The fate and prognostic implications of hyperreflective crystalline deposits in nonneovascular age-related macular degeneration

Serena Fragiotta, Pedro Fernáandez-Avellaneda, Mark P. Breazzano, Christine A. Curcio, Belinda C.S. Leong, Kenneth Kato, Lawrence A. Yannuzzi, K. Bailey Freund

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3100-3109
Number of pages10
JournalInvestigative Ophthalmology and Visual Science
Volume60
Issue number8
DOIs
StatePublished - Jul 2019
Externally publishedYes

Keywords

  • age-related macular degeneration
  • cholesterol
  • complete retinal pigment epithelium and outer retinal atrophy
  • crystals
  • drusen
  • hyperreflective crystalline deposits
  • macular neovascularization
  • refractile deposits
  • spectral-domain optical coherence tomography

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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