Pigmentary abnormality without significant drusen as a risk factor for late age-related macular degeneration

We investigated the incidence and risk factors of late age-related macular degeneration (AMD) in the fellow eye (FE) without significant drusen of patients with unilateral exudative macular neovascularization (MNV). In this retrospective study, 241 eligible patients who were followed-up for more than 3 years were enrolled. We analyzed the incidence and hazard ratios (HRs) of late AMD in the FE according to demographic and ophthalmologic variables. Hypopigmentation on color fundus photography (CFP) corresponds to shallow irregular RPE elevation (SIRE), so-called double-layer sign and/or attenuation or disruption of RPE and/or ellipsoid zone on OCT. The 5-year incidence of FE exudative MNV conversion was 8.6%. The 5-year incidence of FE exudative MNV of large hypopigmentation (>= 0.5 disc area; DA) and small hypopigmentation (< 0.5 DA) on CFP, and SIRE (>= 1000 mu m) and small RPE elevation (< 1000 mu m) on OCT were 36.2%, 14.2%, 55.0%, and 15.6%, respectively. The multivariate Cox proportional hazard model revealed that large hypopigmentation, small hypopigmentation, SIRE, and small RPE elevation showed HRs of 23.230, 8.037, 132.589, and 41.823 for FE exudative MNV occurrence, respectively. Hypopigmentation on CFP and SIRE on OCT could represent the same lesion. Even small hypopigmentation and small RPE elevation were significant risk factors for progression to exudative MNV.

Automated summary

This study investigated the occurrence and risk factors of late age-related macular degeneration (AMD) in the fellow eye (FE) without significant drusen in patients with unilateral exudative macular neovascularization (MNV). The findings suggest that hypopigmentation on color fundus photography (CFP) and shallow irregular RPE elevation (SIRE) on OCT might represent the same lesion. Even small hypopigmentation and small RPE elevation were found to be significant risk factors for progression to exudative MNV.