Topographically Resolved Macular Pigment Optical Density Is Associated with Disease Progression in Macular...

To investigate differences in topographically resolved macular pigment optical density (MPOD) between macular telangiectasia type 2 (MacTel) stages and to analyze its association with disease progression.

Longitudinal cohort study.

Participants of the Natural History and Observation Registry study and the University Eye Hospital in Bonn.

Participants underwent multimodal retinal imaging including spectral-domain OCT, two-wavelength autofluorescence (2WAF) imaging for MPOD, and color fundus photography. Disease stage (0-6) was graded according to Chew et al. Macular pigment optical density en face maps were generated from 2WAF images, aligned to the fovea, and averaged within ETDRS subfields. Spatial differences across stages were assessed using linear mixed-effects models. Progression was defined as stage increase during follow-up and analyzed using univariable and multivariable regression models to estimate odds ratios for progression.

Differences in topographically resolved MPOD, and association with disease progression.

A total of 265 eyes from 220 patients with MacTel (mean age 62.6 ± 7.7 years; 60.5% female) were analyzed. Eyes were staged as follows: stage 0 (38 eyes), stage 1 (45), stage 2 (67), stage 3 (12), stage 4 (24), stage 5 (46), and stage 6 (33). En face maps demonstrated stage-dependent alterations in MPOD: early temporal depletion and a preserved nasal-inferior bridge of MP in stages 1 to 4, followed by progressive central and nasal loss and attenuation of the parafoveal ring. Macular pigment optical density differed significantly across stages in the central and inner ETDRS subfields (all P < 0.001, except superior inner subfield), but not in outer subfields. Among the 232 eyes (stages 0-5) included in progression analysis (mean follow-up 2.5 ± 3 years), progressing eyes showed more pronounced temporal and nasal MPOD depletion. Higher MPOD in the temporal inner subfield was associated with reduced progression risk (odds ratio 0.97, P = 0.006).

Macular pigment optical density maps reveal spatial alterations in MacTel and demonstrate the likelihood of progress of quantitative MPOD measurements. These findings may help identify eyes that could benefit from early neuroprotective interventions before irreversible vision loss occurs.

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