Abstract
To characterize the prevalence of some critical optical coherence tomography (OCT) biomarkers-including cuticular drusen and acquired vitelliform lesions (AVLs)-and to identify their relative risk for progression to late age-related macular degeneration (AMD) over two years in subjects with early or intermediate AMD in the Amish Eye Study.
Prospective, observational, longitudinal, population-based cohort study.
This study included 276 eyes from 171 subjects with early or intermediate AMD at baseline who completed the two-year follow-up.
Baseline OCT scans were evaluated for the presence of: cuticular drusen, AVLs, subretinal drusenoid deposits (SDD), high drusen volume (defined as ≥0.2mm
within the central 5mm), intraretinal hyperreflective foci (IHRF), hyporeflective drusen cores (hDC), thick/thin double-layer sign, and incomplete retinal pigment epithelium and outer retinal atrophy (iRORA). Subfoveal choroidal thickness (SFCT) was also measured.
Incidence of late AMD (geographic atrophy or macular neovascularization) at two years as determined by multimodal imaging (OCT, color fundus photography (CFP), and confocal fundus autofluorescence (FAF)).
By 2-years of follow-up, 26 eyes (10.7%) progressed to late AMD. The most prevalent baseline features in this cohort, in descending order, were cuticular drusen (52.3%), IHRF (17.3%), hDC (16.0%), thin DLS (11.9%), SDD (8.2%), iRORA (7.8%), AVL (7.0%), and high drusen volume (2.5%). The mean SFCT was 243.23 ± 75.45 μm. Univariate analysis demonstrated that the presence of thick DLS, iRORA, AVL, SDD, IHRF, hDC, and SFCT were associated with increased risk of progression. In multivariate regression, however, only the presence of iRORA (OR: 29.60; 95% CI: 6.86-127.84; p < 0.001) and AVL (OR: 15.90; 95% CI: 3.24-78.00; p < 0.001) remained significant, while the presence of IHRF showed borderline significance (OR: 4.71; 95% CI: 1.00-22.16; p = 0.050).
In this cohort, the presence of iRORA and AVL was independently associated with progression to late AMD over 2 years. Although cuticular drusen were highly prevalent, their presence, as assessed in this study, was not significantly associated with an increased risk of progression to late AMD.