Abstract

SA.21.02

Optical coherence tomography findings in reticular pseudodrusen

Sandrine Anne Zweifel1, Yutaka Imamura1, Richard F. Spaide2
1LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, United States; 2Vitreous-Retina-Macula Consultants of New York, United States

Objective
To characterize the spectral domain optical coherence tomography (SD-OCT) appearance of reticular pseudodrusen (RPD), a risk factor for late age-related macular degeneration.
Methods
Consecutive patients with RPD examined in a two month period 2009 were included in this study. The diagnosis of RPD was made by their typical appearance and distribution on the blue channel of color fundus photographs and the near-infrared images obtained with the Heidelberg Spectralis. The patients were imaged by SD-OCT sections each comprised of up to 100 averaged scans. The point-to-point correlation of the Spectralis was used to find correlative pathology between the near-infrared image and the SD-OCT image. The pathology observed was evaluated and graded.
Results
There were 59 eligible eyes with RPD in 34 patients; they had a mean age of 81 years and 20 were females. The correlating SD-OCT scans showed collections of granular hyperreflective material above the retinal pigment epithelium (RPE), in the subretinal space. The material was chiefly located in the region between the RPE and the boundary between the inner and outer segments of the photoreceptors (IS/OS boundary). In a more advanced stage this material formed small mounds displacing the IS/OS boundary, and even penetrated into the outer nuclear layer resulting in a discontinuous IS/OS boundary. The location of this material in RPD is clearly distinguishable from that in soft drusen, which are located under the RPE and where simultaneously found in 35 eyes. The internal reflectivity of the material in RPD was similar to that of soft drusen.
Conclusions
SD OCT demonstrates for the first time that RPD cause nodular accumulation of material in the subretinal space. This is an unexpected location suggests potential pathophysiologic mechanisms on both sides of the RPE and needs to be taken into account in theories related to the development of late age-related macular degeneration.

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