Characterization of Reticular Drusen and Association with Age Macular Degeneration through Multiple Imaging Modalities
Year of Publication
Nigam, DL; Zhou, M; Cunningham, D; Chew, E; Agron, E
Association for Research in Vision and Ophthalmology - ARVO
Ft. Lauderdale, FL
age-related macular degeneration; drusen; retinal neovascularization
Purpose: The clinical significance of reticular drusen is limited because few longitudinal studies specifically evaluate these lesions. The purpose of this study was to examine the characteristics of reticular drusen and its relationship to age-related macular degeneration (AMD) through multiple fundus imaging techniques. Methods: From several clinical protocols of AMD at the National Eye Institute Clinical Center, participants were identified retrospectively from multiple imaging techniques including color fundus photography, fundus autofluorescence, red-free and infra-red, and spectral-domain optical coherence tomography (SD-OCT). Fundus photographs were graded for features of AMD. Reticular drusen was noted when whitish yellow drusen, 125-250 µm in size, appear in an indistinct interlacing pattern. Results: 51 participants (78.4% women) and 86 eyes were identified to have reticular drusen from six protocols. The mean age at initial identification of reticular drusen was 77.6 years and mean follow-up was 2.34 years (0-9 years). The major were bilateral (68.6%) and the rest were unilateral or indeterminate. Reticular drusen were the only lesions in 12.8% of eyes and these participants were the normal volunteers in a number of AMD studies. 65% of eyes had advanced AMD, identified as central geographic atrophy (CGA, 29%) or choroidal neovascularization (CNV, 30.2%). Only four eyes exhibited regression in reticular drusen with CNV. When comparing the multiple imaging modalities used, we found fundus autofluorescence to be the most sensitive as 98.8% of these eyes showed reticular drusen in this modality. Imaging modalities within each patient showed good correspondence in location, appearance and extent of reticular drusen. Reticular drusen were found throughout the retina but two patterns of distribution were noted. In the first pattern, reticular drusen tended to be superior to the fovea and spared the central region which we referred to as “central sparing” (n=36 eyes). In the second pattern, reticular drusen was found throughout the posterior pole and the central region was not spared, “non-central sparing” (n=50 eyes). Both patterns were seen in the context of various stages of AMD pathology and neither showed a statistically significant association with any given stage. Conclusions: We have identified persons with and without AMD who have reticular drusen and delineated some characteristics seen on fundus imaging. Further studies are warranted in evaluating the significance of the association of reticular drusen with aging and AMD.