Bilateral macular drusen in age-related macular degeneration. Prognosis and risk factors.
BACKGROUND
In patients with unilateral visual loss related to age-related macular disease, the risk of visual loss in the second eye is documented as being between 7% and 10% per year. The risk is uncertain in those with good vision with each eye and bilateral macular drusen.


METHODS
In a prospective study, 126 patients with bilateral drusen were reviewed annually for up to 3 years. Serial fundus photographs and fluorescein angiograms were analyzed independently by two readers in a masked fashion using a standardized grading scheme, including size, number, density, and fluorescence angiographic behavior of drusen.


RESULTS
New lesions occurred in one or both eyes of 17 (13.5%) of the 126 patients. The cumulative incidence of exudative or nonexudative lesions was 8.55% at 1 year, at 2 years 16.37%, and 23.52% at 3 years for patients older than 65 years of age. Significant risk factors included the degree of confluence of drusen within 1600 microns of the center of the fovea (P = 0.023), focal hyperpigmentation (P = 0.004), slow choroidal filling (P = 0.023), and focal extrafoveal areas of atrophy of the retinal pigment epithelium (P = 0.042).


CONCLUSIONS
The results give an estimate for the incidence of complicating lesions in patients with bilateral drusen and identify those features indicating higher than average risk of visual loss.
Holz
F G
FG
Department of Clinical and Preventive Ophthalmology, Moorfields Eye Hospital, London, United Kingdom.
Wolfensberger
T J
TJ
Piguet
B
B
Gross-Jendroska
M
M
Wells
J A
JA
Minassian
D C
DC
Chisholm
I H
IH
Bird
A C
AC
D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D015994:Incidence; D008266:Macula Lutea / Q000473:pathology; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015593:Retinal Drusen / Q000209:etiology* / Q000473:pathology; D012307:Risk Factors; D014792:Visual Acuity