Reticular Pseudodrusen Characteristics and Associations in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2), an Ancillary Study of the Women's Health Initiative

Abstract

Purpose: To determine the prevalence and morphologic features of reticular pseudodrusen (RPD) and their association with participant demographics and age-related macular degeneration (AMD) status in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2) sample, an ancillary study of the Women's Health Initiative Observational Study.

Design: Cross-sectional, multicenter, natural history study.

Participants: Nine hundred and twenty-seven eyes from 466 postmenopausal women 69 to 101 years of age.

Methods: Multimodal imaging, including spectral-domain (SD) OCT and infrared reflectance (IR), were used to identify RPD characteristics, including location (within or outside the 6-mm diameter circle centered at the macula), presence of peripapillary RPD, pattern of RPD, and RPD area. Age-related macular degeneration features from SD OCT, IR, and color photographs also were assessed and AMD severity was categorized.

Main outcome measures: Reticular pseudodrusen prevalence using SD OCT and IR imaging and AMD status.

Results: Reticular pseudodrusen were present in 130 eyes (14% of eyes, 16% of participants), with increasing prevalence with age: 7% in those younger than 78 years, 14% in those 78 to 83 years of age, and 30% in those older than 83 years. Using clinical classification of AMD with color photography, RPD were seen in 2.4% of eyes with no AMD or aging changes, 11.5% in early AMD, 25.1% in intermediate AMD, and 51.1% in late AMD. Mean RPD area was 17.4 mm² (standard deviation, 14.7 mm²). Ribbon morphologic RPD (53%) was more common than dot morphologic RPD (36%). Reticular pseudodrusen mostly were located both within and outside the 6-mm circle with primarily superior retinal distribution. Reticular pseudodrusen were visualized with corresponding color fundus photography in only 38 eyes (4% of total eyes). Participants with and without RPD had a visual acuity±standard error of 77.9 ± 1.4 letters and 81.3 ± 0.4 letters, respectively (P = 0.02).

Conclusions: The prevalence of RPD in CAREDS2 increased with age and was associated with AMD severity. Reticular pseudodrusen were detected in eyes without other features of AMD and could represent an earlier disease state. Multimodal imaging with SD OCT and IR has significantly greater sensitivity for visualizing RPD than color fundus photography.

Keywords: Age-related macular degeneration; Carotenoids in Age-Related Eye Disease Study 2; Optical coherence tomography; Reticular pseudodrusen.

Figure 1.

RPD visualized with different imaging modalities. A, RPD are detected as hyporeflective dots and/or confluent ribbons on infrared imaging. B, RPD appear as hyperreflective deposits between the ellipsoid zone and RPE-BrM (asterisks). C, On color fundus photography RPD appear as an ill-defined network of white-to-yellow broad interlacing ribbons (arrow).

Figure 2.

RPD morphology visualized on IR. A, Predominantly ribbon RPD with a superior distribution and peripapillary involvement. B, Dot morphology with a superior distribution.