Global versus localized association of reticular pseudodrusen with relative ellipsoid zone reflectivity in intermediate age-related macular degeneration

Purpose : The relative ellipsoid zone reflectivity (rEZR) is an indicator for outer retinal integrity on spectral-domain optical coherence tomography (SD-OCT). In global (eye level) analyses, reticular pseudodrusen (RPD) are cross-sectionally associated with a more reduced rEZR in intermediate age-related macular degeneration (iAMD) eyes. Further, rEZR decreases over time more rapidly in eyes with vs. without RPD. This study aimed to assess the spatial impact of RPD on the rEZR. Methods : The rEZR [arbitrary units, AU] was determined in raw SD-OCT volume scans (241 B-scans, field size 30°x25°) from baseline visit of the MACUSTAR study. RPDs’ presence topographical information was obtained by its area’s manual annotation in infrared imaging. Other iAMD features, including pigmentary abnormalities (PA) and the RPEDC volume were also determined. Linear mixed-effects models with the rEZR as the dependent variable were applied to evaluate the impact of global vs. spatial vs. global+spatial RPD presence on the localized rEZR (with covariates adjusting for age and eccentricity). Results : A total of 164 eyes of 164 patients (mean±SD age: 71.3±7.52 years) of the iAMD MACUSTAR study cohort were included. The global presence of RPD was associated with a reduced rEZR of -6.45 AU (95%-CI: -12.24;-0.67 [p=0.029]). The presence of PA was also associated with an rEZR reduction (-3.91 AU [-8.52;0.71 (p=0.097)] as well as an RPEDC volume [mm3] increase (-2.49 AU [-39.23;34.24 (p=0.894)]. Considered topographically, RPD exhibited an association with the rEZR of -11.74 AU (-11.90;-11.58 [p<0.001]), the RPEDC volume of -1.87 AU (-38.15;34.40 [p=0.919]) and the presence of PA of -4.26 AU (-8.79;0.28 [p=0.066]). Taken further the global and topographical RPD presence simultaneously into account, only RPD were shown to exhibit an association with the rEZR when considered topographically as demonstrated by an rEZR decrease of -11.74 AU (-11.90;-11.58 [p<0.001]). Conclusions : The rEZR exhibited a significant association with the presence of RPD, a high-risk structural phenotype for AMD progression. This was even more pronounced when the topographical information of RPD within an eye was also taken into account. Ongoing studies assess the prognostic value of the rEZR for progression to late-stage AMD manifestations.

Citation

Thiele, S., Behning, C., Liermann, Y., Sassmannshausen, M., Weinhold, L., Isselmann, B., Schmid, M., Finger, R. P., Schmitz-Valckenberg, S., Pfau, M., Luu, C. D., & Holz, F. G. (2023). Global versus localized association of reticular pseudodrusen with relative ellipsoid zone reflectivity in intermediate age-related macular degeneration. Investigative Ophthalmology & Visual Science, 64(8), Article 4326.

URI

https://hdl.handle.net/20.500.14709/526