In Japan, researchers conducted a retrospective case series to survey the prevalence of reticular pseudodrusen in late age-related macular degeneration (AMD) using multiple imaging methods, and to investigate the association between reticular pseudodrusen and polymorphisms in complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS2) genes.

They included 216 consecutive patients with late AMD (typical AMD, polypoidal choroidal vasculopathy [PCV], retinal angiomatous proliferation [RAP] or geographic atrophy [GA]) in the study. They assessed eyes for reticular pseudodrusen using the blue channel of color fundus photography, infrared reflectance, fundus autofluorescence and spectral-domain optical coherence tomography. Additionally, they genotyped the major AMD-associated single nucleotide polymorphisms (CFH Y402 rs1061170, CFH I62V rs800292 and ARMS2 A69S rs10490024).

A total of 49 eyes of 30 patients had a reticular pattern in two or more imaging modalities and were diagnosed with reticular pseudodrusen, the researchers observed. Of these, they noted that 16 patients had bilateral late AMD, whereas 32 of 186 patients without reticular pseudodrusen had bilateral late AMD (p<.001). They determined that the prevalence of reticular psuedodrusen was 83% in RAP, 50% in GA, 9% in typical AMD and 2% in PCV. Furthermore, the frequency of the T allele in ARMS A69S in patients with and without reticular pseudodrusen was 78.6% and 59.9%, respectively (p=.007).

To conclude, the prevalence of reticular pseudodrusen was low in PCV cases. About 50% of patients with reticular pseudodrusen had bilateral late AMD. The connection of ARMS2 risk allele and reticular pseudodrusen was confirmed in a Japanese population.

The following retrospective review was conducted of 20 eyes of 19 consecutive patients with subfoveal fluid caused by chronic central serous chorioretinopathy (CSC) with choroidal hyperpermeability on indocyanine green angiography (ICGA) and symptoms of at least six months. The purpose of the review was to evaluate the results of ICGA-guided verteporfin (Visudyne) photodynamic therapy (PDT) with half-fluence rate in the treatment of CSC.

ICGA-guided verteporfin (6 mg/m²) PDT with half-fluence rate (25 J/cm²) was performed and ICGA findings were classified as intense, intermediate or minimal hyperfluorescence depending on the degree of choroidal hyperpermeability. The resolution of the subretinal fluid and recurrence rates were assessed in relation to the different degrees of choroidal hyperfluorescence.

Best-corrected visual acuity (BCVA) at baseline was 40 letters (± 13; n=20) according to the Early Treatment Diabetic Retinopathy Study chart. It was noted that at 12 months following PDT, the mean BCVA improved to 44 letters (p<0.01) and that pretreatment central foveal thickness 325 µm decreased by a mean of 103 µm at month 12 control (p<0.5). At month one after PDT, subretinal fluid in spectral-domain optical coherence tomography (SD-OCT) was completely resolved in 100% of eyes regardless of their degree of choroidal hyperfluorescence. Two eyes of the intense hyperfluorescence group and one eye of the intermediate hyperfluorescence group developed recurrence of symptoms over 12 months and received another PDT with half-fluence rate within the 12-month control period. It was reported that treatment effect was not dependent on the degree of choroidal hyperpermeability at baseline. No systemic side effects were observed during the 12-month follow-up.

ICGA-guided half-fluence PDT with verteporfin is effective in treating chronic symptomatic CSC with choroidal hyperpermeability in ICGA, resulting in both visual improvement and reduction of central foveal thickness.

The authors of this Italian study sought to prospectively analyze microperimetry, standard short-wavelength fundus autofluorescent (SW-FAF) and near infrared-wavelength FAF (NIR-FAF) changes in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

They enrolled 20 consecutive eyes (14 patients) affected by GA and obtained repeated microperimetric examinations and FAF images over a mean follow-up period of 12.3 ± 4.5 months.

According to the authors, GA area was always wider on NIR-FAF vs. SW-FAF images (5.05 ± 2.40 mm² vs. 4.45 ± 2.41 mm², p=0.005 baseline; 5.78 ± 2.87 mm² vs. 5.21 ± 2.77 mm², p<0.0001 follow-up). They reported that mean retinal sensitivity significantly decreased during follow-up from 7.68 ± 3.92 dB to 6.71 ± 4.37 dB (p=0.0013) and that 47.3% of the relative dense scotomas (≤5 dB) progressed to dense scotoma (0 dB). Additionally, retinal areas showing relative dense scotoma and characterized by hypo-SW-FAF or hyper-NIR-FAF at baseline had a higher risk of evolving to dense scotoma compared with normo-FAF and hyper-FAF on SW-FAF (OR=2.62 and 2.77, respectively) or normo-FAF at NIR-FAF (OR=2.96).

In conclusion, SW-FAF, compared with NIR-FAF, underestimates GA area at baseline and at follow-up. The enlargement rate of progression based on NIR-FAF is not greater than on SW-FAF. Different SW-FAF and NIR-FAF patterns show different relative risk of progression from relative to dense scotoma. Microperimetry, SW-FAF and NIR-FAF should be combined to obtain adequate morphological and functional prospective information.