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  • Reticular Pseudodrusen Is a Key Risk Factor for Late AMD

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, October 2022

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    In a post hoc analysis of findings from the Age-Related Eye Disease Study (AREDS) and AREDS2, Agrón et al. explored reticular pseudodrusen (RPD) as a potential independent risk factor for progression to late age-related mac­ular degeneration (AMD). They found RPD to be a substantial risk factor for late AMD, particularly for geographic atrophy. As a result, they recommend that RPD be incorporated into AMD clinical trials and classification systems, including risk stratification.

    For this study, the authors analyzed images for eyes that had no evidence of late AMD at baseline in AREDS (6,959 eyes; 3,780 patients) or AREDS2 (3,355 eyes; 2,056 patients). They collected and graded color fundus photographs from the patients’ annual visits. The images were examined for soft drusen, pigment abnormalities, and late AMD. The presence of RPD was determined from deep-learning grading of the fundus photographs (in AREDS) and by grading fundus autofluorescence images (in AREDS2). Proportion­al hazards regression analyses were conducted, which accounted simulta­neously for the AREDS AMD severity scales (modified simplified and 9-step) and the presence of RPD. The main outcome measure was progression to late AMD, geographic atrophy, and neovascular AMD.

    In AREDS, the analysis by person according to the simplified severity scale showed that the presence of RPD was linked to high risk of progression to late AMD (hazard ratio [HR], 2.15). However, the degree of risk differed by disease severity: the HRs for levels 0/1 through 4 were 3.23, 3.81, 2.28, and 1.64, respectively. According to the 9-step scale, RPD also carried a high risk for late AMD (HR, 2.54; 95% confidence interval [CI], 2.38-6.10). In the AREDS2 analysis, presence of RPD did not indicate an elevated risk for late AMD (HR, 1.18). In the 9-step analysis, the HR was 1.57 (95% CI, 1.31-1.89). In both AREDS cohorts, RPD was asso­ciated with a higher risk for geographic atrophy than for neovascular AMD.

    Based on these findings, “RPD status must be considered in combination with the traditional features for an accurate understanding of progression risk and subtype predictions,” said the authors.

    The original article can be found here.