Outer retinal atrophy after regression of subretinal drusenoid deposits as a newly recognized form of late age-related macular degeneration.

PURPOSE

To investigate the long-term clinical course of eyes with pseudodrusen appearance caused by subretinal drusenoid deposits.

METHODS

Eyes from the original study identifying subretinal deposits of material as the cause of pseudodrusen appearance were evaluated in a retrospective study of outer retinal morphology. The distance between the inner plexiform layer and the retinal pigment epithelium, termed the photoreceptor length, was measured from optical coherence tomography approximately 2 mm superior to the fovea at baseline and at follow-up visits. The choroidal thickness was measured directly under this retinal area.

RESULTS

Of the 21 eyes available for follow-up, 9 (42.9%) eventually developed choroidal neovascularization over a mean 2.9-year follow-up period. Regression of subretinal drusenoid deposits was seen in 9 eyes (42.9%) as well. Those with regression of subretinal drusenoid deposits had a decrease in the photoreceptor length with the final photoreceptor length being 74.4% of the initial length (P < 0.001). In eyes with regression, the underlying choroid was 81.4% of its initial value (P = 0.01) at the final follow-up. Eyes with regression also showed loss of the ellipsoid band. Eyes without regression had no change in photoreceptor length, choroidal thickness, or outer retinal architecture.

CONCLUSION

Eyes with regression of subretinal drusenoid deposits develop outer retinal atrophy and loss of the underlying choroidal thickness. This finding seems common in eyes having pseudodrusen and represents a late form of age-related macular degeneration that is not in current classification systems. Further study is needed to determine both the true prevalence and the effects on visual function.