TY - JOUR
T1 - The fate and prognostic implications of hyperreflective crystalline deposits in nonneovascular age-related macular degeneration
AU - Fragiotta, Serena
AU - Fernáandez-Avellaneda, Pedro
AU - Breazzano, Mark P.
AU - Curcio, Christine A.
AU - Leong, Belinda C.S.
AU - Kato, Kenneth
AU - Yannuzzi, Lawrence A.
AU - Freund, K. Bailey
N1 - Funding Information:
Supported by The Macula Foundation, Inc., New York, New York, United States, the Honors Center of Italian Universities (H2CU) (SF), Heidelberg Engineering, and Hoffman La Roche (CAC). The Department of Ophthalmology and Visual Science of the University of Alabama at Birmingham receives institutional support from EyeSight Foundation of Alabama and Research to Prevent Blindness, Inc. Disclosure: S. Fragiotta, None; P. Fernández-Avellaneda, None; M.P. Breazzano, None; C.A. Curcio, None; B.C.S. Leong, None; K. Kato, None; L.A. Yannuzzi, None; K.B. Freund, Genentech (C), Optovue (C), Zeiss (C), Heidelberg Engineering (C), Allergan (C), Novartis (C)
Publisher Copyright:
© 2019 The Authors. All rights reserved.
PY - 2019/7
Y1 - 2019/7
N2 - PURPOSE. To explore patterns of disease progression in nonneovascular age-related macular degeneration (AMD) associated with hyperreflective crystalline deposits (HCDs) in the subretinal pigment epithelium–basal laminar space. METHODS. Retrospective review of medical records, multimodal imaging, and longitudinal eyetracked near-infrared reflectance (NIR) and optical coherence tomography (OCT) spanning years. NIR/OCT images were analyzed with ImageJ software to identify HCD morphology and location. Associated macular complications were reviewed from the time of HCD detection to the most recent follow-up, using NIR/OCT. RESULTS. Thirty-three eyes with HCDs from 33 patients (mean age: 72 ± 7.5 years) had 46.7 months (95% confidence limits: 33.7, 59.6) of serial eye-tracked NIR/OCT follow-up. Baseline best-corrected visual acuity (BCVA) was 0.44 logMAR (Snellen equivalent 20/55). At a mean of 11.3 months (3.1, 19.6) after HCD detection, 31/33 (93.9%) eyes had developed macular complications including de novo areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in 21/33 (64%) eyes, enlargement of preexisting cRORA in 4/33 (12%) eyes, and incident macular neovascularization in 3/33 (9%) eyes. Movement and clearance of HCDs in 9/33 (27%) eyes was associated with enlargement of preexisting cRORA (r = 0.44, P = 0.02). BCVA at the last follow-up visit had decreased to 0.72 logMAR (20/105). CONCLUSIONS. Eyes with nonneovascular AMD demonstrating HCDs are at risk for vision loss due to macular com lications, particularly when movement and clearance of these structures appear on multimodal imaging. HCD reflectivity and dynamism may be amenable to automated recognition and analysis to assess cellular activity related to drusen end-stages.
AB - PURPOSE. To explore patterns of disease progression in nonneovascular age-related macular degeneration (AMD) associated with hyperreflective crystalline deposits (HCDs) in the subretinal pigment epithelium–basal laminar space. METHODS. Retrospective review of medical records, multimodal imaging, and longitudinal eyetracked near-infrared reflectance (NIR) and optical coherence tomography (OCT) spanning years. NIR/OCT images were analyzed with ImageJ software to identify HCD morphology and location. Associated macular complications were reviewed from the time of HCD detection to the most recent follow-up, using NIR/OCT. RESULTS. Thirty-three eyes with HCDs from 33 patients (mean age: 72 ± 7.5 years) had 46.7 months (95% confidence limits: 33.7, 59.6) of serial eye-tracked NIR/OCT follow-up. Baseline best-corrected visual acuity (BCVA) was 0.44 logMAR (Snellen equivalent 20/55). At a mean of 11.3 months (3.1, 19.6) after HCD detection, 31/33 (93.9%) eyes had developed macular complications including de novo areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in 21/33 (64%) eyes, enlargement of preexisting cRORA in 4/33 (12%) eyes, and incident macular neovascularization in 3/33 (9%) eyes. Movement and clearance of HCDs in 9/33 (27%) eyes was associated with enlargement of preexisting cRORA (r = 0.44, P = 0.02). BCVA at the last follow-up visit had decreased to 0.72 logMAR (20/105). CONCLUSIONS. Eyes with nonneovascular AMD demonstrating HCDs are at risk for vision loss due to macular com lications, particularly when movement and clearance of these structures appear on multimodal imaging. HCD reflectivity and dynamism may be amenable to automated recognition and analysis to assess cellular activity related to drusen end-stages.
KW - age-related macular degeneration
KW - cholesterol
KW - complete retinal pigment epithelium and outer retinal atrophy
KW - crystals
KW - drusen
KW - hyperreflective crystalline deposits
KW - macular neovascularization
KW - refractile deposits
KW - spectral-domain optical coherence tomography
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U2 - 10.1167/iovs.19-26589
DO - 10.1167/iovs.19-26589
M3 - Article
C2 - 31323680
AN - SCOPUS:85071608145
VL - 60
SP - 3100
EP - 3109
JO - Investigative Ophthalmology and Visual Science
JF - Investigative Ophthalmology and Visual Science
SN - 0146-0404
IS - 8
ER -