Peripheral Retinal Changes Associated with Age-Related Macular Degeneration in the Age-Related Eye Disease Study 2: Age-Related Eye Disease Study 2 Report Number 12 by the Age-Related Eye Disease Study 2 Optos PEripheral RetinA (OPERA) Study Research Group

• Published in: Ophthalmology (Rochester, Minn.) Vol. 124; no. 4; pp. 479 - 487
• Main Authors: Domalpally, Amitha, Clemons, Traci E, Danis, Ronald P, Sadda, SriniVas R, Cukras, Catherine A, Toth, Cynthia A, Friberg, Thomas R, Chew, Emily Y
• Format: Journal Article
• Language: English
• Published: United States 01.04.2017
• Subjects: Aged; Aged, 80 and over; Cross-Sectional Studies; Docosahexaenoic Acids - administration & dosage; Eicosapentaenoic Acid - administration & dosage; Female; Fluorescein Angiography; Geographic Atrophy - diagnosis; Geographic Atrophy - drug therapy; Humans; Lutein - administration & dosage; Male; Middle Aged; Optical Imaging; Prospective Studies; Retina - pathology; Retinal Drusen - diagnosis; Retinal Drusen - drug therapy; Retinal Pigment Epithelium - pathology; Tomography, Optical Coherence; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy; Zeaxanthins - administration & dosage
• ISSN: 1549-4713
• DOI: 10.1016/j.ophtha.2016.12.004

To compare rates of peripheral retinal changes in Age-Related Eye Disease Study 2 (AREDS2) participants with at least intermediate age-related macular degeneration (AMD) with control subjects without intermediate age-related changes (large drusen). Cross-sectional evaluation of clinic-based patients enrolled in AREDS2 and a prospective study. Participants from prospective studies. The 200° pseudocolor and fundus autofluorescence (FAF) images were captured on the Optos 200 Tx Ultrawide-field device (Optos, Dunfermline, Scotland) by centering on the fovea and then steering superiorly and inferiorly. The montaged images were graded at a reading center with the images divided into 3 zones (zone 1 [posterior pole], zone 2 [midperiphery], and zone 3 [far periphery]) to document the presence of peripheral lesions. Peripheral retinal lesions: drusen, hypopigmentary/hyperpigmentary changes, reticular pseudodrusen, senile reticular pigmentary changes, cobblestone degeneration, and FAF abnormalities. A total of 484 (951 eyes) AREDS2 participants with AMD (cases) and 89 (163 eyes) controls without AMD had gradable color and FAF images. In zones 2 and 3, neovascularization and geographic atrophy (GA) were present, ranging from 0.4% to 6% in eyes of cases, respectively, and GA was present in 1% of eyes of controls. Drusen were detected in 97%, 78%, and 64% of eyes of cases and 48%, 21%, and 9% of eyes of controls in zones 2 and 3 superior and 3 inferior, respectively (P < 0.001 for all). Peripheral reticular pseudodrusen were seen in 15%. Senile reticular pigmentary change was the predominant peripheral change seen in 48% of cases and 16% of controls in zone 2 (P < 0.001). Nonreticular pigment changes were less frequent in the periphery than in the posterior pole (46% vs. 76%) and negligible in controls. Peripheral retinal changes are more prevalent in eyes with AMD than in control eyes. Drusen are seen in a majority of eyes with AMD in both the mid and far periphery, whereas pigment changes and features of advanced AMD are less frequent. Age-related macular degeneration may be more than a "macular" condition but one that involves the entire retina. Future longitudinal studies of peripheral changes in AMD and their impact on visual function may contribute to understanding AMD pathogenesis.