Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging

Abstract

Purpose: To assess the prevalence of subretinal drusenoid deposits (SDD) in older adults with healthy maculas and early and intermediate age-related macular degeneration (AMD) using multimodal imaging.

Design: Cross-sectional study.

Participants: A total of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration from primary care ophthalmology clinics.

Methods: Subjects were imaged using spectral domain optical coherence tomography (SD OCT) of the macula and optic nerve head (ONH), infrared reflectance, fundus autofluorescence, and color fundus photographs (CFP). Eyes were assessed for AMD presence and severity using the Age-Related Eye Disease Study (AREDS) 9-step scale. Criteria for SDD presence were identification on ≥1 en face modality plus SD OCT or on ≥2 en face modalities if absent on SD OCT. Subretinal drusenoid deposits were considered present at the person level if present in 1 or both eyes.

Main outcome measures: Prevalence of SDD in participants with and without AMD.

Results: Overall prevalence of SDD was 32% (197/611), with 62% (122/197) affected in both eyes. Persons with SDD were older than those without SDD (70.6 vs. 68.7 years, P = 0.0002). Prevalence of SDD was 23% in subjects without AMD and 52% in subjects with AMD (P < 0.0001). Among those with early and intermediate AMD, SDD prevalence was 49% and 79%, respectively. After age adjustment, those with SDD were 3.4 times more likely to have AMD than those without SDD (95% confidence interval, 2.3-4.9). By using CFP only for SDD detection per the AREDS protocol, prevalence of SDD was 2% (12/610). Of persons with SDD detected by SD OCT and confirmed by at least 1 en face modality, 47% (89/190) were detected exclusively on the ONH SD OCT volume.

Conclusions: Subretinal drusenoid deposits are present in approximately one quarter of older adults with healthy maculae and in more than half of persons with early to intermediate AMD, even by stringent criteria. The prevalence of SDD is strongly associated with AMD presence and severity and increases with age, and its retinal topography including peripapillary involvement resembles that of rod photoreceptors. Consensus on SDD detection methods is recommended to advance our knowledge of this lesion and its clinical and biologic significance.

Figure 1. Eyes meeting strict criteria for subretinal drusenoid deposits (SDD) with multimodal imaging

A. An 81-year-old man (Age-Related Eye Disease Study [AREDS] grade 4) has visible SDD by infrared reflectance (IR) (indicated by ticks; magnified 3X in inset), spectral domain optical coherence tomography (SD-OCT) (arrows) and fundus autofluorescence (FAF) (not shown). B. A 73-year-old woman (AREDS grade 1) has visible SDD by IR (arrows) and color fundus photographs (CFP) (arrows) without SD-OCT findings (not shown). C. A 78-year-old woman (AREDS grade 2) has visible SDD by CFP (indicated by ticks; magnified 3X in inset), SD-OCT (arrows) and IR (not shown).

Figure 2. Non-age-related macular degeneration (AMD) subject with subretinal drusenoid deposits (SDD) by strict criteria

A–C. A 66-year-old woman (Age-Related Eye Disease Study [AREDS] grade 1).. A. An infrared reflectance (IR) image of a healthy macula. B. When the IR image is magnified, a hyporeflective smudge (arrowhead) that correlates with optical coherence tomography (OCT) scan in C is apparent. C. By spectral domain (SD) OCT, hyperreflective material between retinal pigment epithelium (RPE) and ellipsoid zone (arrowhead) is classified as SDD (stage 2). This lesion was undetectable on fundus autofluorescence (FAF) and color fundus photographs (CFP) (not shown).

Figure 3. Peripapillary subretinal drusenoid deposits (SDD) by strict criteria

A-D. A 70-year-old man (Age-Related Eye Disease Study [AREDS] grade 1). A. color fundus photograph (CFP) shows a healthy macula. Arrowheads indicate locations where SDD (yellow) and basal laminar deposit (cyan) was found on optical coherence tomography (OCT) scans in C. B. Mottled reflectivity seen on infrared reflectance (IR) (yellow) was not seen on fundus autofluorescence (FAF) (not shown). Site of peripapillary basal laminar deposit is shown (cyan). C. SDD is seen in the optic nerve head (ONH) spectral domain (SD) OCT volume as a hyperreflective mound between retinal pigment epithelium (RPE) and ellipsoid zone (yellow). D. Basal laminar deposit without overlying RPE (cyan) is close to the termination of Bruch’s membrane and reflective.