ABSTRACT
A wide spectrum of phenotypic manifestations characterizes age-related macular degeneration (AMD). Drusen is considered the hallmark of AMD and is located underneath the retinal pigment epithelium (RPE). In contrast, subretinal drusenoid deposits (SDDs), also known as reticular pseudodrusens, are located in the subretinal space, on top of the RPE. SDDs are poorly detected by clinical examination and color fundus photography. Multimodal imaging is required for their proper diagnosis. SDDs are topographically and functionally related to rods. SDDs cause a deep impairment in retinal sensitivity and dark adaptation. SDDs are dynamic structures that may grow, fuse with each other, or regress over time. An intermediate step in some eyes is the development of an acquired vitelliform lesion. The presence of SDD confers an eye a high risk for the development of late AMD. SDD leads to macular neovascularization, particularly type 3, geographic atrophy, and outer retinal atrophy.
ABSTRACT
PURPOSE: To study the implementation of the new multimodal imaging-based classification system of central serous chorioretinopathy (CSCR). METHODS: Ninety-three eyes with CSCR with available fundus autofluorescence (FAF), optical coherence tomography (OCT), and OCT angiography at presentation were included in this study. An anonymous data set was classified by two masked graders. Each case was classified as per presence of (i) simple versus complex (< or >2 disc diameters of retinal pigment epithelium abnormality) CSCR; (ii) primary versus recurrent versus resolved CSCR; (iii) persistent (presence of subretinal fluid >6 months) or not; (iv) outer retinal atrophy (ORA); (v) foveal involvement; and (vi) macular neovascularization (MNV). Agreement between the graders was calculated. RESULTS: Kappa value was 0.91 (95% CI 0.8-1.0) for the entire classification; 0.84 (95% CI 0.73-0.95) for simple versus complex; 1.0 (95% CI 1.0-1.0) for primary versus recurrent versus resolved CSCR; 1.0 (95% CI 1.0-1.0) for persistent or not; 0.9 (95% CI 0.81-0.99) for ORA or not; 0.95 (95% CI 0.84-1.0) for presence or absence of MNV; 1.0 (95% CI 1.0-1.0) for presence or absence of foveal involvement. CONCLUSION: The new multimodal imaging based CSCR classification showed "near perfect" agreement between two retinal experts.