SUB RETINAL PIGMENT EPITHELIUM HYPOREFLECTIVE SPACES PRECEDING LARGE DRUSEN COLLAPSE

Area of Science:

• Ophthalmology
• Retinal Imaging
• Age-Related Macular Degeneration

Background:

• Intermediate age-related macular degeneration (AMD) is characterized by large drusen.
• Subretinal pigment epithelium (RPE) spaces are not well-characterized before drusen collapse.

Purpose of the Study:

• To describe and study hyporeflective subretinal pigment epithelium (RPE) spaces in large drusen and drusenoid pigment epithelial detachment before collapse.
• Investigate the association of these spaces with AMD progression.

Main Methods:

• Retrospective longitudinal study of 50 eyes from 41 patients with intermediate AMD.
• Optical coherence tomography (OCT) assessed drusen size, RPE atrophy, fluid, and sub-RPE hyporeflective spaces.

Main Results:

• Eyes with sub-RPE hyporeflective spaces had larger drusen width and height.
• These eyes showed poorer visual acuity and greater RPE and outer retinal atrophy at collapse (P = 0.004).

Conclusions:

• Sub-RPE hyporeflective spaces are a novel OCT finding in large drusen that precede collapse and atrophy.
• Suggests progressive RPE dysfunction and degeneration before structural failure in AMD.