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Retina. 2018 Dec 14. doi: 10.1097/IAE.0000000000002399. [Epub ahead of print]

CUTICULAR DRUSEN: Risk of Geographic Atrophy and Macular Neovascularization.

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LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York.
Vitreous Retina Macula Consultants of New York, New York, New York.
Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, Israel.
Center for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.
Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia.
Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan.
The University of Sydney, Sydney, New South Wales, Australia.
Department of Ophthalmology, New York University of Medicine, New York, New York.
Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York.



Cuticular drusen (CD) have been associated with manifestations of age-related macular degeneration such as atrophy and neovascularization in the macula. In this study, eyes with CD were followed and investigated for the estimated 5-year risk of progression to sequelae of age-related macular degeneration such as geographic atrophy (GA) and macular neovascularization (MNV).


A consecutive series of patients with CD were followed for the development of GA and MNV. Whenever possible, they were also studied retrospectively. The patients with CD were categorized into three phenotypic groups. Phenotype 1: eyes had concentrated, densely populated CD in the macular and paramacular area, Phenotype 2: eyes showed scattered CD in the posterior fundus, and Phenotype 3: involved eyes with CD mixed with large drusen (>200 µm). The 5-year incidence of progression was then estimated using a Kaplan-Meier estimator.


A total of 63 eyes from 38 patients (35 women with a mean age at presentation of 58.9 ± 14.2 years) were studied and followed for a mean of 40 ± 18 months. Thirteen patients had single eyes with GA (84.5%; 11/13) or MNV (15.5%; 2/13) in one eye at presentation and were subsequently excluded. Geographic atrophy developed in 19.0% (12/63) of eyes and MNV in 4.8% (3/63) of eyes. The cumulative estimated 5-year risk of GA and MNV was 28.4% and 8.7%, respectively. The estimated 5-year incidence of MNV or GA was 12.6%, 50.0%, and 51.6% in Phenotype 1, Phenotype 2, and Phenotype 3, respectively (P = 0.0015, log-rank test). No difference in risk was found in the development of GA or MNV (P = 0.11) between the subgroup of patients presenting with GA or MNV in their fellow eye and those with both eyes included.


When patients with CD are followed longitudinally, there was a significant risk of progression to GA or MNV for Phenotype 2 and Phenotype 3. Patients with CD are commonly first diagnosed in the fifth decade of life, and there is a female predominance. Clinicians should use multimodal imaging to detect and be aware of the risk of progression to manifestations of GA and MNV. These risks of GA and MNV suggest that patients with CD may be part of the overall spectrum of age-related macular degeneration.

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