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Reticular pseudodrusen load is associated with an increased risk of stroke
Roy Schwartz1,2,3, Abraham Olvera-Barrios4, Alasdair N Warwick2,5
1NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK roy.schwartz1@nhs.net.
BMJ Open Ophthalmology
|July 20, 2026
Summary
Increased reticular pseudodrusen (RPD) load is linked to a higher stroke risk, independent of other cardiovascular factors. This finding suggests RPD may be a distinct condition requiring cardiovascular risk assessment.
Area of Science:
- Ophthalmology
- Cardiology
- Medical Imaging
Background:
- Reticular pseudodrusen (RPD) are increasingly recognized as a distinct phenotype within the age-related macular degeneration (AMD) spectrum.
- This study investigates the association between RPD and cardiovascular outcomes, specifically myocardial infarction (MI) and stroke.
Purpose of the Study:
- To determine the association between reticular pseudodrusen (RPD) load and cardiovascular outcomes (MI and stroke).
- To differentiate the cardiovascular risk associated with RPD compared to drusen.
Main Methods:
- Retrospective analysis of 2010 UK Biobank participants.
- A deep learning framework identified and quantified RPD and drusen on optical coherence tomography, validated by retina specialists.
- Multivariable logistic regression assessed associations with stroke and MI, adjusting for cardiovascular risk factors.
Main Results:
- A significant association was found between higher RPD load and increased stroke risk (OR 1.02 per 20 lesions, p=0.042).
- Each 20 RPD lesions increased stroke risk by 1.02, with a mean of 199 RPD lesions per patient indicating a 20% increased stroke risk.
- No significant association was observed between drusen and stroke, or between RPD/drusen and myocardial infarction.
Conclusions:
- Increased RPD load is independently associated with a higher risk of stroke.
- RPD may represent a distinct disease entity from drusen, warranting cardiovascular risk evaluation in patients with numerous RPD.
- Further prospective studies are needed to confirm findings and explore underlying mechanisms.
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