schmidt-Erfurth, Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; ursula.schmidt-erfurth{at}meduniwien.ac.at

Abstract

Purpose To evaluate the impact of drusen size and structure on retinal pigment epithelium (RPE) and photoreceptor layers in eyes with early to intermediate age-related macular degeneration (AMD) using polarisation-sensitive optical coherence tomography (OCT).

Design Retrospective investigation of an observational cross-sectional study.

Participants Patients with early to intermediate AMD.

Methods Twenty-five eyes of 25 patients with drusen were imaged with polarisation-sensitive OCT using macular volume scans. Each scan was manually graded for six distinct drusen characteristics and the integrity of both the overlying RPE and photoreceptor layer. The central scan of each single druse, as well as its diameter and location, were selected for statistical calculations.

Results A total number of 5933 individual drusen including their adjacent RPE and photoreceptor layer were evaluated. 41.3% of all drusen demonstrated an intact overlying RPE; in 28.1% the RPE layer was irregular, but continuous. In 30.6%, the RPE layer signal was discontinuous above the area of drusen. The level of RPE alteration was significantly related to shape (p<0.001), internal reflectivity (p<0.001) and homogeneity (p<0.001) of the drusen and their diameter, with a higher probability for larger drusen to have a discontinuous RPE (OR 3.2, p<0.001). The number of drusen showing overlying foci or an altered photoreceptor layer was too small to be conclusive, but showed a trend towards an altered RPE if present.

Conclusions Polarisation-sensitive OCT reveals a correlation between specific drusen characteristics and the integrity of the overlying RPE layer. Drusen diameter and configuration were significantly associated with RPE loss.

  • imaging
  • retina
  • macula

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bjophthalmol-2017-311782

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    Footnotes

    • Correction notice This paper has been corrected since it was published Online First. The first author's first name and surname were transposed and this has since been corrected.

    • Contributors SF: design of the work, data collection, data analysis, drafting the article. BB: data analysis, critical revision of the article. SS: data analysis and interpretation, critical revision of the article. BL: data analysis and interpretation. PM: data analysis and interpretation. HC: conception of the work, data analysis and interpretation, critical revision of the article. S-EU: design of the work, data interpretation, critical revision and final approval of the article to be published.

    • Funding CKH has received support by an independent scientific grant (FWF grant P19624-B02, Austrian Science Fund, Vienna, Austria), the European Union (FP7 HEALTH programme grant 201880, FUN-OCT, Brussels, Belgium) and Canon (Tokyo, Japan). S-EU has received support from an independent scientific grant (Herzfelder'sche Familienstiftung, grant AP0044120FF). None of the grantors had any influence on reporting the study data and interpretation of the data. All other authors did not receive any government or non-governmental fundings.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study protocol was approved by the local ethics committee of the Medical University of Vienna and adhered to the Declaration of Helsinki (approval number EK599/2009).

    • Provenance and peer review Not commissioned; externally peer reviewed.

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