PREVALENCE OF RETICULAR PSEUDODRUSEN IN AGE-RELATED MACULAR DEGENERATION USING MULTIMODAL IMAGING FLORE DE BATS, MD,*† THIBAUD MATHIS, MD,* MARTINE MAUGET-FAŸSSE, MD,‡ FABIEN JOUBERT, MD,§ PHILIPPE DENIS, MD, PHD,* LAURENT KODJIKIAN, MD, PHD* Purpose: To determine the rate of reticular pseudodrusen (RPD) in age-related macular degeneration using multimodal imaging, including color fundus photography, the blue channel image of fundus photography, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography, as well as to compare the sensitivities and specificities of these modalities for detecting RPD. Methods: This prospective study included 243 eyes from 125 consecutive patients with age-related macular degeneration. They underwent fundus examination including color fundus photography, blue channel, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography in both eyes. To be considered as having RPD, eyes had to have reticular patterns on spectral domain optical coherence tomography in a large studied cube of 30° · 25° or on infrared reflectance with at least one other examination. Results: The mean age of the 125 patients was 81.1 years (±8.1). Eighty-six patients (68.8%) were diagnosed with RPD. Spectral domain optical coherence tomography, infrared reflectance, and multicolor imaging had the highest sensitivity (99.3, 84.6, and 87.1%, respectively) and specificity (100%). The color fundus photography, blue channel, and fundus autofluorescence had lower sensitivity to detect RPD. Conclusion: Reticular pseudodrusen is frequently associated with soft drusen in patients with age-related macular degeneration. As RPD may be rarely located only in the perifoveal area, spectral domain optical coherence tomography with a larger cube (30 · 25°) than that usually used (20 · 20°) had the highest sensitivity and specificity to detect RPD and is recommended to optimize the rate of detection. RETINA 36:46–52, 2016

I

n 1990, Mimoun et al1 first described a new entity called reticular pseudodrusen (RPD) as a peculiar yellowish pattern in patients with age-related macular degeneration (AMD). On color fundus photography

(CFP), RPD were identified as indistinct, interlacing, yellowish lesions, which were seen more clearly on blue light photography, currently replaced by blue channel (BC), typically along the superior vascular arcades.2 The wavelength of blue light is attenuated by the retinal pigment epithelium (RPE); this fact suggested that the deposit is located above the level of the RPE in the subretinal space. This was confirmed by spectral domain optical coherence tomography (SDOCT).3 Reticular pseudodrusen was classified as a separate entity in the Wisconsin grading system on the basis of its characteristic appearance on blue light photography.4 The development of new imaging methods such as confocal scanning laser ophthalmoscopy and SD-OCT has led to improved diagnosis of

From the *Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, UMR-CNRS 5510 Matéis, University of Medicine Lyon 1, Lyon, France; †Pôle Vision, Clinique du Val d’ouest, Ecully, France; ‡Professor Sahel Department, Rothschild Ophthalmologic Foundation, Paris, France; and §Department of Medical Information and Epidemiology, Le Vinatier Hospital, University of Medicine Lyon 1, Bron, France. None of the authors have any financial/conflicting interests to disclose. F. De BATS and T. MATHIS are co-first authors. Reprint requests: Laurent Kodjikian, MD, PhD, Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France; e-mail: [email protected]

46

PREVALENCE OF RETICULAR PSEUDODRUSEN  DE BATS ET AL

this condition.5–9 Previous reports showed that infrared (IR), SD-OCT, fundus autofluorescence (FAF), and multicolor imaging (MC) were more helpful than CFP, blue light, and BC in detecting RPD7,10,11 because of its similarity to soft drusen. Many studies have evaluated the prevalence of RPD in patients with AMD, but few have addressed the sensitivity and specificity of each test in the diagnosis of RPD.10 We evaluated the prevalence of RPD among patients with AMD using 6 methods: CFP, BC, MC, IR, FAF, and SD-OCT. Additionally, we determined the best method (sensitivity and specificity) to diagnose RPD. Methods This prospective study included 125 consecutive patients with any type of AMD, who were examined in the Croix-Rousse University Hospital Retinal Center from December 2013 to April 2014 inclusively. The study patients had AMD in at least 1 eye and were classified using the Age-Related Eye Disease Study scale (AREDS)12: no sign of AMD (equivalent Stage 1 of AREDS classification), early AMD (Stage 2 or 3 of AREDS classification), or late AMD (Stage 4 of AREDS classification: typical neovascular AMD, retinal angiomatous proliferation, polypoidal choroidal vasculopathy, or geographic atrophy). Early AMD was defined by the presence of drusen (soft drusen, hard drusen, or RPD) or focal pigmentary changes (hypopigmentation or hyperpigmentation) and absence of any type of late AMD. The diagnosis of late AMD was based on the concordance of multimodal imaging (fluorescein angiogram, indocyanine green angiography, SD-OCT, CFP, BC, FAF, IR, and MC). Macular fibrosis secondary to late AMD was recorded if a fibrovascular scar was present in the macular area. Eyes with other macular abnormalities such as non-AMD serous detachment of the macula (e.g., central serous chorioretinopathy), rhegmatogenous or tractional retinal detachment, high myopia, or any tapetoretinal degeneration were excluded from this study. All images were graded by two masked retinal specialists (F.D.B. and T.M.). The results were later compared, and any disagreement was settled by open adjudication with the senior author (L.K.). We recorded patient characteristics, including age and gender. Ethics committee approval was obtained and all investigations adhered to the tenets of the Declaration of Helsinki. All patients included in this study provided fully informed consent before participation. Multimodal Imaging Methods All patients underwent a complete ophthalmoscopic examination, including best-corrected visual acuity

47

(Early Treatment Diabetic Retinopathy Study scale), biomicroscopy, CFP, SD-OCT, MC (infrared reflectance, green reflectance, and blue reflectance), IR, and FAF. To examine CFP (field 45°) and the corresponding BC, a Topcon nonmydriatic retinal camera was used (Topcon, Tokyo, Japan). The images were viewed in Topcon ImageNet (version 2.55, Topcon America). The commands Utilities . RGB channels were selected to display the individual color channel (red, green, or blue). Brightness and contrast were adjusted if needed to obtain better images. Spectral domain optical coherence tomography and multicolor confocal scanning laser ophthalmoscopy imaging were acquired with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). Multicolor imaging is an imaging modality that combines three reflective images. Each image is simultaneously acquired with a distinctive laser wavelength (blue reflectance: 488 nm, green reflectance: 515 nm, and IR reflectance: 820 nm) in a 30° · 30° rectangle centered on the macula. Thirty-one horizontal B-scans of SD-OCT (30° · 25° rectangle encompasses the macula) were obtained and viewed with the contained Heidelberg software. This cube of 30° · 25° is larger than that usually used in the literature to diagnose RPD that are frequently located in the perifoveal area and near the temporal vascular arcade. If RPD lesions were located outside this cube of 30° · 25° centered on the macula, they were not imaged in all the analyzed SD-OCT sections. Subfoveal choroidal thickness was also evaluated and measured from the outer part of the hyperreflective line corresponding to the RPE to the inner surface of the sclera. IR and FAF were obtained with the Heidelberg Spectralis HRA (Heidelberg Engineering) in a 55° field centered on the macula. IR images were obtained using a light stimulus of 820 nm. Images of FAF were obtained using an excitation light of 488 nm and a barrier filter beginning at 500 nm. Definition of Reticular Pseudodrusen and Image Grading Reticular pseudodrusen was defined on CFP as punctuate drusen and appeared whiter than soft drusen. Blue channel increased their visibility and identified light interlacing networks. Fundus autofluorescence imaging showed a regular network of round-shaped irregularities with decreased FAF signals. In IR imaging, RPD was characterized as a pattern-like grouping of lesions with decreased reflectivity. In SD-OCT, RPD was seen as subretinal drusenoid deposits above the RPE. These deposits varied in shape and thickness, appearing as cones that can breach the external limiting membrane or as flattened

48

RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES  2016  VOLUME 36  NUMBER 1

lesions. Multicolor confocal scanning laser ophthalmoscopy imaging showed RPD as having a yellowishgreen target-like appearance, much more visible on confocal scanning laser ophthalmoscopy IR reflectance and green reflectance (Figure 1). Because SDOCT formally and directly visualizes the deposits above the RPE, the specificity of this imaging method was defined as 100% in patients with AMD.3,13 So, to be considered as having RPD, eyes had to have SD-OCT evidence of 5 or more definite drusenoid accumulations above the RPE in at least 1 horizontal B-scan. If OCT did not show RPD, IR was evaluated; if IR showed RPD, at least one other examination (MC, FAF, CFP, or BC) had to confirm the presence of RPD. Otherwise, eyes were not considered as having RPD. Thus, patients were classified into 2 different groups: patients with RPD and patients without RPD. Statistical Analysis All statistical analyses were performed using IBM SPSS Version 21 (Portsmouth, United Kingdom). The sensitivity and specificity values were calculated with

their 95% confidence intervals. When the application’s conditions were fulfilled, comparison of categorical variables was made using the chi-square test. When this was not possible, Fisher’s exact test was used. For continuous variables, the Kolmogorov–Smirnov test was used. When the distribution was normal, Student’s t test was used to compare continuous variables; otherwise the nonparametric Mann–Whitney U test was used. A P value less than 0.05 was considered statistically significant. Results In this study, 250 eyes of 125 consecutive patients with AMD were reviewed. Seven eyes (2.8%) were excluded because of poor image quality in SD-OCT, IR, or in the 4 other tests (MC, CFP, BC, and FAF). Two hundred and forty-three eyes were finally included for analysis; of these, 66 had early AMD, 173 had late AMD (28 eyes had macular fibrosis), and 4 eyes were classified as Stage 1 of the AREDS classification. In these four eyes, the contralateral eyes

Fig. 1. Reticular pattern in multimodal imaging of a left eye. A. Color fundus photography: white punctuate drusen in the macular area. B. Blue channel: light interlacing networks. C. Fundus autofluorescence: network of round-shaped irregularities with decreased autofluorescence signal. D. Infrared imaging: pattern-like lesions with decreased reflectivity. E. Multicolor imaging: yellowish-green target-like appearance of RPD. F. B-scan SD-OCT: subretinal drusenoid deposits are seen above the RPE with a conical (arrows) or flattened appearance (asterisks).

49

PREVALENCE OF RETICULAR PSEUDODRUSEN  DE BATS ET AL Table 1. Characteristics of the Study Patients and Eyes RPD Patients Age, n (mean ± SD), years Sex ratio—men, n (%) Eyes ETDRS, n (mean ± SD) Choroidal thickness, n (mean ± SD), mm Diagnosis n (%) No AMD Early AMD Late AMD Macular fibrosis Soft drusen n (%)

86 (80.9 ± 7.3) 26 (30.2%)

Absence of RPD

Odds Ratio (95% Confidence Interval)

P

— 0.77 (0.35–1.72)

0.13 0.67

— —

0.89 0.028

39 (78.3 ± 9.4) 14 (35.9%)

146 (59.1 ± 24.2) 145 (168.3 ± 65.3)

92 (56.6 ± 29.6) 87 (195.6 ± 90.4)

0 (0%) 47 (31.5%) 94 (63.1%) 8 (5.3%) 103 (69.13%)

4 19 51 20 51

— 1 0.76 (0.40–1.44) 0.17 (0.06–0.44) 1.89 (1.11–3.22)

(4.2%) (20.2%) (54.2%) (21.4%) (54.26%)

— — 0.43 ,0.001 0.027

ETDRS, Early Treatment Diabetic Retinopathy Study.

had polypoidal choroidal vasculopathy in three cases and retinal angiomatous proliferation in one case. The mean age of the patients was 80.1 years (±8.1); 85 (68%) were female. Eighty-six patients (68.8% [95% confidence interval, 60.7–76.9]) and 149 eyes (61.3% [95% confidence interval, 55.2–67.4]) had RPD. There was no difference between the 2 groups in age (mean age 80.9 ± 7.3 years in the group with RPD vs. 78.3 ± 9.4 years in the group without RPD; P = 0.13) or gender (30.2% men in the group with RPD vs. 35.9% in the group without RPD; P = 0.67). Also, there was no difference in best-corrected visual acuity between the 2 groups (59.1 ± 24.2 letters in the group with RPD vs. 56.6 ± 29.6 letters in the group without RPD; P = 0.89). Soft drusen was statistically associated with RPD (P = 0.027). The presence or absence of RPD in each type of AMD is summarized in Table 1. Using SD-OCT, IR, FAF, CFP, BC, or MC, it was determined that of 243 eyes, 148 eyes (69.9%), 126 eyes (51.9%), 93 eyes (38.3%), 45 eyes (18.5%), 61 eyes (25.1%), and 122 eyes (50.2%), respectively, had RPD. The sensitivities for the detection of RPD using SDOCT, IR, MC, FAF, CFP, and BC were 99.3, 84.6, 87.1, 73.2, 33.1, and 45.5%, respectively, whereas their specificities were 100, 100, 100, 96.7, 92, and 92%, respectively (Table 2). Spectral domain optical coherence tomography misdiagnosed only 1 eye that had RPD located outside the area of the macular cube 30° · 25°, in the nasal peripapillary area (Figure 2). This RPD was seen on IR with a 55° field. The prevalence of RPD was calculated according to the severity of AMD: 0 of the 4 eyes (0%) with no sign of AMD (Stage 1 of the AREDS classification), 47 of the 66 eyes (71.2%) with early AMD (Stage 2 or 3 of the AREDS classification), 94 of the 145 eyes (64.8%) with late AMD, and 8 of the 28 eyes (28.6%) with

macular fibrosis. There was no statistical difference between the early AMD and late AMD groups (P = 0.43), but there was a statistical difference between the early AMD and macular fibrosis groups (P , 0.001) (Table 3). Similarly, there was no statistical difference in the prevalence of RPD in the various “late AMD” subgroups: 50 of 79 eyes (63.3%) with Type I or Type II neovascularization, 6 of 11 eyes (54.5%) with Type III neovascularization, 3 of 9 eyes (33.3%) with polypoidal choroidal vasculopathy, and 35 of 46 eyes (76.1%) with geographical atrophy. Subfoveal choroidal thickness was measured in 231 eyes. We found a thinned choroid in the group with RPD compared with the group without RPD (168.3 ± 65.3 mm vs. 195.6 ± 90.4 mm; P = 0.028). Discussion Motivated by the current interest in the significance of RPD in AMD, recent studies have used several imaging methods to describe such deposits. Thus, Zweifel et al3 used SD-OCT to show RPD as a subretinal drusenoid deposit located above the RPE. IR and FAF methods were also widely used by many authors to detect RPD.9,10,14,15 More recently, Querques et al Table 2. Sensitivity and Specificity of the Various Imaging Modalities Studied Sensitivity SD-OCT IR FAF MC CFP BC

99.33% 84.56% 73.23% 87.14% 33.09% 45.52%

(98.02–100) (78.76–90.37) (65.53–80.93) (81.60–92.69) (25.18–41.00) (37.09–53.95)

Specificity 100%* 100% 96.74% (93.11–100) 100% 91.95% (86.24–97.67) 91.95% (86.24–97.67)

*According to the RPD definition criteria.

50

RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES  2016  VOLUME 36  NUMBER 1

Fig. 2. Reticular pseudodrusen located in the nasal peripapillary area of a left eye. A. Infrared imaging (IR) with the area of SD-OCT cube (greendotted cube). B. Horizontal Bscan SD-OCT (green line on SD-OCT cube): IR imaging with 55° field shows the reticular pattern (arrow), whereas the 30° · 25° cube of SD-OCT, which encompasses the macula, did not show this pattern.

and Alten et al described the utility of MC imaging in diagnosing RPD.16,17 Reticular pseudodrusen has been shown to be an independent risk factor in developing late AMD,5,6,18–21 neovascular AMD,6,22 and even more frequently geographical atrophy.23–26 The development of multimodal imaging has increased the diagnosis of RPD, and so the prevalence of such deposits.10,15,19 Previous studies found a prevalence of 16% to 38% of RPD in patients with any type of AMD5,10 and 37% to 56% in late exudative AMD.6,19,21,22 However, previous authors used fewer methods of evaluating eyes, such as BC and SD-OCT

Table 3. Prevalence of RPD Depending on the Severity of AMD Diagnosis No AMD Early AMD Late AMD Macular fibrosis

Prevalence of RPD 0/4 eyes (0%) — 47/66 eyes (71.2%) Reference 94/145 eyes (64.8%) P = 0.43 8/28 eyes (28.6%) P , 0.001

with a smaller cube, which could have underestimated the diagnosis of RPD. In our clinical experience, RPD appeared to be more frequently associated with patients with AMD. In this study, 68.8% of the patients had RPD. Unlike other studies, we did not find a higher ratio of RPD in women.27 This high rate was obtained using a large SD-OCT cube or combining it with a technique that viewed a larger field, allowing the location of deposits that were outside the central macular area. The large cube of 30° · 25° in SD-OCT with 31 horizontal B-scans appeared to be the most helpful imaging method in diagnosing RPD. Unlike the classical SD-OCT cube (20° · 20°), this larger cube can detect RPD located along the superior vascular arcades. Moreover, SD-OCT is a tomographic technique enabling the easy visualization of reticular lesions in different layers of the retina and their location relative to the RPE.3,9 However, SD-OCT visualizes the deposit only if the lesion is located in the area screened by the sections of the cube centered on the macula. Therefore, adding one more method with larger field, such as IR, allows the diagnosis of RPD even if they are located in the midperiphery of the fundus or in the nasal peripapillary area (Figure 2).

PREVALENCE OF RETICULAR PSEUDODRUSEN  DE BATS ET AL

We found that MC is a useful screening method for RPD when they are located along with soft drusen because lesions such as soft drusen have a similar appearance to RPD on IR. Consistent with previous reports, RPD was not statistically associated with a particular type of AMD.19,27 However, RPD was statistically less associated with advanced AMD lesions with macular fibrosis. Two hypotheses could explain this result: 1) the subretinal deposits may not have been visualized in advanced AMD with fibroglial scarring in the macular area and 2) RPD are dynamic lesions that could change and disappear with time and perhaps migrate into the retinal layers.28 The high rate of RPD observed in our study (68.8%) is the highest in the published literature and allows the question regarding the significance of such deposits. Reticular pseudodrusen has been statistically associated with soft drusen, the precursor sign of AMD. This result is consistent with the histological results of Curcio et al,13 which suggested that both soft drusen and RPD result from RPE dysfunction. We also found that subfoveal choroidal thickness was thinner in the RPD group than the group without RPD. This observation is consistent with the hypothesis of a choroidal etiology of RPD.29–32 Conclusion In this study, RPD was a very frequent (68.8%) lesion in patients with AMD. Spectral domain optical coherence tomography was the most helpful diagnostic modality in detecting RPD. A larger cube (30° · 25°) than usually used in daily practice (20° · 20°) is recommended to optimize the rate of detection. Indeed, RPD are typically located along the superior vascular arcades, not imaged by the classical 20° · 20° SD-OCT cube. Also, as RPD may be rarely located only in the macular area, another method with a larger field, such as IR, must also be used. Looking forward to new wide-field SD-OCT, we currently recommend that at least two imaging methods, SD-OCT and IR, should be used to detect RPD. Further large-scale studies would help improve and confirm our results. Key words: age-related macular degeneration, fundus autofluorescence, infrared imaging, multicolor imaging, reticular pseudodrusen, spectral domain optical coherence tomography. References 1. Mimoun G, Soubrane G, Coscas G. Macular drusen [in French]. J Fr Ophtalmol 1990;13:511–530. 2. Arnold JJ, Sarks SH, Killingsworth MC, et al. Reticular pseudodrusen. A risk factor in age-related maculopathy. Retina 1995; 15:183–191.

51

3. Zweifel SA, Spaide RF, Curcio CA, et al. Reticular pseudodrusen are subretinal drusenoid deposits. Ophthalmology 2010; 117:303–312. 4. Klein R, Davis MD, Magli YL, et al. The Wisconsin agerelated maculopathy grading system. Ophthalmology 1991; 98:1128–1134. 5. Zweifel SA, Imamura Y, Spaide TC, et al. Prevalence and significance of subretinal drusenoid deposits (reticular pseudodrusen) in age-related macular degeneration. Ophthalmology 2010;117:1775–1781. 6. Cohen SY, Dubois L, Tadayoni R, et al. Prevalence of reticular pseudodrusen in age-related macular degeneration with newly diagnosed choroidal neovascularisation. Br J Ophthalmol 2007;91:354–359. 7. Querques G, Querques L, Martinelli D, et al. Pathologic insights from integrated imaging of reticular pseudodrusen in age-related macular degeneration. Retina 2011;31:518–526. 8. Schmitz-Valckenberg S, Steinberg JS, Fleckenstein M, et al. Combined confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography imaging of reticular drusen associated with age-related macular degeneration. Ophthalmology 2010;117:1169–1176. 9. Suzuki M, Sato T, Spaide RF. Pseudodrusen subtypes as delineated by multimodal imaging of the fundus. Am J Ophthalmol 2014;157:1005–1012. 10. Ueda-Arakawa N, Ooto S, Tsujikawa A, et al. Sensitivity and specificity of detecting reticular pseudodrusen in multimodal imaging in Japanese patients. Retina 2013;33:490–497. 11. Smith RT, Sohrab MA, Busuioc M, et al. Reticular macular disease. Am J Ophthalmol 2009;148:733–743. 12. Bird AC, Bressler NM, Bressler SB, et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 1995;39:367–374. 13. Curcio CA, Messinger JD, Sloan KR, et al. Subretinal drusenoid deposits in non-neovascular age-related macular degeneration: morphology, prevalence, topography, and biogenesis model. Retina 2013;33:265–276. 14. Ooto S, Ellabban AA, Ueda-Arakawa N, et al. Reduction of retinal sensitivity in eyes with reticular pseudodrusen. Am J Ophthalmol 2013;156:1184–1191. 15. Sohrab MA, Smith RT, Salehi-Had H, et al. Image registration and multimodal imaging of reticular pseudodrusen. Invest Ophthalmol Vis Sci 2011;52:5743–5748. 16. Querques G, Srour M, Massamba N, et al. Reticular pseudodrusen. Ophthalmology 2013;120:872. 17. Alten F, Clemens CR, Heiduschka P, et al. Characterisation of reticular pseudodrusen and their central target aspect in multispectral, confocal scanning laser ophthalmoscopy. Graefes Arch Clin Exp Ophthalmol 2014;252:715–721. 18. Lee MY, Yoon J, Ham DI. Clinical features of reticular pseudodrusen according to the fundus distribution. Br J Ophthalmol 2012;96:1222–1226. 19. Ueda-Arakawa N, Ooto S, Nakata I, et al. Prevalence and genomic association of reticular pseudodrusen in age-related macular degeneration. Am J Ophthalmol 2013;155:260–269. 20. Boddu S, Lee MD, Marsiglia M, et al. Risk factors associated with reticular pseudodrusen versus large soft drusen. Am J Ophthalmol 2014;157:985–993. 21. Pumariega NM, Smith RT, Sohrab MA, et al. A prospective study of reticular macular disease. Ophthalmology 2011;118: 1619–1625. 22. Hogg RE, Silva R, Staurenghi G, et al. Clinical characteristics of reticular pseudodrusen in the fellow eye of patients with

52

23.

24.

25.

26.

27.

RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES  2016  VOLUME 36  NUMBER 1 unilateral neovascular age-related macular degeneration. Ophthalmology 2014;121:1748–1755. Schmitz-Valckenberg S, Alten F, Steinberg JS, et al. Reticular drusen associated with geographic atrophy in age-related macular degeneration. Invest Ophthalmol Vis Sci 2011;52: 5009–5015. Finger RP, Wu Z, Luu CD, et al. Reticular pseudodrusen: a risk factor for geographic atrophy in fellow eyes of individuals with unilateral choroidal neovascularization. Ophthalmology 2014; 121:1252–1256. Marsiglia M, Boddu S, Bearelly S, et al. Association between geographic atrophy progression and reticular pseudodrusen in eyes with dry age-related macular degeneration. Invest Ophthalmol Vis Sci 2013;54:7362–7369. Xu L, Blonska AM, Pumariega NM, et al. Reticular macular disease is associated with multilobular geographic atrophy in age-related macular degeneration. Retina 2013;33: 1850–1862. Yoneyama S, Sakurada Y, Mabuchi F, et al. Genetic and clinical factors associated with reticular pseudodrusen in exudative

28.

29.

30.

31.

32.

age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2014;252:1435–1441. Querques G, Canoui-poitrine F, Coscas F, et al. Analysis of progression of reticular pseudodrusen by spectral domainoptical coherence tomography. Invest Ophthalmol Vis Sci 2012;53:1264–1270. Grewal DS, Chou J, Rollins SD, et al. A pilot quantitative study of topographic correlation between reticular pseudodrusen and the choroidal vasculature using en face optical coherence tomography. PLoS One 2014;9:e92841. Ueda-Arakawa N, Ooto S, Ellabban AA, et al. Macular choroidal thickness and volume of eyes with reticular pseudodrusen using swept-source optical coherence tomography. Am J Ophthalmol 2014;157:994–1004. Querques G, Querques L, Forte R, et al. Choroidal changes associated with reticular pseudodrusen. Invest Ophthalmol Vis Sci 2012;53:1258–1263. Garg A, Oll M, Yzer S, et al. Reticular pseudodrusen in early age-related macular degeneration are associated with choroidal thinning. Invest Ophthalmol Vis Sci 2013;54:7075–7081.

PREVALENCE OF RETICULAR PSEUDODRUSEN IN AGE-RELATED MACULAR DEGENERATION USING MULTIMODAL IMAGING.

To determine the rate of reticular pseudodrusen (RPD) in age-related macular degeneration using multimodal imaging, including color fundus photography...
384KB Sizes 1 Downloads 9 Views