Longitudinal Assessment of Age-Related Macular Degeneration Using Ultrawidefield Imaging: The Optos Peripheral Retina Follow-up Study.

Abstract

With the widespread availability of Ultrawidefield (UWF) imaging, peripheral retinal abnormalities in age-related macular degeneration (AMD) have garnered attention. However, longitudinal studies of AMD peripheral findings are limited. This study aimed to characterize and quantify these features over 5 years. Longitudinal ancillary study. The Optos Peripheral Retina (OPERA) study was an ancillary study of the Age-Related Eye Disease Study 2. A total of 137 participants (265 eyes) in the OPERA study with gradable UWF color and autofluorescence imaging at years 5 and 10 were included. Ultrawidefield color and autofluorescence images were captured using Optos UWF devices and were graded at the Wisconsin Reading Center for macular and peripheral AMD features using the 3-zone OPERA study grid. Presence of peripheral retinal lesions (neovascular AMD, geographic atrophy [GA], drusen, increased pigment, decreased pigment, reticular pseudodrusen, reticular pigmentary changes, and cobblestone degeneration) and their association with central AMD progression. In zone 1 at year 5 and year 10, the AMD severity scale (AMDSS) score was ≤ 5 in 8% and 6%, 6 to 8 in 49% and 30%, noncentral and central GA in 15% and 27%, and neovascular AMD in 28% and 37%, respectively. In zone 2, peripheral AMD abnormalities in year 5 versus year 10 included: drusen, 99% versus 99%; hyperpigmentation, 11% versus 11%; and hypopigmentation, 4% versus 7%, respectively. Peripheral degenerations not associated with AMD were present in year 5 versus year 10 as follows: cobblestone, 19% versus 30%; and reticular pigmentary changes, 25% versus 33%, respectively. Among eyes with an AMDSS level of 6 to 8 at year 5, progression to late AMD occurred in 41% without substantial peripheral findings and in 41% with such findings, which include drusen of ≥ 1 disc area, any hypopigmentation or hyperpigmentation in zones 2 or 3, or a combination thereof. The OPERA study revealed that AMD features often extend beyond the macula, suggesting that AMD is a panretinal disease. In this study, peripheral findings were not associated with increased risk of progression to late AMD. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.