Reticular Macular Disease

PURPOSE: To present a unified description of reticular macular disease (RMD), a common clinical entity that includes reticular pseudodrusen (RPD) and confers high-risk of progression to advanced age-related macular degeneration. DESIGN: Population-based, retrospective, cross-sectional study. Forty-two patients with reticular findings in at least one imaging method, of whom 21 were followed up. METHODS: RMD was defined as RPD in color or red-free photography, in a reticular pattern on scanning laser ophthalmoscope imaging (autofluorescence scans, infrared photographs, or indocyanine green angiography), or both. Color and red-free images were contrast-enhanced, and color photographs were examined in green and blue channels. Image registration in different methods allowed comparison of areas involved and assessment of lesion colocalization. RESULTS: RMD generally was present in both photography and scanning laser ophthalmoscope imaging. When present in two image methods, areas of RMD either largely overlapped or one fell within the other. Individual lesions had high spatial correspondence. Serial imaging showed faded to absent findings in eyes in which choroidal neovascularization developed. CONCLUSIONS: RMD is a single disease entity with stereotypical presentations in multiple imaging methods, of which RPD is one. Autofluorescence, infrared imaging, and indocyanine green angiography suggest that it involves the retinal pigment epithelium and choriocapillaris, whereas photographic patterns implicate the inner choroid. Infrared imaging, unlike other methods, can demonstrate RMD in the central macula. RMD is associated with progression to advanced age-related macular degeneration, perhaps on an inflammatory basis. RI M deserves wider recognition among clinicians caring for elderly patients. (Am J Oph, thalmol 2009;148:733-743. (C) 2009 by Elsevier Inc. All rights reserved.)