title: Retinal Pigment Epithelium Degeneration Associated With Subretinal Drusenoid Deposits in Age-Related Macular Degeneration.
abstract: OBJECTIVE
  To test whether increased light transmission (hypertransmission) through subretinal drusenoid deposits (SDD) into the choroid in age-related macular degeneration (AMD) represented retinal pigment epithelium (RPE) degeneration.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Nineteen eyes of 12 patients with early- to intermediate-stage AMD and 18 eyes of 12 normal subjects were evaluated with color fundus photography, optical coherence tomography (OCT), and high-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) at baseline and 24 months later. SDD were classified using an OCT-based 3-stage grading system. Hypertransmission beneath SDD into the choroid was examined in OCT. SDD microstructure was assessed with AOSLO. To characterize the hypertransmission-associated chorioretinal degeneration, choroidal thickness and photoreceptor length were measured in OCT at 1 mm and 2 mm superior, inferior, temporal, and nasal to the foveal center.
  
  
  RESULTS
  OCT disclosed hypertransmission beneath stage 3 SDD in 8 eyes. These lesions showed a distinctive regressing structure in AOSLO, compared with stage 3 lesions without hypertransmission. The phenomenon persisted at follow-up, and new hypertransmission developed as SDD advanced. In eyes with hypertransmission, choroids were thinner than those of normal eyes at all sites (by 44%-56%, P ≤ .0028) and those of eyes with SDD but without hypertransmission at superior and temporal sites (by 31%-46%, P ≤ .039). Photoreceptors were significantly shorter than those in normal eyes (by 6%-26%, P ≤ .0379).
  
  
  CONCLUSIONS
  Hypertransmission into the choroid, accompanied with SDD regression and thinning of choroid and photoreceptor layers, indicates RPE degeneration associated with advanced stages in the SDD life cycle.
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Xu
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Clark
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owsley
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Curcio
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: zhanghua@uab.edu.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000368:Aged; D002829:Choroid / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000175:diagnosis; D008297:Male; D009887:Ophthalmoscopy; D015593:Retinal Drusen / Q000175:diagnosis* / Q000209:etiology; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*