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THE ASSOCIATION BETWEEN DRUSEN EXTENT AND FOVEOLAR CHOROIDAL BLOOD FLOW IN AGE-RELATED MACULAR DEGENERATION

Berenberg, Thomas L MD; Metelitsina, Tatyana I MD; Madow, Brian MD; Dai, Yang MSc; Ying, Gui-Shuang PhD; Dupont, Joan C CCRC; Grunwald, Lili MD; Brucker, Alexander J MD; Grunwald, Juan E MD

doi: 10.1097/IAE.0b013e3182150483
Original Study

Purpose: To investigate the relationship between drusen extent and foveolar choroidal blood flow in nonexudative age-related macular degeneration.

Methods: Total drusen area, average druse area, and total drusen number were determined using a computer program developed to quantify the extent of manually outlined drusen from fundus photographs of 157 patients (239 eyes) with nonexudative age-related macular degeneration. Laser Doppler flowmetry was used to assess relative choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow) in the center of the fovea.

Results: We found a significant inverse relationship between total drusen area and ChBVol or ChBFlow. For every 1-mm2 increase in total drusen area, ChBVol decreased by 0.0061 arbitrary units (P = 0.03) and ChBFlow decreased by 0.23 arbitrary units (P = 0.049). Average druse area was also significantly inversely related to ChBVol and ChBFlow. For every 0.01-mm2 increase in average druse area, the ChBVol decreased by 0.0149 arbitrary units (P = 0.001) and the ChBFlow decreased by 0.4951 arbitrary units (P = 0.003). Adjustment for age weakened the significance, although it remained strong for average druse area versus ChBFlow (P = 0.017) and ChBVol (P = 0.004). The computer-aided quantification of drusen used in this study showed high intra- and intergrader agreement.

Conclusion: In patients with nonexudative age-related macular degeneration, there is an association between increased drusen extent and decreased ChBVol and ChBFlow. This suggests the presence of ischemia and possibly the reason why patients with high-risk drusen are prone to advanced disease.

In patients with nonexudative age-related macular degeneration, there is an association between increased drusen extent and decreased ChBVol and ChBFlow. This suggests the presence of ischemia and possibly the reason why patients with high-risk drusen are prone to advanced disease.

From the Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.

Supported by the National Eye Institute Grant EY12769, the Vivian Simkins Lasko Research Fund, the Nina C. Mackall Trust, and an unrestricted grant from the Research to Prevent Blindness.

The authors have no proprietary or conflicts of interest to disclose.

Reprint requests: Juan E. Grunwald, MD, Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, 51 North 39th Street, Philadelphia, PA 19104; e-mail: juan.grunwald@uphs.upenn.edu

© The Ophthalmic Communications Society, Inc.