title: Associations Between Retinal Pigment Epithelium and Drusen Volume Changes During the Lifecycle of Large Drusenoid Pigment Epithelial Detachments.
abstract: OBJECTIVE
  Drusenoid pigment epithelial detachments (PEDs) are a defined path to atrophy in age-related macular degeneration (AMD). We analyzed the relationships between retinal pigment epithelium (RPE) and drusen volume changes during the PED lifecycle, using spectral-domain optical coherence tomography (SD-OCT).
  
  
  METHODS
  Twenty-one cases of drusenoid PED tracked using SD-OCT through periods of growth and collapse were evaluated. Volumetric calculations and piece-wise linear regression analysis were used to determine the breakpoint between growth and collapse. Spectral-domain OCT scans were independently evaluated for the appearance of intraretinal hyperreflective foci, acquired vitelliform lesions (AVLs), and disruptions to the RPE+basal lamina band. Timing of these events with respect to the breakpoint was statistically evaluated. Morphometric characteristics of drusenoid PEDs were correlated with rate of PED collapse and final visual acuity.
  
  
  RESULTS
  Mean age of subjects was 75.3 years and mean period of follow up was 4.1 years (median 4.5 years; range, 0.6-6.6 years). The lifecycle of drusenoid PEDs was asymmetric, in that the rate of collapse (0.199 mm3/month) is significantly faster (P < 0.001) than the rate of growth (0.022 mm3/month). Appearance of intraretinal hyperreflective foci and AVLs preceded the breakpoint (both P < 0.001). The timing of disruptions to the RPE+basal lamina band did not differ from the breakpoint (P = 0.510). Maximal height, volume, and diameter of drusenoid PEDs were inversely correlated with final visual acuity (all P < 0.001) and positively correlated with the rate of PED collapse (all P < 0.001).
  
  
  CONCLUSIONS
  Spectral-domain OCT signatures, plausibly attributable to anteriorly migrated RPE and disintegration of the RPE layer, precede or occur simultaneously with changes in volume of drusenoid PED during the lifecycle of this lesion.
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 2Vitreous-Retina-Macula Consultants of New York, New York, United States 3Department of Ophthalmology, New York University School of Medicine, New York, New York, United States 4Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia.
authors.forename: Chandrakumar
authors.initials: C
authors.lastname: Balaratnasingam
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 2Vitreous-Retina-Macula Consultants of New York, New York, United States.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
authors.affiliation: Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Curcio
authors.affiliation: Department of Ophthalmology, New York University School of Medicine, New York, New York, United States.
authors.forename: William H
authors.initials: WH
authors.lastname: Morgan
authors.affiliation: Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France 7Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.affiliation: Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Capuano
authors.affiliation: Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France 7Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Eric
authors.initials: E
authors.lastname: Souied
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 2Vitreous-Retina-Macula Consultants of New York, New York, United States 8East Bay Retina Consultants, Inc., Oakland, California, United States.
authors.forename: Jesse
authors.initials: J
authors.lastname: Jung
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 2Vitreous-Retina-Macula Consultants of New York, New York, United States 3Department of Ophthalmology, New York University School of Medicine, New York, New York, United States.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012163:Retinal Detachment / Q000175:diagnosis* / Q000209:etiology; D015593:Retinal Drusen / Q000150:complications / Q000175:diagnosis*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity