Listed in Issue 260


DOMALPALLY and COLLEAGUES, 1. Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin; 2. EMMES Corporation, Rockville, Maryland; 3. Doheny Eye Institute, Los Angeles, California; 4. Clinical Trials Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland; 5. Department of Ophthalmology, Duke University, Durham, North Carolina; 6. Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 7. Clinical Trials Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland.  compared 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).


Design: Cross-sectional evaluation of clinic-based patients enrolled in AREDS2 and a prospective study. Participants: Participants from prospective studies. The 200° pseudocolour 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. Main Outcome Measures: Peripheral retinal lesions: drusen, hypopigmentary/hyperpigmentary changes, reticular pseudodrusen, senile reticular pigmentary changes, cobblestone degeneration, and pseudocolour and fundus autofluorescence (FAF) abnormalities.



A total of 484 (951 eyes) AREDS2 participants with AMD (cases) and 89 (163 eyes) controls without AMD had gradable colour 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.


Domalpally A1, Clemons TE2, Danis RP1, Sadda SR3, Cukras CA4, Toth CA5, Friberg TR6, Chew EY7. 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. Writing Committee for the OPTOS PEripheral RetinA (OPERA) study (Ancillary Study of Age-Related Eye Disease Study 2) Ophthalmology. 124(4):479-487. Apr 2017.DOI:  10.1016/j.ophtha.2016.12.004. Epub Jan 12 2017.

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