Elsevier

Ophthalmology

Volume 118, Issue 8, August 2011, Pages 1619-1625
Ophthalmology

Original article
A Prospective Study of Reticular Macular Disease

https://doi.org/10.1016/j.ophtha.2011.01.029Get rights and content

Purpose

To determine the risk of progression to advanced age-related macular degeneration (AMD) conferred by reticular pseudodrusen (RPD), an imaging presentation of reticular macular disease (RMD), in high-risk fellow eyes of subjects with AMD and unilateral choroidal neovascularization (CNV) in a large, prospective study.

Participants

Two hundred seventy-one subjects with AMD; 94 with RPD and 177 without RPD.

Methods

Images from a cohort of 271 subjects with AMD in the Nutritional AMD treatment phase II (NAT 2) Study, a 3-year prospective study of subjects with unilateral CNV and large soft drusen in the fellow eye, were studied. The fellow eye, at high risk for advanced AMD developing, was the study eye. There were 5 visits per subject. Imaging at each visit consisted of color, red-free, and blue-light photography and fluorescein angiography. The images were analyzed for the presence of RPD, following disease progression throughout the 3-year study.

Main Outcome Measures

The development of advanced AMD (CNV or geographic atrophy).

Results

For the 271 subjects who completed the full 3-year study, there was a significantly higher rate of advanced AMD (56% or 53/94) in fellow eyes with RPD at any visit compared with eyes without RPD (32% or 56/177; P < 0.0001, chi-square test; relative risk [RR], 1.8; 95% confidence interval [CI], 1.4–2.4). The chance of developing advanced AMD in the fellow eye in women with RPD (66%) was more than double that of women without RPD (30%; P < 0.00001; RR, 2.2; 95% CI, 1.6–3.1).

Conclusions

To the authors' knowledge, this is the first comprehensive prospective study of RMD, a distinct clinical phenotype of AMD that includes RPD. It provides strong confirmation that RMD, a disease entity with stereotypical presentations across imaging methods, is associated with a high risk of progression to advanced AMD, perhaps on an inflammatory or vascular basis. Reticular macular disease deserves wider recognition and consideration by clinicians caring for patients with AMD.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Subjects

Data were used from the Nutritional AMD treatment phase II (NAT 2) Study, sponsored by Bausch & Lomb, Inc (Montpellier, France), which had a 3-year follow-up duration for each subject. The research adhered to the tenets of the Declaration of Helsinki and was approved by the Medical Ethics Committee of L'Hôpital Intercommunal de Créteil (Créteil, France). The NAT 2 Study was a prospective, single-center, double-blind, randomized, parallel, placebo-controlled, comparative study. The data set

Results

The 3-year NAT 2 Study yielded complete data for 271 subjects from a total of 300. The 29 subjects who did not complete the study were lost to follow-up, with 1 recorded death among them (an 86-year-old woman); these subjects were demographically similar to those who completed the full study (72.4%, or 21/29, female with an average age of 75±5.8 years). Among the subjects who completed the study, there was a significantly higher rate of progression to late-stage AMD in eyes with RPD at any

Discussion

Reticular macular disease, a subphenotype of AMD that includes RPD, has been shown to be associated with advanced AMD.3, 4, 5, 6, 7 This study, to the authors' knowledge, is the first prospective study that examines high-risk eyes with early AMD and demonstrates significantly increased progression to both types of advanced AMD (CNV and GA) among such subjects with RMD. It was found that 56% of eyes with RPD progressed to late-stage AMD: 45% of these progressed to CNV, 20% of these progressed to

References (21)

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  • Reticular Pseudodrusen on the Risk of Progression in Intermediate Age-Related Macular Degeneration

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    Our study is unable to comment on the prognostic significance of RPD in the fellow eye of individuals with late AMD in one eye. Several previous studies, including our own, have reported an association between RPD and an increased risk of developing late AMD14-19 or geographic atrophy (GA) only11,20 in the non-late, fellow AMD eyes of individuals with unilateral nAMD. Note, however, that in one of these studies, longer-term follow-up of individuals no longer revealed a significant association between RPD and an increased risk of disease progression.21

  • The role of dark adaptation in understanding early AMD

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Manuscript no. 2010-1144.

Supported by grants from The New York Community Trust, New York, New York; the National Eye Institute, Bethesda, Maryland (grant no.: R01 EY015520 [RTS]); and unrestricted funds from Research to Prevent Blindness, Inc., New York, New York. The funding organizations had no role in the design or conduct of this research. Images from the NAT 2 Study were obtained from L'Hôpital Intercommunal de Créteil, Créteil, France, and Eric H. Souied, MD, PhD. ISRCTN (numeric system for the unique identification of randomized controlled trials) number for the NAT 2 Study: 98246501.

Financial Disclosure(s): The author (s) have made the following disclosure (s): Eric H. Souied - Consultant - Bausch & Lomb and Novartis; Lecturer - Alcon

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