Morphological and Angiographic Peripheral Retinal Changes in Patients with Age-Related Macular Degeneration

Abstract

Objective: To show morphologic and angiographic changes in the peripheral retina in patients with age-related macular degeneration (AMD) using wide-field fundus imaging, and to compare these findings with those from healthy controls.

Design: Cross-sectional clinical study.

Participants: In total, 152 patients with clinical AMD and 150 healthy controls (without AMD in either macula) were studied. Subjects were ≥50 years of age. Exclusion criteria were diabetic retinopathy, previous retinal surgery, high myopia, or dense cataract, as well as any retinal inflammatory, degenerative, or occlusive disease.

Methods: For both groups of patients, color fundus images were captured with the Optos P200 MA camera (Optos, Dunfermline, Scotland). Image analysis software was used to characterize each image. Angiography was performed on the AMD group only. Morphological and angiographic peripheral retinal changes were studied per the frequency of their occurrence, the affected peripheral retina (clock hours), and the localization of peripheral changes with regard to the eye equator. Statistical significance was defined at a level of P < 0.05.

Main outcome measures: Peripheral changes in both groups according to their type and frequency (percentage of eyes with detected retinal changes), the number of clock hours of affected peripheral retina, and their localization with regard to the equator of the eye.

Results: Drusen, reticular pigmentary changes, and paving stone degeneration occurred more frequently in the AMD group than in controls (P < 0.001, P < 0.001, and P < 0.001 respectively), whereas white without pressure occurred more frequently in the control group (P = 0.027). In both groups, peripheral retinal changes were observed peripheral to the equator in more than 40% of analyzed eyes. In control Croatian subjects, peripheral drusen were seen in 38% of subjects compared with 68% of AMD subjects.

Conclusion: Drusen, reticular pigmentary change , and paving stone degeneration occur significantly more frequently in subjects with AMD compared with controls. White without pressure degeneration was present in a high percentage of control subjects.