title: Effect of change in drusen evolution on photoreceptor inner segment/outer segment junction.
abstract: OBJECTIVE
  To evaluate the integrity of photoreceptor inner segment/outer segment (IS/OS) junction after change of drusen size in age-related macular degeneration using spectral-domain optical coherence tomography.
  
  
  METHODS
  Drusen volume raster scans were performed with the Spectralis spectral-domain optical coherence tomography (Heidelberg Engineering) through 2,624 drusen in 14 eyes with clinically dry age-related macular degeneration, which had been longitudinally followed-up between 23 and 28 months without intervention (mean, 26.3 months). All eyes had Early Treatment Diabetic Retinopathy Study visual acuity. A total of 416 of 2,624 drusen were analyzed.
  
  
  RESULTS
  Of 416 drusen, 83 (20%) were found to have regressed spontaneously (Group A), 212 (51%) showed no change in size (Group B), and 121 (29%) progressed (Group C). Mean drusen size of all drusen was 63.7 ± 25.7 μm. Cross-sectional analysis of drusen morphology showed a correlation between drusen size and disrupted IS/OS junction/photoreceptor integrity (r = -0.48, P < 0.001). Of the drusen that regressed over time, there was intact IS/OS junction integrity. Even drusen that caused a major disruption showed IS/OS restoration in 74% of the drusen (P < 0.001).
  
  
  CONCLUSIONS
  Progression of drusen shows structural disruption of the IS/OS junction. After drusen regression, the IS/OS junction is either able to restore as drusen regress or was artifactitiously compressed and not initially visible because of the initial drusen compression of the IS/OS junctional line. Therefore, drusen evolution may play an important role in affecting the photoreceptor IS/OS junction integrity.
authors.affiliation: Department of Ophthalmology, University of California, San Diego, La Jolla, California 92037, USA. freeman@eyecenter.ucsd.edu
authors.forename: Kathrin I
authors.initials: KI
authors.lastname: Hartmann
authors.forename: Maria L
authors.initials: ML
authors.lastname: Gomez
authors.forename: Dirk-Uwe G
authors.initials: DU
authors.lastname: Bartsch
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Schuster
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D057092:Geographic Atrophy / Q000175:diagnosis*; D006801:Humans; D015593:Retinal Drusen / Q000175:diagnosis*; D055211:Retinal Photoreceptor Cell Inner Segment / Q000473:pathology*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology