Excess risk associated with reticular pseudodrusen varies by disease severity.
Excess risk associated with reticular pseudodrusen varies by disease severity. Photo: Getty Images. Click image to enlarge.

Researchers recently reported at the 2022 ARVO meeting in Denver that the presence of reticular pseudodrusen is an important risk factor for progression to late-stage age-related macular degeneration (AMD).

Reticular pseudodrusen are distinct from other drusen subtypes by their location above the retinal pigment epithelium. The researchers wrote in their abstract that reticular pseudodrusen are risk factors for both subtypes of late AMD, especially for geographic atrophy.

In the study, AREDS study participants’ color fundus photographs were graded for large drusen, pigment abnormalities and late AMD. The researchers used a deep-learning grading system to determine the presence of reticular pseudodrusen in 3,780 participants with no late AMD at baseline. For patients who showed the finding, they calculated proportional hazard ratios (HRs) using two AMD severity scales, called the simplified and the nine-step.

The HRs for reticular pseudodrusen, using the overall assessment not stratified by severity, were as follows:

  • Late AMD: 2.5.
  • Geographic atrophy: 2.6
  • Neovascular AMD: 1.7          

The HRs for reticular pseudodrusen according to the simplified severity scale were as follows:

  • Late AMD: 2.2.
  • Geographic atrophy: 2.6
  • Neovascular AMD: 1.3.

Importantly, the researchers wrote that excess risk associated with reticular pseudodrusen varies by disease severity; lower or moderate levels of reticular pseudodrusen are associated with greater risk than higher levels of reticular pseudodrusen. They concluded in their abstract that reticular pseudodrusen status should be included in updated AMD classification systems, risk calculators and clinical trials.

Original abstract content © Association for Research in Vision and Ophthalmology 2022.

Agron E, Keenan T, Clemons T, et al. Effect of reticular pseudodrusen on progression to late age-related macular degeneration alongside traditional severity scales. ARVO 2022 annual meeting.