Risk factors for development of hyper-reflective foci overlying drusen in eyes with intermediate age-related macular degeneration.

AIMS: The aim of this study is to assess baseline characteristics of drusen preceding the development of intraretinal hyper-reflective foci (IHRF) in eyes with intermediate age-related macular degeneration (AMD). METHODS: In this retrospective case-control study, longitudinal optical coherence tomography (OCT) volume data from eyes with intermediate AMD in a retina clinic population were screened. All drusen that developed overlying IHRF were marked. A random number generator was used to select for further grading three drusen that did not develop IHRF. RESULTS: Ninety eyes (from 72 patients), including 140 drusen with overlying IHRF and 270 IHRF- drusen, were analysed. Greater drusen height, basal drusen width and overlying ellipsoid zone (EZ) and external limiting membrane disruption were associated with a significantly greater risk for IHRF development (p≤0.001). Regression analysis revealed EZ disruption increased these odds by 4.1 (p≤0.001). Each 10-µm increase in drusen height and width increased the odds by 34% (p≤0.001) and 3% (p: 0.005), respectively. Each 100-µm increase in distance from the fovea decreased the odds by 10% (p: 0.013). CONCLUSIONS: The presence of overlying EZ disruption and a greater drusen height substantially increased the risk for IHRF development, whereas drusen further from the fovea indicated reduced risk. Given the importance of IHRF as a biomarker for AMD progression, these findings may be of value in defining patient populations for future early intervention trials.

Relationship between the Presence of a Cilioretinal Artery and Subretinal Fluid in Neovascular Age-Related Macular Degeneration.

PURPOSE: To evaluate the relationship between presence of a cilioretinal artery (CRA) and the extent of subretinal fluid (SRF) in eyes with treatment-naïve neovascular age-related macular degeneration (nAMD). Eyes with nAMD have varying amounts of SRF, and factors affecting exudation volume are not well established. We hypothesize that presence of CRA may affect the extent of SRF by affecting the hemodynamics of blood flow supplying the choroidal neovascular membrane. DESIGN: Retrospective case-control study. PARTICIPANTS: Two hundred twelve patients with treatment-naïve nAMD in at least 1 eye from anonymized datasets available at the Doheny Image Reading Center. METHODS: Color fundus photographs and fluorescein angiograms of the study eyes were reviewed to identify those with a CRA (cases) and those without (controls). Spectral-domain OCT data were evaluated by 2 masked graders to identify presence and volume of SRF. We identified subtypes of CNV and evaluated other OCT features that could affect SRF, such as presence of subretinal hyperreflective material (SHRM), cystoid macular edema (CME), and pigment epithelial detachment (PED). Nonparametric Mann-Whitney U test and univariate and multivariate analyses were performed to identify significant differences between cases and controls and to evaluate the relationship between these factors and SRF volume. MAIN OUTCOME MEASURES: Presence and volume of SRF, presence of CME, PED types, and CNV types. RESULTS: We identified 44 cases and 168 controls. Mean SRF volume was significantly lower in cases than controls (0.72±0.9 mm3 vs. 1.60±2.36 mm3; P = 0.03). Univariate regression analysis showed a weakly significant correlation between presence of CRA and SRF volume (r = -0.15; P = 0.03) and OCT parameters, including SHRM (r = 0.16; P = 0.023), CME (r = -0.20; P = 0.004), and type 2 CNV (r = 0.16; P = 0.02). Multivariate analysis demonstrated that the presence of a CRA (r = -0.17; P = 0.02) was correlated independently with the presence of SRF. CONCLUSIONS: Presence of a CRA was correlated negatively with the volume of SRF in eyes with nAMD. These findings may draw insights into the potential hemodynamic effect of the CRA, which warrants further investigation.