Purpose: To evaluate drusenoid retinal pigment epithelial detachments (DPED) secondary to age-related macular degeneration (AMD) using spectral-domain optical coherence tomography imaging.
Methods: In this prospective natural history study, eyes from patients with the diagnosis of nonexudative AMD and DPEDs were followed for at least 6 months. Eyes were scanned using the Cirrus spectral-domain optical coherence tomography instrument and the 200 × 200 A-scan raster pattern. A custom software was used to quantify volumetric changes in DPEDs and to detect the evolution and formation of geographic atrophy and choroidal neovascularization. Changes in DPED area and volume and development of the advanced forms of AMD were the main outcome.
Results: Of the 130 patients (186 eyes) with nonadvanced AMD, 11 patients (16 eyes) presented with DPEDs during the study. Mean follow-up was 18.5 months. Most DPEDs had an area exceeding 1 disk area (14 of 16 eyes) based on color fundus images with a mean area of 4.19 mm2 (SD = 1.35) measured by spectral-domain optical coherence tomography. The mean volume at the time the DPED was diagnosed was 0.48 mm3 (SD = 0.28). Four different patterns of progression were observed: DPEDs remained unchanged in 8 of 16 eyes (50%), DPEDs tended to increase in volume before progressing to geographic atrophy in 5 eyes (31.25%) and choroidal neovascularization in 2 eyes (12.5%), and a DPED decreased by more than 50% without progressing to geographic atrophy or choroidal neovascularization in 1 eye (6.25%).
Conclusion: Spectral-domain optical coherence tomography imaging is able to detect subtle changes in the area and volume of DPEDs. Quantitative spectral-domain optical coherence tomography imaging of DPEDs is useful for identifying the natural history of disease progression and as a clinical tool for monitoring eyes with AMD in clinical trials.
Drusenoid detachments of the retinal pigment epithelium were evaluated over time using a novel algorithm capable of measuring the area and volume of retinal pigment epithelial elevations when imaged with spectral-domain optical coherence tomography.
*Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; and
†Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
Reprint requests: Philip J. Rosenfeld, MD, PhD, Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136; e-mail: firstname.lastname@example.org
Supported by a grant from Carl Zeiss Meditec, Inc, Dublin, CA, an unrestricted grant from Research to Prevent Blindness, Inc, NEI core center grant P30 EY014801 and Department of Defense (DOD-Grant#W81XWH-09-1-0675) to the University of Miami, the Jerome A. Yavitz Charitable Foundation, the Macula Vision Research Foundation, Feig Family Foundation, the Gemcon Family Foundation, the Carl and Lily Pforzheimer Foundation, and the Emma Clyde Hodge Memorial Foundation.
Drs. Garcia Filho, Yehoshua, Gregori, and Rosenfeld received research support from Carl Zeiss Meditec, Inc. G. Gregori coowns a patent that is licensed to Carl Zeiss Meditec, Inc. P. J. Rosenfeld has received honoraria for lectures from Carl Zeiss Meditec, Inc. W. Feuer and Dr. M. E. Farah has no financial or proprietary interest in the materials presented herein.