A prospective study of reticular macular disease

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Age-related macular degeneration (AMD) is a leading cause of vision loss.
• Reticular pseudodrusen (RPD) are an imaging finding associated with reticular macular disease (RMD).
• The risk of progression conferred by RPD in high-risk eyes is not fully understood.

Purpose of the Study:

• To determine the risk of progression to advanced AMD in fellow eyes with RPD.
• To assess RPD as an imaging presentation of RMD.
• To evaluate progression in high-risk eyes of subjects with unilateral choroidal neovascularization (CNV).

Main Methods:

• A prospective cohort study of 271 subjects with AMD.
• Analysis of fellow eyes at high risk for advanced AMD.
• Imaging included color, red-free, blue-light photography, and fluorescein angiography over 3 years.
• Eyes were assessed for RPD and progression to advanced AMD (CNV or geographic atrophy).

Main Results:

• Eyes with RPD showed a significantly higher rate of advanced AMD (56%) compared to eyes without RPD (32%).
• The relative risk of advanced AMD in eyes with RPD was 1.8 (95% CI, 1.4-2.4).
• Women with RPD had more than double the risk of developing advanced AMD compared to women without RPD.

Conclusions:

• Reticular macular disease (RMD), characterized by RPD, is associated with a high risk of progression to advanced AMD.
• This is the first prospective study to confirm RMD as a distinct clinical phenotype with significant AMD progression risk.
• RMD may warrant wider clinical recognition due to its association with AMD progression, potentially on an inflammatory or vascular basis.