Integrated Imaging of Reticular Pseudodrusen in Age-Related Macular Degeneration

Purpose:To analyze the integrated imaging of age-reated macular degeneration patients with reticular pseudodrusen using confocal scanning laser ophthalmoscopy (cSLO) and eye-tracked Spectralis high-resolution spectral domain optical coherence tomography in a prospective observational cases series. Methods:Patients with reticular pseudodrusen were evaluated regarding fundus autofluorescence (FAF), infrared (IR) reflectance, and eye-tracked SD-OCT findings. Results:Forty-two eyes from 22 consecutive patients (12 female, 10 male; mean age 81.38 ± 6.47 years) were included for analysis. Best-corrected visual acuity ranged from 20/20 to 20/400. In 14 eyes the coincident diagnosis was late AMD. Four eyes from 3 patients with reticular pseudodrusen, showed coincident pseudovitelliform material within the macular area.FAF and IR reflectance, revealed a "target" aspect for the center of reticular pseudodrusen: an area of increased autofluorescence/reflectance surrounded by halos of reduced autofluorescence/reflectance. SD-OCT showed a well-defined round or triangular hyper-reflective deposit localized between, externally, the retinal pigment epithelium (RPE) layer, and, internally, the external limiting membrane (ELM) or the outer plexiform layer (OPL). Moreover, SD-OCT showed the loss of both outer segment (OS)/RPE interface, and inner segment (IS)/OS interface over the hyper-reflective lesions, as well as an abrupt interruption of both these 2 interfaces at the border of the hyper-reflective lesions. Conclusions:The peculiar "target" aspect of reticular pseudodrusen suggests the presence of central lipofuscin-like retinal deposits localized above the RPE. These findings give insights on other possible aspects of age-related retinal changes.