ABSTRACT
PURPOSE: Reticular pseudodrusen (RPD) are considered to be a distinct feature in AMD. Population studies have studied the epidemiology of RPD using standard color fundus photographs (CFP). However, recent studies have shown that RPD are better imaged using near-infrared (NIR) imaging. We studied the epidemiology of RPD in a large population-based study using NIR and CFP. METHODS: Participants aged 65+ years from the Rotterdam Study underwent ophthalmologic examination including NIR and CFP. Both images were graded for the presence of RPD and soft indistinct drusen (SID). Associations with demographic and environmental factors, 26 genetic variants, and total genetic risk score were analyzed using logistic regression analysis. RESULTS: Reticular pseudodrusen were detected in 137 (4.9%) of 2774 study participants; of these, 92.7% were detected with NIR imaging and 38% on CFP. Most eyes with RPD showed presence of SID, whereas other drusen types coincided less frequently. Reticular pseudodrusen were significantly associated with age (odds ratio [OR] 1.21, 95% Confidence Interval [CI] 1.17-1.24) and female sex (OR 2.10, 95% CI 1.41-3.13). Environmental factors did not show a significant association with RPD. Major AMD risk variants were significantly associated with RPD and SID; however, ARMS2, C3, and VEGFA were more associated with RPD (RPD vs. SID P < 0.05). Total genetic risk score did not differ significantly (P = 0.88). CONCLUSION: Detection of RPD was better with NIR imaging than on CFP in a population-based setting. Presence of RPD often coincided with presence of SID; however, they showed quantitative differences in genetic risk profile.
Subject(s)
Macular Degeneration/complications , Population Surveillance , Retinal Drusen/epidemiology , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Incidence , Macular Degeneration/diagnosis , Macular Degeneration/epidemiology , Male , Microscopy, Confocal , Netherlands/epidemiology , Odds Ratio , Prevalence , Prospective Studies , Retinal Drusen/diagnosis , Retinal Drusen/etiology , Risk Factors , Tomography, Optical CoherenceABSTRACT
PURPOSE: To compare stereo digital images with stereo 35-mm color transparencies as to the quality and reliability of grading age-related maculopathy (ARM) in the context of a multicenter European epidemiologic study (the EUREYE Study). DESIGN: Instrument validation study. PARTICIPANTS: Ninety-one subjects (137 eyes) with varying degrees of ARM, including no ARM. METHODS: From both eyes of the participants, 35-mm film and digital stereoscopic fundus images were obtained with two identical Topcon fundus cameras. Two experienced graders classified all signs of ARM according to the International Classification System. Agreement between imaging techniques and between graders was calculated using the weighted kappa statistic. MAIN OUTCOME MEASURES: Signs of ARM (number, size, and morphologic characteristics of drusen; pigmentary changes; geographic atrophy; and neovascular macular degeneration) as well as an overall staging system of increasing ARM severity. RESULTS: The weighted kappa value for between-technique agreement ranged from 0.41 for number of drusen <63 microm to 0.79 for drusen type and total area occupied by drusen. The kappa values for atrophic and neovascular end-stage ARM were 0.87 and 0.94, respectively. The between-technique agreement on stages of ARM was approximately 0.76. The agreement between graders was largely the same for both techniques of imaging. CONCLUSIONS: In the described setting, digital images were as good as 35-mm film for the grading of ARM. Considering the practical advantages of digital imaging, this technique may serve well in epidemiologic studies of ARM.
